GLOBAL

Web film illustrates impact of war on women’s health

The new UNFPA web film Women War Health highlights the urgent need to protect women's health in war and refugee settings. The three-minute Flash presentation depicts the indirect ways that war can threaten women’s lives and well-being – from the danger of unassisted childbirth to increased incidence of sexual violence and HIV transmission – and warns of the dangers of treating reproductive health as a secondary concern in conflict and refugee settings.

The web film can be viewed online in English, Spanish, French and six other languages. The film was designed with a simple Send to a Friend function, and has already been viewed by thousands of people worldwide. UNFPA hopes to reach one million viewers with the film in 2004.

Become an advocate for refugee women! Please take five minutes to view the film and send to as many friends and colleagues as possible: http://www.unfpa.org/emergencies/psa/

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Global evaluation underway to identify global gains and gaps in RH for refugees

The first-ever, inter-agency global evaluation of reproductive health services worldwide is being conducted by the Inter-agency Working Group on Reproductive Health for Refugees (IAWG). The evaluation, due for publication in mid-2004, will provide a comprehensive picture of when and where services are being provided, identify gaps and constraints, and help UNFPA and its partners to better target resources and interventions. UNFPA is taking the lead on evaluation of worldwide delivery of the Minimum Initial Services Package (MISP) of RH services to refugees, and analysis of financial resource trends for emergency RH programming. UNHCR, Columbia University’s Mailman School of Public Health, and the University of New South Wales are overseeing other components of the evaluation, including: literature review and analysis of existing country and regional-level evaluations of RH services for displaced populations; inventory of coverage of services in refugee camps and IDP sites; site reviews of quality, access to and use of RH services, based on field visits; policy analysis of changes in organizational awareness of, and commitment to, RH service provision; and review of resource requirements and trends.

Preliminary findings, presented at the RHRC conference in Brussels (see next story), suggest RH services for internally displaced persons are severely lacking, but are gradually becoming more available in stable settings. Access to family planning services has improved since the 1990s, while services for HIV/AIDS and other sexually-transmitted infections and gender-based violence were found to be less comprehensive and in some cases very limited.

The full evaluation is scheduled for completion in June. For more information, please contact Judith O’Heir at joheir@bigpond.com or Wilma Doedens at doedens@unfpa.org.

Third RHRC International Conference on Reproductive Health for Refugees

Co-sponsored by UNFPA and UNHCR, the second international research conference of the Reproductive Health Response in Conflict (RHRC) Consortium was held in Brussels in October 2003. More than 150 people from 36 countries representing 70 organizations participated in the conference, bringing people together from Asia, Africa, Australia, Europe and the Americas to share programme findings, research, model programmes, innovative strategies, and practical tools and guidelines for assisting conflict-affected populations around the world. The conference, titled Reproductive Health from Disaster to Development, also highlighted the importance of using research as an advocacy tool to positively impact reproductive health program funding and development and advance the cause of RH for conflict-affected populations.

For full conference proceedings, please visit http://www.rhrc.org/pdf/confprocdingsNEW.pdf

Security Council briefing on HIV/AIDS and peacekeeping

The importance of HIV prevention programmes targeting UN peacekeepers was highlighted in a Security Council briefing in November. In separate statements, Under-Secretary-General for Peacekeeping Operations Jean-Marie Guéhenno and UNAIDS Executive Director Peter Piot made reference to the important contributions made by UNFPA and UNIFEM to the work by the UN Department of Peacekeeping Operations (DPKO).

Mr Guéhenno commended the partnership between DPKO, UNFPA, UNIFEM and the UN Mission in Sierra Leone (UNAMSIL) to hold workshops for peacekeepers on HIV/AIDS prevention, gender and human rights awareness. He discussed the importance of maintaining high levels of knowledge and training skills among key personnel dealing with HIV/AIDS issues, citing the UNFPA-supported workshop on “Malaria, HIV/AIDS and Related Diseases in Peacekeeping Operations, which trained senior mission medical personnel and HIV/AIDS focal points from 20 troop-contributing countries, as an example. Mr Guéhenno also spoke of the Memorandum of Understanding signed with UNFPA for the provision of reproductive health items, including condoms and post-exposure prophylaxis (PEP) kits to prevent HIV transmission to rape victims and health workers.

Mr Piot spoke of the importance of programming guides, peer education kits and other materials developed by UNFPA and its fellow UNAIDS cosponsors.

COUNTRY ACTIVITIES

HAITI

Emergency UNFPA airlift arrives in Haiti

PORT-AU-PRINCE, Haiti, 26 March 2004 – An airlift of emergency medical supplies from UNFPA, the United Nations Population Fund, has arrived in the Haitian capital of Port-au-Prince. The provisions – which include drugs and supplies for safe childbirth and for treatment of rape and sexually-transmitted infection – are urgently needed after weeks of civil conflict have led to the destruction and looting of much of Haiti’s health care system and continue to contribute to alarming levels of sexual violence. Read the full press release at http://www.unfpa.org/news/news.cfm?ID=442.

SUDAN AND CHAD  

Safeguarding the reproductive health of displaced Sudanese on both sides of the border

UNFPA has dispatched supplies for safe childbirth, blood transfusion equipment, medications to prevent the transmission of sexually transmitted diseases, and other medical provisions to protect the reproductive health of thousands of Sudanese displaced by ongoing fighting in Darfur, Sudan.

Inside Sudan, UNFPA is distributing reproductive health supplies to camps and health facilities, through its partners Save the Children UK and the Irish organization GOAL. The UNFPA team in Sudan is also working with Medecins Sans Frontieres (MSF) France, Belgium and Holland to help prevent and treat cases of gender-based violence among populations displaced by the conflict.

UNFPA has also sent reproductive health supplies and equipment to assist refugees in neighbouring Chad, where more than 110,000 Sudanese have fled since fighting in Darfur escalated last year.

About 75 per cent of adult refugees in Chad are women. Already vulnerable because they must look after children, the elderly and wounded family members, UNFPA warns that refugee women and girls are also at risk of rape and sexual exploitation.

WEST AFRICA

Sierra Leone: Ex-combatant joins Global Youth Partners

Sheriff Parker, a 20-year-old ex-combatant, has joined the Global Youth Partners (GYP) initiative to help prevent the spread of HIV among young people in his native Sierra Leone.

Supported by UNFPA, GYP is a youth-led global campaign for universal access to HIV/AIDS information, education and services. UNFPA field offices have helped to identify youth advocates in 28 countries so far, and brought 38 young people from these countries to a global meeting in New York in September, to share ideas and experiences and to plot a global advocacy strategy to be kicked off later this year.

Sheriff, the first ex-combatant to become a GYP youth advocate, fought with the Revolutionary United Front (RUF) during Sierra Leone’s 11-year civil war. At the beginning of the peace process, he headed the RUF delegation from the North for UN-mediated peace negotiations between the RUF and the Government. During subsequent meetings with UN representatives, he presented a proposal for a project focusing on the reintegration and rehabilitation of ex-combatants, many of whom had spent most of their adolescent lives as forced conscripts in the war.

Sheriff now works as director of Mabulum-nu Agricultural and Community Development Association (MADA), an NGO that helps the Sierra Leonean Government reintegrate ex-combatants into society. Specifically, he works to ensure that ex-combatants like himself are aware of the dangers of STIs and HIV and how they can contribute to the fight against the disease.

With the support of UNFPA, Sheriff has coordinated many activities, including: peer leadership training on HIV/AIDS prevention; an RH education program for illiterate adolescents; a workshop on HIV/AIDS prevention strategies targeting vulnerable youth; and training on the gender, culture and human rights dimensions of HIV/AIDS and counselling.

Restoring Dignity to Displaced Liberians

People displaced by conflict lose not only their homes. Forced into flight with little more than the clothes on their backs, many lack even the most basic personal hygiene items, such as a toothbrush or soap or even a comb. Most displaced women also lack sanitary napkins for menstruation, something most women in the developing world take for granted but consider an absolute necessity.

Simple hygiene items like these are not a part of most humanitarian assistance but can make an enormous difference in helping to restore the dignity, self-respect and hope of people who have already lost so much. In late 2003, UNFPA, the Community Empowerment Program (CEP) and other partners distributed over 2000 “dignity kits” to displaced Liberians in the capital of Monrovia. Produced both in Liberia and by the UNFPA office in neighbouring Ghana, the kits contained toothpaste, a toothbrush, soap, towels, combs and sanitary napkins. The program also sought to assess the general reproductive health situation of the displaced persons receiving the kits.

“You can’t imagine how much being able to fix one’s hair can mean to a woman who has been progressively dehumanised after months of being herded from one place to another,” says CEP president Lucy Page. “Food and water can save someone’s life. But I haven’t seen anything like the look on a woman’s face when she receives these simple items. We’re helping them to feel human again.”

After years of fighting, hundreds of thousands of women and their families remain displaced in Liberia, and UNFPA is seeking additional funds to step up local production and distribution of the dignity kits. According to UNFPA Representative Deji Popoola, a small program like this can have a big impact. “In places where we’ve run out of kits, women are sharing them with their neighbors. Thanks to their solidarity, one kit can help several women. And if we can also put other women to work producing the kits, the multiplier effect will be even greater.”

Rebuilding Liberia: update on 2003 activities

In 2003, UNFPA Liberia served the needs of approximately 250,000 internally displaced Liberians in and around the capital of Monrovia. Access to populations outside the capital was extremely limited but the Fund closely partnered with NGOs with good access to refugee and IDP camps to reach as many people as possible.

The bulk of UNFPA support was effected through the provision of equipment for safe child delivery, post-rape medications, contraceptives, drugs to treat sexually transmitted infections, HIV test kits, blood transfusion equipment and condoms. Because most of Liberia’s health facilities have been destroyed or looted during 14 years of intermittent fighting, UNFPA is also working to replenish hospitals in and around Monrovia with referral level surgical equipment and supplies, and to train health workers and midwives to use them.

Although Liberia has become relatively stable in recent months, UNFPA continues to provide emergency funding for supplies and training to neighboring countries, to help field offices there serve the hundreds of thousands of Liberians that crossed into these countries when fighting escalated in June 2003. UNFPA responded to that crisis by convening a sub-regional humanitarian strategy workshop in Ghana to plan a comprehensive approach for regional response. As part of this strategy, UNFPA positioned essential RH kits and supplies in Sierra Leone, Guinea, Ghana and Cote d’Ivoire. UNFPA also partnered with UNHCR, the International Centre for Migration and Health (ICMH), Merlin and various NGOs to train health professionals and midwives on the use of RH kits in Liberian refugee camps in Sierra Leone and Guinea.

IRAQ

Assessment Finds Reproductive Health Services Now Operating at 40% of Capacity

Now online, a reproductive health assessment conducted by UNFPA in August 2003 notes that damage to and looting of most health facilities, disruptions to water and electricity supply, and the lack of drugs and medical equipment are having devastating impacts on the reproductive health of the Iraqi people. Reproductive health care services, which were already severely impaired after the 1991 Gulf War and years of sanctions, are now estimated to be working at no more than 40% of capacity. The number of pregnant women delivering at home has increased to more than 65 per cent, and at least 80 per cent of these deliveries are taking place without the assistance of trained birth attendants.

In addition, the breakdown in security within and around health care facilities has made access to remaining services very difficult for women and girls. “Women are not willing to leave their homes and immediate neighborhoods for fear of violence and even female health care workers are now reluctant to go to work because of insecurity.”

Despite these serious problems, the report noted opportunities for reconstruction and development. “Iraq still benefits from a strong cadre of well-qualified health care personnel who remain committed to their work but who are lacking refresher training and financial renumeration.”

To read the report, please visit http://www.unfpa.org/rh/docs/iraq-rept04-08-03.doc

Emergency Assistance for Earthquake Survivors in Iran

Following December’s massive earthquake in the ancient city of Bam, UNFPA continues to provide assistance to tens of thousands of Iranians affected by the disaster.

The earthquake, which killed more than 42,000 people, destroyed or severely damaged 85 per cent of all buildings in Bam, including all three local hospitals. Devastation of infrastructure has been compounded by the loss of over half the city’s health care personnel, paralysing the health care system throughout the surrounding district.

In the wake of the disaster, UNFPA provided emergency funds to the Ministry of Health and Medical Education (MOHME) and other national partners for the purchase of medical equipment and reproductive health supplies, and participated in an inter-agency assessment mission. In mid-January, in response to government concerns about deteriorating hygienic conditions, UNFPA provided additional funds for the installation of 360 sanitary points, including showers, throughout the affected area. A generous grant from the Bill and Melinda Gates Foundation has helped UNFPA support the establishment of temporary health facilities, provision of urgently needed medical and reproductive health supplies, RH training for health workers, and dissemination of information to the public about various health dangers.

Contingency planning for natural disasters in Ecuador

Ecuador is exceptionally prone to natural disasters, including regular flooding, earthquakes, drought, volcanic eruptions, landslides and the effects of the El Niño current. Ecuador is vulnerable to man-made crises as well, as areas along Ecuador’s northern border are faced with an increasing influx of Colombian refugees.

In 2003, with assistance from the New York-based Humanitarian Response Unit, UNFPA Ecuador held a two-day workshop with members of the Ministry of Health, Ecuadorian Civil Defense, and several Ecuadorian and international NGOs to define UNFPA’s role, standards and procedure in responding to future emergencies in Ecuador. The workshop was part of a larger contingency planning exercise to establish UNFPA’s role vis-à-vis its partners on Ecuador’s UN Disaster Management Team, and included a simulation exercise for 28 NGO and government technical experts. Among other outputs, the workshop resulted in the establishment of a network of NGOs, most of whom are already UNFPA Ecuador partners, that can be quickly activated in the wake of an emergency.

For more information, or to request Spanish-language training materials prepared for this workshop, please contact Lydia Leon at leon@unfpa.org.

RESOURCES

Forced Migration Review: Reproductive Health for Displaced People

Why does Afghanistan have the highest maternal mortality rate in the world? What four conditions must be met to reduce it? How is a missionary helping hundreds of former bush wives and survival sex workers in post-war Sierra Leone come together as a family to rebuild their lives and their country? Why is meeting the reproductive health needs of displaced Colombians a critical step in restoring their lost social and political rights?

These and other issues are addressed in a special issue of the journal Forced Migration Review – Reproductive Health for Displaced People: Investing in the Future – now online at http://www.fmreview.org/mags1.htm. Sponsored by UNFPA, the United Nations Population Fund, and the United Nations High Commissioner for Refugees (UNHCR), the journal highlights lessons from recent reproductive health research and programming in conflict and post-conflict settings.

Field reports from West Africa, Afghanistan, Guatemala, Colombia, Yemen and the Thailand/Myanmar border celebrate progress in delivering reproductive health services but warn of the challenges faced by humanitarian agencies working to safeguard the reproductive health of the displaced. Other articles examine the issue of gender-based violence in displaced communities, and how conflict endangers the reproductive health of adolescents and youth.

The special issue was co-edited by UNFPA and Marie Stopes International. An introduction by the guest editors traces the relatively short history of reproductive health provision in humanitarian settings, and notes progress to date.

To obtain a hard copy of this issue or to subscribe to Forced Migration Review, please send an email to fmr@geh.ox.ac.uk.

Guidelines for HIV/AIDS Interventions in Emergency Settings

The Guidelines for HIV/AIDS Interventions in Emergency Settings have been developed by the Inter-Agency Standing Committee (IASC) Task force on HIV/AIDS in Emergency Settings to respond to the growing concern for the development of a more specific response to HIV/AIDS in crises. The purpose of these Guidelines is to enable governments and cooperating agencies, including UN Agencies and NGOs, to deliver the minimum required multi-sectoral response to HIV/AIDS during the early phase of a crisis. UNFPA in partnership with fourteen other agencies (UN and international NGOs) has made substantial contributions towards the development of the Guidelines.

Women War Peace
www.womenwarpeace.org

UNIFEM’s new web portal on women, peace and security tracks country-by-country progress on implementation of UN Security Council 1325 by providing timely information and analysis on the impact of armed conflict on women and women’s roles in peacebuilding. Companion to the UNIFEM/UNFPA book of the same name, available at http://www.unifem.org/index.php?f_page_pid=149

Enlisting the Armed Forces to Protect Reproductive Health and Rights: Lessons from Nine Countries

Taking advantage of the considerable organizational and human resources of military institutions to protect reproductive health and rights is emerging as a powerful strategy in both peacetime and conflict situations. For decades, UNFPA has worked with the military sector to reach out to men with information, education and services on family life and family planning. This experience is now being applied to a wider spectrum of reproductive and sexual health concerns, including maternal health, HIV/AIDS prevention and reduction of gender-based violence. This digital document offers lessons learned from reproductive health projects in nine different military organizations.

To view the report, please visit http://www.unfpa.org/rh/armedforces/index.html

Still in Need: Reproductive Health Care for Afghan Refugees in Pakistan

Based on a Women’s Commission reproductive health needs assessment of Afghan refugees in the Northwest Frontier, Baluchistan and Punjab provinces of Pakistan conducted from August 2002 to July 2003, this study finds that while some basic RH health services are being implemented, there are substantial gaps in RH programming, particularly in the areas of emergency obstetric care, gender-based violence, sexually transmitted infections and youth and male involvement. In addition, where basic services are provided, there is a lack of RH protocols, guidelines, technical assistance, monitoring and supervision of RH service delivery.

http://www.womenscommission.org/pdf/Pk_RH.pdf