A/HRC/19/73 are part of the so-called “noma belt” and which have high rates of malnutrition are now not included in the WHO regional noma programme, however. Reports show that several other countries in Africa are placing emphasis on “severe oral health problems”, including noma.119 54. The German foundation Hilfsaktion Noma – a non-governmental organization that works on prevention and treatment of noma and aftercare in the Niger and Guinea-Bissau – inter alia through setting up vaccination centres, noma children houses and hospitals120 – is supporting the WHO Regional Office for Africa in the development of a manual on the integrated prevention and the management of main oral diseases, including noma, in the African region.121 55. A number of NGOs and charities are funding reconstructive surgery on survivors of noma in Africa and are increasingly investing in the aftercare of patients in their home countries. These include the British foundation Facing Africa which has been financially supporting the multiannual trips of teams of volunteer surgeons, anaesthetists and nurses to Nigeria and Ethiopia to operate on victims of noma.122 AWD-Stiftung Kinderhilfe from Germany and Noma-Hilfe-Schweiz are active in Nigeria and Guinea-Bissau, respectively.123 Among others, the Dutch Noma Foundation, Interplast France and PhysioNoma are involved.124 Sentinelles is carrying out awareness raising and prevention work and treatment and has financially supported surgery on children affected by noma in Burkina Faso and Niger.125 56. The multidisciplinary Geneva Study Group on Noma initiated a large case-control study that includes acute cases in children under 12 years from Niger, aiming to identify the exact causes of noma and establish a treatment for it.126 Over the last decade, Dr. Enwonwu explored the etiopathogenesis of noma and has contributed to a better understanding of the potential roles of viruses (noma is seen now as a co-infection with HIV),127 bacteria, parasites and close residential proximity to livestock in the genesis of the very destructive disease.128 D. Discrimination of children affected by noma and neglect of noma itself 57. Children who survive noma are stigmatized, excluded and discriminated against, in addition to suffering from disfigurement and functional impairment. Given the lack of appropriate information for the population in general and mothers in particular, noma tends 119 120 121 122 123 124 125 126 127 128 18 Health Ministry of Niger, Winds of Hope, Programme régionale de lutte contre le noma, “Rapport de l‟atelier conjointement organisé par le Bureau Régional de l‟OMS pour l‟Afrique et le Ministère de la santé publique du Niger”, 7–9 December 2010, Niamey. World Dental Federation, WHO, Planning Conference for Oral Health in the African Region. Conference Report, 14–16 April 2004, Nairobi. www.nomahilfe.de/index.php?id=69&L=1; submission from Leo Sibomana, Resident Representative in Niger and Coordinator, Hilfsaktion Noma 1996–2006, 24 July 2009. Communication of J. Ziegler and I. Cismas with Dr. B. Varenne. See www.facingafrica.org. See www.awd-stiftung-kinderhilfe.de/kinderhilfe/en/home/Our_projects/sokoto_noma_project.html and www.noma-hilfe.ch/. See www.noma.nl, http://missions-interplast.blogspot.com and http://www.physionoma.fr. www.sentinelles.org/soinsenfants.htm. D. Baratti-Mayer et al., “GESNOMA (Geneva Study group on Noma): an aetiological research on noma disease”, Stomatologie, vol. 104, No. 1, pp. 1–2. See also www.gesnoma.org. MSF, “Noma – what is it, where is it and what to do?”, 1 July 2011 (unpublished study). See www.dental.umaryland.edu/dentaldepts/micropath/enwonwu_mission.html.