War in Ukraine: situation report from WHO Ukraine country office. Issue No. 44, 8 February 2023

Issue No. 44 8 February 2023 17H00 CET WAR IN UKRAINE Situation report from WHO Ukraine country office BY THE NUMBERS (since 24 February): AFFECTED 17.6 M LEFT UKRAINE 18 159 214 (UNHCR) INJURED 11 662 (OHCHR) CONFLICT-RELATED DEATHS 7155 (OHCHR) WHO KEY FIGURESHIGHLIGHTS 2238.6 SUPPLIES PROCURED USD 253 MILLION FUNDING REQUESTED 192 HEALTH CLUSTER PARTNERS 9.4 MILLION TARGET POPULATION 764 VERIFIED ATTACKS ON HEALTH 1 169 NUMBER OF PERSONNEL DEPLOYED & REPURPOSED IN UKRAINE WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 1734 PATIENTS RECEIVED TRANSFER & MEDEVAC SUPPORT Source: ERCC NUMBER OF AMBULANCES DELIVERED Since 1 March 2022 59 NUMBER OF GENERATORS DELIVERED Since 1 March 2022 82 ▪ The WHO Country Office (CO) in Ukraine has delivered medicines and medical supplies to Hulyaipole of the Zaporizhzhya region in Ukraine as part of a United Nations (UN) multiagency convoy to deliver essential goods to the region. Financial support was provided by EU Civil Protection & Humanitarian Aid, USAID’s Bureau for Humanitarian Assistance and the German Embassy in Kyiv. ©WHO Ukraine ▪ The WHO CO handed over 26 ambulances to the Ministry of Health (MoH) of Ukraine to meet the urgent needs of patients affected by the war. The ©WHO donation included six cars for transporting patients and 20 ambulances equipped with oxygen tanks, defibrillators, ventilators and other medical equipment for transporting severely injured patients to health-care facilities. The delivery was made possible with funding support from the European Union. SITUATION UPDATE 2 WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 WAR IN UKRAINE Situation report from WHO Ukraine country office Leadership & Coordination Issue No. 44 8 February 2023 17H00 CET ▪ Repair crews worked round the clock to restore power systems in Odesa following a fire that left hundreds of thousands of residents without electricity. The mass blackout — though attributable to a fire — was one of many that have hit Ukraine’s grid since Russian forces focused in October on attacking the energy infrastructure as part of their invasion of Ukraine. ▪ UN Secretary-General António Guterres has warned in a speech to the UN General Assembly that further escalation in the war in Ukraine could mean that the world is heading towards a wider war as the prospects for peace keep diminishing and the likelihood of escalation and bloodshed keeps growing. ▪ The head of the Odesa Regional Military Administration Maksym Marchenko stated that 360 000 residents are still without electricity, which is almost half of the population of Odesa. Power is restored only for a few hours per day, according to the outage schedule. The Minister of Energy of Ukraine Herman Halushchenko stated that 82 diesel generators have been delivered to the city so far. ▪ The acting WHO Representative (WR) in Ukraine continued high-level engagement with the MoH, authorities and partners in Kyiv. ▪ The acting WR/Incident Manager (IM) attended a townhall meeting hosted by UN Resident Coordinator Denise Brown. ▪ The IM, along with the Resident Coordinator and other heads of agencies, facilitated a UN humanitarian interagency convoy to Kherson. ▪ The IM went to Dobropillia/Hulyaipole to deliver two Interagency Emergency Health Kits and more than 100 doses of pneumonia treatment. HEALTH INFORMATION Conflict-related health information ▪ As of 5 February 2023, the Office of the UN High Commissioner for Human Rights (OHCHR) recorded: • 7155 civilians killed (2853 men, 1927 women, 180 girls, and 226 boys, as well as 32 children and 1937 adults whose sex is yet unknown); and • 11 662 civilians injured (2576 men, 1833 women, 248 girls, and 339 boys, as well as 264 children and 6402 adults whose sex is yet unknown). ▪ According to the United Nations High Commissioner for Refugees, as of 31 January over 18.1 million border crossing movements to neighbouring countries, of whom just over 9.4 million and over 2.1 million crossed the border to Poland and Hungary, respectively. 3WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 Local media monitoring WAR IN UKRAINE Situation report from WHO Ukraine country office Issue No. 44 8 February 2023 17H00 CET ▪ Ukraine's first children's mental health room opened at St. Nicholas Children’s Hospital of the First Medical Association of Lviv. “We treat about half a thousand children every week, and some of them undergo long-term treatment. In this multifunctional room, they can separate themselves from the hospital space and get more positive emotions and motivation for recovery”, said Zoryana Ivanyuk, medical director of St. Nicholas Hospital. In the mental health room, young patients can rest and acquire new skills: engage in art therapy and other useful activities. In 2022 the Neurosurgery Centre team at St. Nicholas Hospital saved a record number of children. The doctors performed 440 operations and treated more than a thousand patients, which is one of the highest indicators among all health-care facilities in Ukraine that provide neurosurgical care for children. ▪ A dispensary of the Dmytrivka village council in the district of Bucha, which was completely destroyed in March, has been rebuilt. Serving more than 6000 local patients, the facility is critically important as family doctors in rural areas are relied on to treat a variety of ailments. The dispensary has now been fully restored, equipped with the necessary modern equipment and has reopened its doors to patients. It is heated with a solid fuel boiler as a temporary alternative heat source, and powered by two generators, which are used as needed. ▪ In Vuhledar in the Donetsk oblast 100% of the buildings in the city have been damaged, and almost all infrastructure and utility companies have been destroyed. There is no heating, water, electricity, communication, with approximately 500 people remaining in the city. ▪ In the city of Mariupol, the health-care situation is dire due to a critical lack of medicines and skilled care personnel. ATTACKS ON HEALTH Verified reports of attacks (1 January 2022 to date) For further information, click here. COVID-19 and other communicable diseases ▪ As of 2 February, the average daily number of new COVID-19 cases is at 530 an increase from 425 per day in the previous week. The seven-day average daily polymerase chain reaction (PCR) tests performed increased to 3652 from 3475 in the previous week (compared to 42 460 in the last week before the war). A similar trend is observed with rapid diagnostic tests performed in laboratories and at primary health-care and hospital level. A comprehensive weekly COVID-19 dashboard can be found here. Surveillance from open-source intelligence WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 4 Surveillance WAR IN UKRAINE Situation report from WHO Ukraine country office Test Positivity rate (PCR) in private and state labs Trend in new cases 7-day average testing data as per 2 February Issue No. 44 8 February 2023 17H00 CET ▪ During the reporting week, a rare case of chronic Lyme disease was reported in the Kalush raion in the Ivano-Frankivsk oblast. More information is available here. ▪ In the Lviv oblast, the number of rabies cases in animals increased fivefold to 10 in January 2023 (compared to the corresponding period of the previous year, when only two confirmed cases were reported). More information is available here. ▪ An active influenza A virus circulation was reported in the Poltava oblast. During the reporting week, 7427 cases of acute respiratory infection, including COVID-19, were reported in the oblast – an 80% increase from the previous week. For more information, click here. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 5 WAR IN UKRAINE Situation report from WHO Ukraine country office Operational Support and Logistics - OSL ▪ As of 5 February, WHO warehouses in Kyiv, Kyiv Oblast and Lviv have received medical supplies with a value of over US$ 62.1 million and a total weight of over 2542 metric tonnes. They included Trauma and Emergency Surgery Kits (TESK) 2019, WHO trauma bags, Interagency Emergency Health Kits (IEHKs) and other items. ▪ On 30 Jan – 5 February 2023 medical supplies and equipment with a total value exceeding US$ 420 thousand and a total weight of more than 9 metric tonnes were delivered to 22 oblasts across Ukraine. They included IEHKs, trauma/surgery supplies (TESK 2019, surgical instruments etc.), noncommunicable disease kits, personal protective equipment & communicable disease supplies, Biomed equipments, Generators, etc. UKRAINE COUNTRY OFFICE ACTIONS 0 50 100 150 200 250 300 M et ri c to n es Metric tonnes dispatched by Oblasts, Ukraine Issue No. 44 8 February 2023 17H00 CET TESK IEHK PED-SAM WHO CTT NCD WHO Trauma 1st aid kit WHO Emergency Trauma backpack complete Trauma backpack kit WHO emergency 7759 3765 678 163 987 8194 617 413 The number of WHO modules delivered to Ukraine from 1 March 2022 to date WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 6 WAR IN UKRAINE Situation report from WHO Ukraine country office UKRAINE COUNTRY OFFICE ACTIONS National laboratories ▪ WHO continues its assessment of the basic quality and biosafety requirements of the Clinical and Diagnostic Laboratory using the WHO Laboratory Assessment Tool for laboratories implementing COVID-19 testing. An assessment of the Clinical and Diagnostic Laboratory in Kyiv City Clinical Hospital No. 1 was conducted on 30 January. As part of the assessment, the condition of the laboratory premises was inspected, gaps in the certification of biosafety cabinets were identified, and biosecurity recommendations were given. ▪ A standard operating procedure (SOP) titled “Preparing smears for chromogenic staining” was drafted in English and Ukrainian and sent to the laboratory experts at the WHO Regional Office for Europe for comment and review. Three other SOPs, titled “Detection of catalase”, “Oxidase test” and “Detection of urease”, were translated into Ukrainian. These SOPs serve to standardize procedures for the measurement of catalase, oxidase, and urease in biological samples. ▪ Sequencing and analysis of 80 SARS-CoV-2 samples collected in January was performed and the following variants were identified: BA.2.75.5, BA.5.1.23, BA.5.1.3, BA.5.2, BA.5.2.1, BA.5.2.20, BA.5.2.6, BF.11, BF.14, BF.18, BF.5, BF.7, BF.7.1, BN.1, BN.1.2.1, BN.1.3, BN.1.3.1, BQ.1.1, BQ.1.10, BQ.1.11, CH.1.1, CL.1, CV.1, X and BB.1. Seventy-six genome sequences of SARS-CoV-2 samples were uploaded to the GISAID database. ▪ A webinar titled “Verification and calibration of measuring equipment in a clinical and diagnostic laboratory” was held on 3 February for 219 Ukrainian laboratory employees. The webinar serves to improve the professional competence of laboratory personnel performing tests on laboratory measuring equipment. ©WHO Ukraine Issue No. 44 8 February 2023 17H00 CET WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 7 WAR IN UKRAINE Situation report from WHO Ukraine country office UKRAINE COUNTRY OFFICE ACTIONS Structures and biomed Health operations – Emergency Medical Services (EMS) ©WHO Ukraine Issue No. 44 8 February 2023 17H00 CET With financial support from the United States Agency for International Development (USAID), WHO in Ukraine has provided a full scope of supply, installation, and implementation of pressure swing adsorption oxygen generation plants for medical use in Chernihiv City Hospital No. 2 and the Kharkiv Regional Infectious Disease Hospital. “Access to medical oxygen has been placed under threat during attacks on critical infrastructure and health care in Ukraine and it is essential that health-care facilities are provided with necessary support in this area,” said Dr Jarno Habicht, WR in Ukraine. WHO provided a full scope of services, including installation of the oxygen systems, commissioning training for health-care workers on their use, provision of spare parts, extended warranty, preventive maintenance service and transport. On 3–5 February WHO conducted a three-day training on pre-hospital trauma care. The training, attended by 18 emergency medical care providers from the Rivne and Volyn regions, was held to improve trauma care knowledge and practical skills at pre-hospital level. Further trainings are expected to continue until the end of February 2023. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 8 WAR IN UKRAINE Situation report from WHO Ukraine country office UKRAINE COUNTRY OFFICE ACTIONS Health Cluster/Partner updates ▪ Since its launch on 15 April the Health Requests, Planning and Response (HRPR) tool has been revised and upgraded, and 481 requests have been logged overall, with ten oblasts logging their largest numbers in the past two months. The oblasts with the largest number of requests were Dnipropetrovsk, Donetsk and Cherkasy. As of 1 February, 31 Partners have contributed information on supplies and pipeline delivered, to be delivered and ready for shipment. Medicines, Medical supplies & Equipment Status Items Kits Metric tonnes USD Delivered 31 828 001 469 00 3 760 12.4M To be delivered 2 624 918 7 386 - 25K To be shipped - - - - ▪ Distribution of generators to health facilities to ensure continuity of care remains a key priority for the Health Cluster. As of 31 January Health Cluster Partners have donated 382 generators to health facilities, including in the Kharkiv (65), Kherson (48), Kyiv (36), Dnipropetrovsk (28), and Chernihiv (24) oblasts. ▪ Health Cluster Ukraine has identified three Partner co-coordinators to represent and support the Health Cluster at oblast level. The Lviv oblast will be supported by Première Urgence Internationale, the Kyiv oblast – by International Medical Corps, and the Mykolayiv oblast – by Alima. The co- coordination is planned to be launched in March 2023. The Health Cluster is in the process of identifying co-coordinators for the Kharkiv and Zaporizhzhya oblasts. ▪ At the national Health Cluster Coordination Meeting held on 2 February: ➢ Partners provided feedback and suggestions to strengthen operational coordination and information management through an interactive discussion session around national coordination updates; ➢ WHO presented the Protection from Sexual Exploitation and Abuse (PSEA) framework. All organizations in the Health Cluster are required to commit to humanitarian principles (humanity, impartiality, neutrality, and independence), the Principles of Partnership, Cluster-specific guidance and internationally recognized programme standards, and the Secretary-General's Bulletin on Special measures for protection from sexual exploitation and sexual abuse; and ➢ WHO presented the results of Round 2 (conducted in December 2022) of the Health Needs Assessment, a nationally representative serial cross-sectional study that aims to gain insight into reported health needs, particularly in terms of primary and specialized health services, medicines and other essential health services. Issue No. 44 8 February 2023 17H00 CET WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 9 WAR IN UKRAINE Situation report from WHO Ukraine country office UKRAINE COUNTRY OFFICE ACTIONS Mental health and psychosocial support (MHPSS) WHO, together with IOM Ukraine, organized a two-day training in Dnipropetrovsk on the development of MHPSS coordination skills. The participants learned the basic principles of MHPSS coordination, the coordination model in Ukraine, and the operational roadmap “Priority multisectoral measures for MHPSS in Ukraine during and after the war” through practical case studies demonstrating how cross-sector interaction can be improved for providing assistance. For further information, click here. Issue No. 44 8 February 2023 17H00 CET ©WHO Ukraine ©WHO Ukraine WHO organized a workshop on mental health and psychosocial support (MHPSS) as part of emergency response. The workshop was held at Kyiv for the partners of the Technical Working Group on MHPSS co-chaired by the WHO CO. The workshop, led by Dr Fami Hanna, expert at the Department of Mental Health and Psychoactive Substance Abuse at WHO headquarters and co-chair of the interdepartmental standing committee’s MHPSS reference group, focused on fundamental principles of MHPSS coordination. The workshop format promotes better knowledge acquisition and allows participants to delve into problem-solving and to view problems in broader context. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 10 WAR IN UKRAINE Situation report from WHO Ukraine country office UKRAINE COUNTRY OFFICE ACTIONS Vaccine-preventable diseases and Immunization (VPI) Issue No. 44 8 February 2023 17H00 CET ▪ Dr Datta Siddhartha, Regional Advisor on Vaccine-preventable Diseases and Immunization (VPI), visited Ukraine on 30 January–2 February 2023. The first day of the mission was dedicated to top priorities in the National Immunization Programme, namely strengthening the immunization- related legislative base in Ukraine and strengthening Ukraine’s Immunization Information System, discussed with Dr Viktor Liashko, Minister of Health, and Dr Oleksandr ▪ On 3 February 2023 the VPI team lead attended a meeting of the Vaccine-preventable Disease (VPD) Task Force of the MoH, and provided technical recommendations as part of discussions on estimating target group size for routine immunization in 2023. Among other priority VPD issues, the Task Force members also discussed: a) the current status of COVID-19 vaccine distribution at district level in Ukraine, b) heterologous COVID-19 vaccination schemes and their proper documentation for vaccination certificates; and c) procedures and algorithms for capacity building for the delivery of vaccination services by health-care personnel. ▪ During the reporting week the VPI team adapted into Ukrainian three additional online modules of the Immunization Programme course for mid-level managers (MLM) and published them on the online WHO- UPHC MLM platform: (1) Surveillance of VPDs; (2) New Vaccine Introduction; and (3) Immunization Safety. ▪ The VPI team adapted into Ukrainian and published the following 50 additional short educational videos for health-care workers who deliver immunization services. These videos can be viewed on Immunization Academy’s website and on UPHC’s YouTube. ▪ The WHO CO has continued to provide support for trainings on new COVID-19 vaccine products; the most recent training was conducted in the Kirovohrad Oblast Regional Immunization Training Hub covering 24 health-care workers delivering COVID-19 vaccination services. Komarida, First Deputy Minister, with both the MoH and WHO sharing a common vision and perspectives and committed to continue close collaboration for many years. Both organizations agreed that in the context of the war and the Immunization Programme Recovery Plan, the measles and diphtheria outbreak preparedness and response remains a vital action, and catch-up vaccination efforts on measles and diphtheria in high-risk groups should be prioritized for joint work in 2023. Further technical discussions on the National Immunization Programme and review of the current status of vaccine supply took place during a meeting with Dr Matskov, Deputy Director of the Public Health Centre of the MoH, Dr Andrii Pashynnyi, head of the Immunization Unit, and Ms. Liudmyla Pavlyuk, head of the Pharmaceuticals Management and Inventory Control Unit, as well as senior specialists from both teams. ©WHO Ukraine WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 11 WAR IN UKRAINE Situation report from WHO Ukraine country office UKRAINE COUNTRY OFFICE ACTIONS Poliomyelitis (Polio) 11* Total Acute Flaccid Paralysis (AFP) 6 With Lab results 0 Not sent yet 0 En Route 5 In the lab *as of week 5 46% 27% 27% 0% Distribution of AFP Cases by Age Week 5, 2023 Ukraine Under 5 5 to 9 10 to 14 above 15 9% 9% 55% 27% Distribution of AFP Cases by IPV immunization status Week 5, 2023 Ukraine 0 doses 1 dose 2 dose 3 and above dose S/N Oblast No of AFP Cases 1 Dnirpropetrovsk 2 2 Kharkiv 1 3 Kyiv 1 4 Odesa 3 5 Poltava 1 6 Rovenskaja 1 7 Zaporyzhzhia 2 Total 11 Issue No. 44 8 February 2023 17H00 CET ▪ As of Week 5 of 2023, the number of confirmed cVDPV2 isolates in Ukraine remains at two from acute flaccid paralysis (AFP) cases, with 19 asymptomatic contacts from two oblasts (Rivne and Zakarpattya). ▪ In the reporting week 11 cases of AFP have been reported in seven oblasts. ▪ Inactivated polio vaccine catch-up vaccination of children aged from six months to six years is ongoing across Ukraine. ➢ First dose: 12 883 ➢ Second dose: 13 274 ▪ The WHO Regional Adviser for Vaccine-Preventable Diseases WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 12 UKRAINE COUNTRY OFFICE ACTIONS WAR IN UKRAINE Situation report from WHO Ukraine country office Communications Issue No. 44 8 February 2023 17H00 CET From 30 January to 5 February the WHO CO published ten Twitter posts, 15 Facebook posts and six Instagram posts, which received a total of 40 627 impressions on Twitter and a Facebook page reach of over 24 592, covering topics such as: the launch of an online training platform for MLMs of the Extended Programme on Immunization; the WHO CO’s support of the National Health Service of Ukraine in conducting costing studies with primary health-care providers; a meeting of the Head of the UN in Ukraine Denise Brown, including WHO, with Ukrainian journalists in Kyiv; a visit to Ukraine by Dr Siddhartha Sankar Datta, Regional Adviser for the VPI Programme of the WHO Regional Office for Europe on immunization and polio activities; a video on WHO’s donation of 26 ambulances to the MoH of Ukraine to enable the provision of emergency medical care to patients during the war; delivery of medicines and supplies to Toretsk in the Donetsk region, to Hulyaipole in the Zaporizhzhya region; health attacks; vacancies; WHO support in meeting the basic needs of people with mental disorders; and MHPSS trainings in Kyiv and Dnipropetrovsk. Social listening The following rumours are being monitored and evaluated. ▪ Increased retail princes of medicines due to stock shortages of imported medicines and their substitution with locally manufactured medicines at higher prices. ▪ WHO updating the list of medicines to be stockpiled by governments in case of a nuclear emergency. ▪ New “superbug” strain of gonorrhea outsmarting most antibiotics. ▪ Risks related to blackouts: ➢ increased motor vehicle fatality rates due to lack of street lighting; and ➢ increased incidence of fires and thermal burns due to overvoltage in the power grid. COVID-19 discussion is being revived with a new wave of rumours related to post-vaccination topic as a result of the World Economic Forum meeting in Davos and related social media posts (claims of increased post-vaccination mortality rates and birth rate decline related to mRNA vaccines and claims that vaccines do not provide protection against virus transmission). War-related disease searches are being monitored (concerning a case of rabies in the Lviv region and increased incidence of strokes and heart attacks). Media A news story titled “Supporting free primary health care in Ukraine – the story of a Ukrainian doctor” was published on the WHO/Europe website. Production A video on WHO’s donation of 26 ambulances to the MoH to support emergency health needs during the war was produced and is available on Facebook (in Ukrainian), Twitter (in English) and Instagram (in English). WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 13 UKRAINE COUNTRY OFFICE ACTIONS ▪ WHO Representative, Jarno Habicht, habichtj@who.int ▪ WCO Incident Manager, Emanuele Bruni, brunie@who.int ▪ WCO WHE Lead, Guillaume Simonian, simoniang@who.int WHO Ukraine Contacts Key links and useful resources ▪ Online courses & knowledge-transfer platform For updated interactive, web-based, online courses, click here. ▪ Emergency Medical Teams (EMT) For updated EMT network activities, click here. ▪ WHO Publications and Technical Guidance For updated WHO Publications and Technical Guidance on technological hazards and health risks in Ukraine, click here. WAR IN UKRAINE Situation report from WHO Ukraine country office OpenWHO.org: Free online courses in Ukrainian supporting health emergency response Total number of Ukrainian language courses 22 Total number of enrolments in Ukrainian courses 5630 Total number of certificates issued in Ukrainian courses 1981 Total number of digital badges issued in Ukrainian courses 431 eLearning platform Ukraine Humanitarian Fund: 2022 Allocations Dashboard, January – December 2022 In the last quarter of 2022, the Ukraine Humanitarian Fund (UHF) allocated US$75 million through the second Standard Allocation in September. The funds are supporting time-critical winter assistance and other priority activities under the 2022 Ukraine Flash Appeal. Some $20 million was allocated to support more than 300 civil society organizations, community-based organizations and volunteer groups supporting people impacted by the war in Ukraine, especially in areas close to the front line. Local partners will receive grants, in-kind assistance, training and other capacity building that is enabling them to sustain critical assistance and services that they have been providing to millions of people since the war began. Overall, in 2022 the UHF allocated $192 million supporting 109 projects through 56 humanitarian partners, including 30 international NGOs, 18 national NGOs and 8 UN agencies. Of the total allocated, $63 million (33 per cent) in net funding was transferred to national and local partners, including $44 million (23 per cent) directly to support 38 projects of national NGOs. These grants enabled UHF partners to target approximately 3.7 million people whose lives have been devastated by the war. Through four rounds of Reserve Allocations and one Standard Allocation, the UHF played a critical role in kickstarting response activities immediately after the Russian invasion on 24 February 2022, and in sustaining humanitarian response throughout the year. Having received $327 million from 28 donors and private contributions, the UHF was the largest country-based pooled fund (CBPF) globally in 2022. Sizable top-up contributions received in the last months of the year have allowed early new allocations in 2023. Issue No. 44 8 February 2023 17H00 CET Document number: WHO/EURO:2023-5319-45083-68277 © World Health Organization 2023. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.