Download the EU SHIPSAN ACT JA - Newsletter: Issue 3 in .pdf format 

 

Editorial

 Mauro Dionisio, Ministry of Health, Italy

 

 Dear all,

it’s summertime, the favourite season for travelling by boat and for  taking a holiday on a cruise ship.   

Thousands of passengers are actually embarking on ships all over the European ports. They will enjoy eating at restaurants, swimming into swimming pools, relaxing at the onboard spa. All of them will use toilet facilities and will touch surfaces. Unfortunately, a few passengers may need to visit the onboard medical facilities too. I prefer to believe, since at the same time I start my holidays, that many tourists enjoy their short trip over a ferry, or a long navigation over a ship cruise, in a safer way thanks to seafarers’ work, but also thanks to inspectors’ work! Who guarantees that the procedures for sanitation (but also for inspections) are correct? Training activities! So let me thank also the people involved in providing training activities for seafarers and port health officers, like the EU SHIPSAN ACT Joint Action does! Now I wish to greet all of you and to make an appointment with you for the next issue of this newsletter where we will update you on SHIPSAN ACT training activities.

I hope you enjoy your summer holidays with your family or your friends.

 

 

 

The EU SHIPSAN ACT Joint Action (JA) is currently on the 6^th month of its implementation. The administrative and technical coordination of the JA is very demanding and all partners are excellent at working together and moving forward all activities.

The benefits from the permanent implementation of the SHIPSAN ACT have been demonstrated many times in the past and the hard work that all partners have devoted over these years should not go astray. It is important that partnership works on the sustainability of the JA from the early stages of the JA through a structured and systematic strategy. The SHIPSAN ACT sustainability working group, established from the beginning of the JA, will have the tasks (i) to draft legal documents for implementation of the JA activities (e.g. Memorandum of Understanding), (ii) to explore and draft operation procedures for sustainable implementation of JA activities including analysis of costs and potential income and (iii) to prepare recommendations to General Assembly which is the JA decision body. The sustainability working group, together with the coordination team and the advisory board, will draft proposals and legal documents and inform and report to the General Assembly, which is the JA decision body.

The base for a sustainable implementation of the JA activities is, amongst others, its concrete  actions supported by science, but also the concrete human networks established allowing for the successful achievement of the objectives.

The SHIPSAN ACT JA will expand the pool of trainers through a new call (see the News section below) to include more experts from the fields of public health, concerning also cargo ships and focusing on IHR implementation in close collaboration with WHO.   SHIPSAN ACT launches training activities with the first training course for “Hygiene and Health Practices on Passenger Ships” for ship operators, officers and crew that will be organized from 8-10 October 2013, in Italy.

The pilot inspection programme will not be possible to be implemented without the excellent cooperation of the port health officers in 41 European ports and the passenger ship industry sailing in European waters. Until today, a total of 8 cruise ships, 2 ferries and 28 port health officers participated in the pilot inspections. The pilot inspection programme, an important activity of the Joint Action, allows on the job training of the inspectors and gives the opportunity to develop an efficient and effective inspection regime before the permanent implementation.

The Executive Agency for Health and Consumers and DG SANCO initiated the cooperation between SHIPSAN ACT Joint Action and the European Agency for Safety and Health at Work (EU-OSHA). The OiRA tool developed by EU-OSHA will be used to develop the risk assessment tool for occupational and public health risks per cargo ship type.

Further meetings and teleconferences have been scheduled for the next months with stakeholders and European Agencies so that opportunities for cooperation can be further identified and to ensure that all key actors actively participate in the core activities of the JA. 

 

 

People from the project

Raquel Duarte Davidson

 

I was born in Madrid and grew up in Malaga in the south of Spain but now live and work in the UK. I have practiced as a senior environmental toxicologist and principal chemical risk analyst since graduating with a PhD form Lancaster University in 1992. I currently head the International Research and Development Group within the Centre for Radiation, Chemical and Environmental Hazards (CRCE) at Public Health England. Many of our current projects are international collaborations with different public health bodies, universities and poisons centres across Europe. Projects relate to risk assessment, exposure assessment, developing alerting systems using poisons centres across Europe and developing guidance, protocols and training material on the management of chemical incidents. I also hold a Visiting Professorship at Cranfield University.

I am an expert advisor on risk assessment to the European Commission and frequently chair international meetings and conferences. I teach courses at universities and institutions at post-graduate level and have published papers, reports and book chapters that address a wide range of environmental topics directly associated with health and environmental risk. I have a young family and in my spare time I enjoy pending time with them cycling and camping or visiting family in Spain. I look forward to working on maritime issues as part of SHIPSAN ACT project.

 

 

Thematic Sections

Chemical and radiological issues on ships

Tiberio Cabianca,

Scientific Group Leader for Planned Radiation Exposures, CRCE,

Public Health England, Chilton, Oxfordshire.

Key message:

SHIPSAN Joint Action will develop guidance for competent authorities in support of their risk assessment and response to chemical and radiological incidents on ships. This development signals a desire to take an all-hazards approach to public health events on passenger ships and cargo vessels.

The Centre for Radiation Chemical and Environmental hazards (CRCE) of Public Health England (PHE) has the responsibility to develop guidance for competent authorities in support of their risk assessment and response to chemical and radiological incidents for ships for the SHIPSAN Joint Action (Work Package 6). Tiberio Cabianca is the lead on the work on radiation for this work package. Tiberio is a member of the UK delegation at the Transport Safety Standards Committee (TRANSSC), a committee of experts in the transport of radioactive material convened on a regular basis by the International Atomic Energy Agency (IAEA) to discuss and agree regulations for the safe transport of radioactive material. From 17 to 20 June TRANSSC met at the headquarters of the IAEA in Vienna for the first of its biannual meetings. During the meeting Tiberio had the opportunity to discuss the objectives of SHIPSAN ACT with colleagues from other European countries, particularly from Spain, Germany and Ireland and to gauge their possible interest in what SHIPSAN ACT is trying to achieve. The response was positive and Tiberio has agreed the he will contact these experts to obtain information on the procedures to respond to radiological events in place in their country. Arrangements on how to respond to a radiological emergency are generally well established in these countries and the guidance which will be developed for SHIPSAN ACT will be linked to these arrangements. Some information has already been collected through TRANSSC and Tiberio will try to get access to relevant data directly from the IAEA.

 

 

Environmental health and hygiene on ships

 

Crew and Passenger Accommodation

Martin Walker, Port Health Officer, Suffolk Coastal Port Health Authority, Felixstowe, England

Key Message: Bed Bugs – a potential for vessels to harbour them and what inspectors and seafarers can look for

Bed Bugs (Cimex lectularius) are small blood-sucking insects that live in cracks and crevices in and around beds and bedding. Previously associated with “slum” housing (An English word meaning poor quality housing) they are now found in the cleanest of homes, hotels and (and thankfully seemingly less commonly) ships. Once reported as close to extinction in America through the use of pesticides such as DDT, it started a comeback after use of the pesticide was banned in several countries. Nowadays, it has become prevalent in many places including the hotels of New York.

Adult Bed Bugs are red to brown in colour, oval shaped and about 4-5mm long  with well-developed legs but no wings.

(Picture Source: NHS Choices) 

The lack of wings does not harm the ability of the bed bug to move  from place to place. They can travel rapidly across solid surfaces but also have the ability to hitch-hike  on clothes, luggage and  furniture. It is this latter feature that means that they can easily infest any property, hotel or ship. Overnight accomodation can be one of the commonest ways of acquiring Bed Bugs and so the potential for them to spread becomes obvious. Due to their ability to hide in small cracks and crevices and the fact that they feed nocturnally, they are difficult to detect in transit. The female lays 200-500 eggs over a two month period with a life cycle that takes 2-4 months. Eggs appear as white specks but are very difficult to spot. As eggs hatch, they form tiny straw coloured insects and as they grow into adults, they shed their skin.

The mouthparts of the Bed Bug are adapted to piercing skin and adult bedbugs can feed many times. That said, if no host is available, adults can survive up to a year without food.

Symptoms of bed bug bites

Some people  can be bitten by Bed Bugs but show no symptoms at all whilst others will show mild or even severe swelling and itching. Common sites for biting include the neck, hands arms and legs. They can be mistaken for mosquito bites, but although not a definitive means of identification, Bed Bug bites are often found in a straight line of 3 (the classic phrase of “Breakfast, Lunch and Dinner” comes to mind).

How to spot a possible bed bug infestation

Skin rashes, itchy bumps on a victim in a linear pattern

Black spots on mattresses which could be their faeces

Blood spots on mattresses where bed bugs have been squashed as a victim has rolled over in bed

Mottled shells that have been shed on sheets or mattresses.

Looking when they are most active. This is usually in the early hours of morning whilst it is dark and so may be one only for the most dedicated inspectors!

Treatment

 Bed bug infestations can be extremely difficult to eliminate therefore an experienced pest controller must be used. Clothes or bed linen must be washed at 60 degrees C or put in a dryer on a hot setting for at least 30 minutes. Spraying with specifically designed insecticides or steamers/rapid freeze systems may also be used.

Are they a Public Health Risk?

Whilst extremely unpleasant and stressful, there appears to be little evidence that an infestation of Bed Bugs can spread human diseases. The World Health Organization (WHO) states that bedbugs are not vectors of disease. Therefore, bedbugs do not appear to fit within  the criteria of “Evidence of Infection or Contamination” for the issuance of Ship Sanitation Control Certificates (SSC). The issuance of a Ship Sanitation Exemption Control Certificate (SSEC) with an accompanyingEvidence Report Form (to control the bed bugs) would  therefore appear to be the correct procedure where a bedbug infestation is present. Do you have any evidence that would counter act this view?

Next issue, I will feature a relevant food safety issue in the Galley. If you have any good examples of cases that you would like to share with SHIPSAN ACT readers, please email details to me at martin.walker [ AT ] suffolkcoastal.gov.uk

References:

World Health Organization, International Health Regulations 2005, available through http://whqlibdoc.who.int/publications/2008/9789241580410_eng.pdf

World Health Organization, 2011 Handbook for Inspection of Ships and Issuance of Ship Sanitation Certificates available through http://www.who.int/ihr/publications/handbook_ships_inspection/en/

http://pestcemetery.com/bed-bugs-extinct/

http://www.nhs.uk/conditions/bed-bugs/Pages/Introduction.aspx

Chartered Institute of Environmental Health, Pest Control Procedures in the housing sector  January 2010

 

 Occupational health on ships

Dr.med. Martin Dirksen-Fischer

Behörde für Gesundheit und Verbraucherschutz

Institut für Hygiene und Umwelt

Hamburg Port Health Center

 

European work in progress: A report from the SHIPSAN Joint Action working group in Hamburg

 Key Message:

The importance of  hygiene and public health issues in general on inland waterway vessels are often neglected. SHIPSAN Joint Action will develop a state of the art report on the current status. Also , the collaboration with EU OSHA and the other partners of the Hamburg working group in the field of developing a risk assessment tool for occupational risks on cargo ships are presented.

 

Passau, an idyllic city in Lower Bavaria, has much to offer -a historic old town, beautiful surroundings and the location on the river Danube. Tourists from many countries flock to this attractive town near the Austrian border.  Every year about 250.000 passengers embark on river cruises in Passau. Furthermore there is a considerable amount of inland waterway vessels passing through Passau, on their way towards the Rhine-Main-Danube canal or to ports further downstream in Austria, Hungary or any other destination. Before the Danube flows into the Black Sea, the river passes through Slovakia, Croatia, Serbia, Romania and Bulgaria just as well as Moldova and Ukraine.

 Accordingly Passau like any other city in Europe situated on a navigable inland waterways has to deal with the issue of hygiene on ships, even when this is not the first thing that comes to mind

 

 

It has occurred in the past to repeatedly to not pay attention to very serious incidents with hygienic and public health relevance. For instance: Norovirus outbreaks occurred in the past on river cruise ships, there  were  problems with the supply of safe potable water for inland navigation ships and also accidents involving chemical substances with high relevance for humans and the environment. Until now there is relatively little European literature on this issue, especially on international cooperation in the European setting. As part of the “State of the art-report” within the Work Package 4 (Work Package Leader: Dr. Carmen Martinez Varela, Spain) the Hamburg working group will systematically collect and present this literature. A questionnaire will be developed to find out how European authorities, be it local or national, are dealing with controlling the hygiene  on inland waterways. We will especially concentrate on the question how port health authorities issue Ship Sanitation Control and Ship Sanitation Control Exemption Certificates.

By enumerating the Danube-neighboring countries, it is clear how many actors could be involved in dealing as an example  with an major infectious outbreak on an inland waterway cruise ship.

The emphasis of the survey to be conducted will be on the Rhine and Danube, but other areas are also considered.

Equally import in the work of the Hamburg working group,  is the second work task:  Under the work package 9 we have the objective to develop an outline of a risk assessment tool for occupational health risks per cargo ship type. A site visit was conducted in the EU-OSHA in Spain by SHIPSAN ACT Joint Action representatives (Bilbao, 25-26 April 2013) aiming to discuss about the process for the development of a risk assessment tool. During this site visit the EU-OSHA project managers presented the general principles of the Online Interactive Risk Assessment (OiRA) project, the OiRA tool for the risk assessment and the technical characteristics of the tool (e.g. content, management system) (http://www.oiraproject.eu/). Τhe project officer in Executive Agency for Health and Consumers, the Joint Action Coordination Team and the leaders of Work Package 9, concluded to cooperate and to develop the risk assessment tool for occupational and public health risks per cargo ship type using the OiRA tool. A training course will be organised on the use of the OiRA software together with our partners, teachers  and friends from Thessally, Klaipeda, Bilbao and last not least Hamburg.

 

 

Recent Publications   

Middle managers’ role in safeguarding OHS: The case of the shipping industry.

Syamantak Bhattacharya, Lijun Tang

Safety Science, Volume 51, Issue 1, January 2013, Pages 63-68,

Abstract

Employee participation and commitment from top management are important factors in effective occupational health and safety (OHS) management. However, between top management and employees there are middle managers, who are given little room in the top management/employee dichotomy. In this context, using the shipping industry as a case study, this paper investigates the impact of senior officer leadership on ratings’ participation in OHS management. Results suggest that while ratings’ precarious employment coupled with a steep hierarchy of command on board ships make upward communication in formal environments practically impossible, it is possible for senior officers to elicit effective participation from ratings by making good use of informal settings, working alongside ratings and engaging with them in social activities. Such leadership efforts bring in temporary relief to the constraints of participation and create spaces for them to contribute in the management of shipboard OHS.

 

Inactivation of Norovirus Surrogates after Exposure to Atmospheric Ozone,

 Jennifer L. Cannon , Grishma Kotwal & Qing Wang

Ozone: Science & Engineering: The Journal of the International Ozone Association, 35:3, 217-219, (2013) DOI: 10.1080/01919512.2013.771953

 Abstract

Human norovirus is the leading cause of epidemic gastroenteritis, especially in semiclosed settings such as daycares, nursing homes, hospitals, schools and on cruise ships. Outbreaks are often accompanied by contamination of environmental surfaces and commonly handled items. Surface disinfection of norovirus surrogates, feline calicivirus and murine norovirus, by 20 parts per million atmospheric ozone in a chamber maintaining 80% relative humidity was investigated. After treatment, neither virus could be detected on glass surfaces, but >5 log infectious virus was recovered from untreated controls. Ozone chambers used to decontaminate small, hand-contact items could be an important tool for controlling norovirus outbreaks.

 

Travel-associated Legionnaires' disease in Europe, 2010

de Jong, B. , Payne Hallström, L., Robesyn, E., Ursut, D., Zucs, P.   Surveillance and Response Support Unit, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

Eurosurveillance Volume 18, Issue 23, 6 June 2013

 Abstract

In 2010, the European surveillance network for travel-associated Legionnaires’ disease (ELDSNet, previously EWGLINET) received reports of 864 cases of travel-associated Legionnaires’ disease, of whom 24 were reported to have had a fatal outcome. As in previous years, a very low proportion of clinical isolates were obtained (45 cases, 5.6%). In the 2010 dataset, male cases outnumbered female cases by 2.6:1 and had a median age of 61 years (range: 21–96), while the median age for women was 63 years (range: 12–95). The network identified 100 new clusters in 2010, of which 44 involved only one case from each reporting country and would probably not have been detected by national surveillance schemes alone. The largest cluster (having 14 cases) was associated with a cruise ship. Legionella species were detected at 61 of the 100 accommodation site clusters investigated. The names of five accommodation sites were published on the ECDC website  

 

Review of maritime and port-related HNS accidents.

 

IAME 2013 Conference, July 3-5 - Marseille, France. Häkkinen, J. & Posti, A. (2013).

 http://www.merikotka.fi/chembaltic/Files/IAME_2013_Hakkinen_Posti.pdf

 Abstract

This paper provides a worldwide overview of maritime and port-related accidents involving hazardous of noxious substances (HNS). The data mining was carried out as a literature review. The study mainly focuses on liquefied chemicals but also other HNSs and accidents involving hazardous substances in packaged form were considered. Oil and oil products were observed only for comparison and on a very general level. Comparisons were made especially in case response actions were needed. Furthermore, studies focusing on port-related accidents were reviewed in this study. In addition, studies on the costs of chemical accidents were surveyed. The study revealed that the risk of an HNS accident is highest in seas where the highest tones of chemicals are transported, the density of maritime traffic is highest and, of course in the ship-shore interface where unloading/loading takes place. The data on marine pollution effects and the economic impacts of most transported chemicals is limited. Costs of a chemical tanker accident are almost unstudied, while study showed that the costs of an oil tanker accident could be enormous. Incidents involving chemical spills are statistically much less likely to occur than oil spills. However, chemical cargoes can be more dangerous to humans and property because chemicals can be more combustible, poisonous, irritating and reactive. The most important difference between a chemical and an oil spill may be related to response actions. In case of a chemical accident, the air quality or the risk of explosion should be more carefully evaluated before any response actions are taken. In case of chemical spills, the response is more limited in comparison to oil.

 

Overview of Maritime Accidents Involving Chemicals Worldwide and in the Baltic Sea.

Häkkinen, J. & Posti, A. 2013.

In Weintrit, A. & Neumann, T. (Eds.). Maritime Transport & Shipping - Marine Navigation and Safety at Sea Transportation. CRC Press, Taylor & Frances Group. http://www.merikotka.fi/chembaltic/Files/Transnav_2013_Hakkinen_Posti.pdf

 ABSTRACT:

Transport and handling of hazardous chemicals and chemical products around the world’s waters and ports have considerably increased over the last 20 years. Thus, the risk of major pollution accidents has also increased. Past incidents/accidents are, when reported in detail, first hand sources of information on what may happen again. This paper provides an overview of the past tanker accidents in the Baltic Sea and chemical related accidents in seas worldwide. The aim is to find out what can be learned from past accidents, especially from the environmental point of view. The study is carried out as a literature review and as a statistical review.

 

News and forthcoming dates   

 Announcement of SHIPSAN ACT Joint Action Training Courses

The 10 training courses (TC) will take place between October 2013 and December 2015 as shown in the following table:

 

CALL FOR TRAINERS – EU SHIPSAN ACT Joint Action

The SHIPSAN ACT Joint Action funded by the European Commission DG SANCO will organise 10 pilot training courses.

The SHIPSAN ACT Joint Action is looking for experienced trainers in the following areas:

 

 

Meeting of Experts to Adopt Guidelines on the Training of Ships’ Cooks

ILO - A Meeting of Experts will be held with the purpose of reviewing an initial draft and adopting guidelines for ships’ cooks.

 

For more information http://www.ilo.org/sector/activities/sectoral-meetings/WCMS_204810/lang--en/index.htm

 

What’s new on the website     

The NEW SHIPSAN ACT Joint Action website has gone live.  Visit the new SHIPSAN ACT website by following the link www.shipsan.eu

 

Quiz

Dr Raquel Davidson, Public Health England

Scurvy is a disease resulting from a deficiency of vitamin C, which is required for the synthesis of collagen in humans. Ascorbic Acid, the chemical name for vitamin C is derived from the Latin name of scurvy scorbutus. It was at one time common among sailors, pirates and others aboard ships at sea longer than perishable fruits and vegetables could be stored. While today scurvy is known to be caused by a nutritional deficiency, until the isolation of vitamin C and direct evidence of its link to scurvy in 1932, numerous theories and treatments were proposed.

However a surgeon in the Royal Navy first proved scurvy could be treated with citrus fruit in experiments he described in his 1753 book. Who was the surgeon and on which ship did he conduct his pioneering work?

Please send your answers to info@shipsan.eu

Answer to Issue 2 quiz:

What may be considered the first international health care expedition in History? What disease was it related to and what mean of transport did they use?

THE SPANISH ROYAL PHILANTHROPIC EXPEDITION OF THE VACCINE.

It was a three year mission to the Americas led by Dr Francisco Javier de Balmis with the aim of inoculating thousands against smallpox. The Balmis expedition was supported by King Charles IV of Spain in response to a large outbreak of smallpox in the Spanish colonies. The expedition occurred on board the ship “Maria Pita” that set off from La Coruña (Spain) on 30 November 1803. During the journey, the vaccine was kept viable by passing it from arm to arm in orphaned children who were brought along as successive carriers of the disease. The mission took the vaccine to the Canary Islands, Colombia, Ecuador, Peru, Mexico, the Philippines and China.

The discoverer of the vaccine Edward Jenner himself wrote "I don’t imagine the annals of history furnish an example of philanthropy so noble, so extensive as this."

Congratulations to Dr Audrone Lavruvianec, Chief specialist of Klaipeda Public Health Centre

 

 

Port in focus

The Port of Zadar – Croatia

Danira Sirinic, Dipl.Ing., Croatian Ministry of Health,Senior Border Sanitary Inspector; Zadar

Koraljka Knezic, MSc, Croatian Ministry of Health, Head of Border Sanitary Inspection; Zagreb

 

Throughout its history Zadar, as a nautical city, was and still is connected to the sea and ships. What characterises Zadar is a millennium urban existence, which ranks it as not only the oldest Croatian city but also among the oldest cities in the wider Adriatic region. The City of Zadar is easily accessible by land, sea or air. Through excellent infrastructure it is directly connected with major Croatian cities: Zagreb, Rijeka, Split and Dubrovnik with exceptional accommodation, modern services in numerous marinas.

  The ferry port and the new tourist port for cruise ships are located on the peninsula (the old town). While entering by ferry or boat in the port of Zadar it offers a magnificent view of the city which makes your arrival in Zadar a truly unique experience.

Sea Organ and Sun Salutationare two urban installations located near the new port for cruise ships as part of the old city waterfront. The Sea Organs are recognizable by its cascade coastal profile. The Sun Salutation, a model of the solar system with the accompanying planets is connected to the Sea Organs, whose sounds are transmitted into the light game performance that appears after the most beautiful sunsets in the world.

 

From the traffic point of view, Zadar is the center of the region which connects the north and south of Croatia with one of the most modern motorway networks in Europe. Located halfway between Venice and Dubrovnik, it has always been an important transit port and still is one of the busiest ports on the Mediterranean. With intense local, domestic and international routes with Italy, the Port of Zadar in the past few years records an increase of cruise ships visits.

 

Thanks to the geographical position of the mild Mediterranean climate, there are almost no flight cancellations at the airport, which is only a one to two hour flight from all European capitals. Considering the history and enchanting natural beauty, makes Zadar an excellent tourist destination.

 

 The increasing passenger and cargo traffic imposed the relocation of the ferry port from the heart of the city at a more suitable location in the port “Gaženica” which is located a few kilometres south of the city center.

 

 

The above idea has been around for a long time but in the actual realization of the same goes back 10 years. Construction of the new port is carried out in three phases. The first phase includes the construction of embankment and a secondary breakwater-the same is realized. The second phase includes the construction of the seafront, the road infrastructure in “Gaženica”, waiting areas, parking lots, and other supporting infrastructure-the same is mostly realized. The Third phase includes the construction of the terminal building with all the technical, control, traffic and commercial activities. Completion of construction of the entire port is expected in early 2014.

The construction of the passenger ferry port "Zadar-Gaženica" with all internal roads, terminal buildings and waiting areas for cars and the piers to a maximum depth of 15 meters to gain the conditions for simultaneous loading and unloading of passengers and cars: six ferries on local lines of lengths 50 -150 meters, three ships on international routes  lengths of 150-200 meters and three cruise ships with a lengths of 250-400 meters and possibility of accommodating RO-RO ships on the same piers.

      Relocation of the current port, Zadar achieves multiple gains. First of all, moving the focus of the highest frequency traffic to the southern part of the city means relief of the historic city and protecting what is most valuable as Zadar. At the same time, the new ferry port will allow previously impossible berthing for ships with deep drafts, which brings in new marine lines, and an even better and more numerous connections with the world. Zadar would then acquire conditions to become the centre of the shortest traffic artery between Southeast and southwest Europe.