The Humanitarian Response Newsletter
July 2003
     
CONTENTS  
West Africa

UNFPA Convenes Strategy Workshop on Health Emergency in West Africa

Sierra Leone: Training Peacekeepers to Promote HIV Prevention and Gender-Awareness

Sierra Leone: Facilitating the Reintegration of War-Affected Women

Côte d’Ivoire: Supporting HIV-Positive Soldiers and Their Families
Iraq

UNFPA Moves RH Supplies into Iraq to Protect Pregnant Women

Southern Africa Reproductive Health Severely Affected by Deadly Mix of Hunger and HIV/AIDS
UNFPA Regional Response to Humanitarian Crisis
Swaziland: New Partnership with WFP to Empower Women and Fight HIV and SGBV
Zimbabwe: Raising and Meeting Demand for Voluntary Counselling and Testing
Zambia: Giving Hope in One of Africa’s Largest Refugee Settlements
Afghanistan

Maternity Ward Reopens in Kabul

Census Preparations Underway
Publications

Women War Peace

Reproductive Health for Communities in Crisis

Impact of Armed Conflict on Women and Girls
HIV/AIDS and Conflict: Research in Rwanda, Burundi, and Eastern DRC
Conference

RHRC Conference 2003: Reproductive Health from Disaster to Development

   
   

WEST AFRICA

UNFPA Convenes Strategy Workshop on Health Emergency for Millions in West Africa

UNFPA Representatives from eight African countries and regional officials from WHO, UNHCR, UNAIDS, OCHA and the International Centre for Migration and Health (ICMH) met in Ghana in early June to share findings on the impact of more than a decade of conflict on women’s health and the transmission of HIV/AIDS. They also worked on national and sub-regional plans to better protect millions of displaced and otherwise war-affected women, men and children in West Africa.

The participants in the four-day meeting warned of the spill-over effect of the crisis into neighbouring countries, as hundreds of thousands of refugees are moving back and forth across borders, mostly among Liberia, Guinea, Sierra Leone and Côte d’Ivoire. As the conflict spreads, so does the tragic situation of women and girls. The civil conflict in Côte d’Ivoire, for example, has been accompanied by steep increases in unassisted births, maternal mortality, sexual abuse and violence and, almost certainly, increased HIV infection, according to Tamany Safir, UNFPA Representative in that country.

Delegates at the Akosombo meeting also issued a declaration imploring the international community, humanitarian agencies and other parties to take urgent action to address the mounting disaster.

Read more about the Akosombo meeting.

Read the Akosombo Declaration.

Sierra Leone: Training Peacekeepers to Promote HIV Prevention and Gender-Awareness

In March, UNFPA launched a groundbreaking two-year programme for HIV/AIDS prevention and gender awareness among peacekeepers in Sierra Leone. With over 15,000 troops, the United Nations Mission in Sierra Leone (UNAMSIL) is currently the largest peacekeeping force in the world.

Designed and executed in partnership with the UN Department of Peacekeeping Operations (DPKO), UNAIDS, the International Centre for Migration and Health (ICMH), UNAMSIL and UNIFEM, the programme includes training of medical staff within peacekeeping contingents, provision of information and education to troops and local communities, and gender sensitization.

The project recognizes the high level of interaction that peacekeepers have with the communities they serve. In parts of the world where such training and sensitization were not provided, peacekeepers have sometimes been blamed for helping to spread HIV/AIDS. The UNFPA/DPKO initiative aims to make peacekeepers part of the solution: to curb infection by and among troops, and to capitalize on their leadership role by mobilizing them to help educate communities on how to stay HIV-free.

Read more about the HIV/peacekeeping initiative.

Sierra Leone: Facilitating the Reintegration of War-Affected Women

In a tiny shelter on the outskirts of Freetown, the UNFPA-supported “Women in Crisis” project is supporting more than 400 women and girls, many of whom suffered terribly during Sierra Leone’s recently concluded civil war. Many of the women were raped, sexually abused, or purposely disabled during the conflict. Some were raped in front of their husbands, who were then executed in front of them. Thousands of Sierra Leonean women have turned to commercial sex work to survive, but with HIV/AIDS on the rise, such work can be a death sentence.

The Women in Crisis project supports women who lost their families during the war and have nowhere else to turn. UNFPA is supporting drop-in centres offering counselling and training, clinics offering services to prevent and treat sexually-transmitted infections, and the building of a new vocational training centre, where women can learn fabric tying and dying, tailoring and hairdressing skills. The three-story structure will also have a health clinic, staffed with nurses provided by the Ministry of Health.

Read more about the Women in Crisis project.

Côte d’Ivoire: Supporting HIV-Positive Soldiers and Their Families

UNFPA is working with the local NGO HopeFANCI in Côte d’Ivoire to provide psychosocial care and support to soldiers and their families living with HIV/AIDS. In May, a sensitization campaign was launched in and around the capital city of Abidjan. In addition to programme support, UNFPA has provided more than 43,000 condoms, 5000 educational pamphlets, and enough antibiotics and other medicines and supplies to treat thousands of people suffering from sexually transmitted infections.

IRAQ

UNFPA Moves RH Supplies into Iraq to Protect Pregnant Women

A new shipment of emergency reproductive health supplies arrived in Baghdad on 9 June, on a UNFPA/UNICEF convoy that crossed the border from the Iranian city of Kermanshah. The shipment, facilitated by the Iranian Ministry of Health and Medical Education, included much needed emergency obstetric care materials, clean delivery equipment, contraceptives, syringes, essential drugs and other medical products. Gynaecological beds, wheelchairs, sanitary pads, baby diapers, clothing, and more drugs will be included in another convoy to be dispatched shortly by the UNFPA office in Iran.

This is the second shipment of reproductive health equipment and supplies provided by UNFPA to Iraqi hospitals since the end of the armed conflict in April. The first was delivered in May to the northern city of Mosul, and included emergency obstetric care supplies, clean delivery equipment, contraceptives, essential drugs and other medical products. Equipment for blood transfusion and testing were also delivered. The Mosul shipment is intended to serve a population of 400,000 people for three months.

UNFPA is currently conducting an emergency assessment of 18 hospitals and 30 primary health care centres providing reproductive health and family planning services around Baghdad. The assessment is undertaken in collaboration with a number of international health partners operating in Iraq, including Enfants du Monde, Première Urgence and Architects for People in Need.

Before the conflict began, UNFPA pre-positioned essential medical supplies and equipment inside the country and at sites in neighbouring countries where refugees were anticipated. Now that UNFPA has resumed its operations inside the country, it is moving these supplies across borders to the people who need them most.

Read more about the Baghdad shipment.

Read more about the Mosul shipment.

Read more about all UNFPA activities in Iraq.

SOUTHERN AFRICA

Reproductive Health Severely Affected by Deadly Mix of Hunger and HIV/AIDS

Severe food shortages in Malawi, Zambia, Zimbabwe, Lesotho and Swaziland have left millions dependent on dwindling international food aid for survival. Although erratic weather is partly to blame, HIV/AIDS is contributing to a new type of famine that could persist long after the rains return.

For centuries, people in Southern Africa have adjusted to cyclical food shortages by eating less and relying on relatives and friends. But reducing food intake can be fatal for people who are HIV-positive as malnutrition weakens their already vulnerable immune systems, accelerating development of the virus and pushing them into full-blown AIDS. Moreover, traditional support networks have been decimated as many who have not already succumbed to the disease are overburdened with the support they must provide to the children of relatives and friends who have.

Women and children are especially at risk. Women are socially, culturally and biologically more vulnerable to HIV infection than men, and bear most of the burden of care for sick and orphaned relatives. When a parent dies, children not only lose a mother or father. Many, particularly girls, are forced to drop out of school, greatly increasing their own vulnerability to HIV infection.

UNFPA representatives from the affected countries report that hunger and diminished access to health services, including reproductive health care, are taking a heavy toll on women, adolescents, and other vulnerable groups across Southern Africa. The crisis is having a devastating impact on maternal health. Malnutrition renders pregnant women more susceptible to infection, miscarriage and premature labour, and increases the likelihood that pregnant and lactating women who are HIV-positive will transmit the virus to their children. Food shortages and high poverty levels are also contributing to a decrease in the number of women seeking family planning services and antenatal care, and an increase in home deliveries, as the constant search for food for their families leads women to neglect their own health.

Read more about HIV/AIDS and the food crisis in Southern Africa.

Read “’New-Variant’ Famine: How AIDS Has Changed the Hunger Equation”.

Read “The Unequal AIDS Burden”.

UNFPA Regional Response to Humanitarian Crisis

UNFPA convened a week-long regional conference in Cape Town, South Africa in February 2003, to bring together UNFPA representatives from 16 African countries, members of the South African Government, and senior regional officials from WFP, OCHA and UNAIDS to discuss ways to better address reproductive health concerns as part of the UN-wide response to the humanitarian crisis. The UNFPA meeting was part of the multisectoral approach initiated with the opening of the UN Regional Inter-Agency Coordination Support Office (RIACSO) in Johannesburg in September 2002. Dr. Gebreamlak Ogbaselassie, formerly with the Country Support Team in Harare, has been seconded by UNFPA to the inter-agency office, which also includes staff from WFP, OCHA, UNDP, FAO, UNAIDS, UNICEF and WHO.

Consistent with its emergency operations in other parts of the world, UNFPA is assisting in the procurement and distribution of RH kits and commodities, and in the training and deployment of service providers to distribute them in areas affected by the crisis. The Fund has also responded by stepping up its advocacy for better access to sexual and reproductive health services and for greater empowerment of women.

Since the meeting, Dr. Ogbaselassie and country office representatives have collaborated in the design and development of specially designed projects for at least four affected countries. Country offices are also intensifying their efforts to address acute condom shortages by establishing inter-agency RH commodity security committees, mobilizing resources through partnerships to address gaps, and procuring and distributing supplies and equipment.

Read more about the Cape Town conference.

Swaziland: New Partnership with WFP to Empower Women and Fight HIV and SGBV

UNFPA will partner with the World Food Programme on an innovative new programme to train and empower Women’s Relief Committees, whose Herculean efforts have helped to avert mass starvation in Swaziland, to spearhead the fight against HIV/AIDS and sexual and gender-based violence in this drought-stricken country.

WFP established the 179 Women’s Relief Committees in December 2002, with the permission of area chiefs and the cooperation of village elders, to manage emergency food distribution during the ongoing humanitarian crisis. The survival of at least one third of the population has depended on this aid, following poor harvests last year, which early signs suggest will be repeated this year. Experience in other countries has shown women to be ideally suited to food distribution because they readily share information among themselves and are keenly aware of the needs of individual households in their communities. According to Erika MacLean, the WFP emergency coordinator who founded the committees, “women know whose pot is empty.” UNHCR and other agencies have long advocated for women’s involvement in food distribution to lessen the possibility for sexual exploitation by food distributors.

The new joint initiative will train two women from each of the 179 committees as counsellors for a range of reproductive health issues, especially HIV/AIDS and sexual abuse and exploitation. In a country where nearly 40 per cent of the population is infected with HIV and many rural populations are not reached by mass media campaigns about the epidemic, the two agencies believe these women can play a critical role in raising awareness of reproductive health issues.

The project will serve as a pilot for future UNFPA/WFP collaborations in other countries affected by the HIV/food crisis (see previous two stories), and is a direct response to the recent call to action by the UN Secretary-General’s Special Envoys for Humanitarian Needs in Southern Africa and for HIV/AIDS in Africa. “An immediate, strongly led and broadly implemented joint effort to take action on gender and HIV/AIDS must be initiated without delay,” stated the Special Envoys’ February 2002 Mission Report. “The effort should feature leadership from the United Nations, the active engagement of governments and substantially increased support to civil society organizations, including remarkable grassroots initiatives.”

Read the Mission Report of the Special Envoys of the Secretary-General for Humanitarian Needs in Southern Africa and for HIV/AIDS in Africa.

Zimbabwe: Promoting Voluntary Counselling and Testing

As adult HIV prevalence rates in Zimbabwe climb above 33 per cent, UNFPA and ZAPSO, a local NGO, are working together to raise and meet demand for voluntary counselling and testing (VCT) services. During a recent visit by a journalist to a VCT centre on the outskirts of Harare, clients discussed their feelings about getting tested. “Why should I be afraid?” asked a 35-year-old woman who suspected she might be infected. “If I do have it, I just want to know how I can live longer. I have my children to think of.”

Studies show that people who learn their HIV status through VCT are more motivated to modify their behaviour whatever the results. People who test positive are more likely to seek advice on how to stay healthy and to take steps to avoid infecting others. Those who test negative tend to take more precautions to stay HIV-free. Knowing one’s status is also an entry point to care and support services, such as the prevention of mother-to-child transmission (PMTCT), the treatment of opportunistic infections such as tuberculosis, and support groups.

Another woman waiting to be tested spoke about the difficulty of sharing the test results with her husband, who admits to sleeping with other women but is unwilling to wear a condom. “We’ve talked about it,” she said, “But he always tells me the same thing: ‘You can’t taste the sweet if it’s still wrapped in the paper’.” The difficulty of getting men to come in to be tested, and to take responsibility for protecting their partners from infection, was confirmed by a nurse-counsellor at the VCT centre. “Seventy per cent of our clients are still women,” she said, “But we’re getting there. We’re seeing a lot more men than we used to.”

Read the full article, including interviews with clients and staff and a description of the VCT process.

Zambia: Giving Hope in One of Africa’s Largest Refugee Settlements

Meheba, in northwest Zambia, is home to more than 50,000 refugees – mainly from Angola, the Democratic Republic of the Congo, Rwanda and Burundi. YMCA, with support from UNFPA, has been providing reproductive health services in one of sub-Saharan Africa’s largest refugee settlements since 1999. One of the project’s many components is the provision of reproductive health information and counselling to newly arrived refugees.

UNFPA recently spoke with YMCA project staff about some of the special issues faced by refugee women. In addition to sexual abuse and low HIV awareness, YMCA project staff report the common desire among refugee women to produce as many children as possible to replace lost relatives, and the special needs of adolescent refugees.

Read the full interview.

AFGHANISTAN

Maternity Ward Reopens, Preparations for Census Underway

A baby boy weighing 2.85 kilograms was the first infant delivered at the newly rebuilt maternity ward of Kabul’s Khair Khana hospital, which reopened in March after being renovated and refurbished by UNFPA. During the eight months the hospital was closed, the Fund supported the operations of a Danish Emergency Mobile Hospital nearby, which trained over 100 local staff members, and treated 200 to 300 patients a day with trauma care, selective surgery, obstetrics and gynaecology. Between July and December 2002, nearly 1,500 babies were delivered at the facility.

UNFPA has been named the UN’s lead agency to support preparations for a national Population and Housing Census, which is urgently needed by the Afghan Government and international agencies for development planning. As part of this effort, the UNFPA office in Kabul has begun to strengthen and revitalize the Central Statistics Office.

In addition to direct support to the Afghan Ministry of Health, UNFPA is working closely with a number of national and international NGOs to improve women’s health in Afghanistan – by increasing access to quality reproductive health services and emergency obstetric care, providing needed supplies, and supporting training. UNFPA and its partners also continue to support measures to reduce maternal mortality among Afghan refugees, tens of thousands of whom remain in camps and refugee settlements in Pakistan’s North-west Frontier, Baluchistan and Punjab Provinces.

Read more news from the latest Afghanistan update.

Read more about all UNFPA activities in Afghanistan.


PUBLICATIONS

Women War Peace

This UNIFEM-commissioned report examines the progress made in implementing UN Security Council Resolution 1325 dealing with women, peace and security. Prepared by two independent experts with support from UNFPA, the report highlights the prevalence of violence against women before, during and after armed conflicts, based on firsthand data and testimonies from women who were victims and survivors of wars in 14 areas around the world.

Women are particularly vulnerable to the threat of HIV/AIDS in conflict situations, warns the report. "Women are more susceptible to infection than men, yet often have little control over their sexuality. At the same time, they are forced by conflict conditions to trade sex for money, food, shelter and any other number of necessities." Fuelling the spread of HIV/AIDS are sexual violence and exploitation, all too common in conflict and post-conflict settings.

The report recommends that UNFPA should take the lead in providing reproductive health and psychological services to women affected by conflict, with special attention to those who have experienced physical trauma, torture and sexual violence. Such services, it says, should be an integral part of all emergency assistance and post-conflict reconstruction.

Read the full report.

Read the Report of the Secretary-General on Women, Peace and Security.

Reproductive Health for Communities in Crisis

Wars and natural disasters deprive people of life-saving reproductive health information and services. This advocacy booklet details UNFPA's work with global partners to respond to the reproductive health needs of refugees and internally displaced persons in crisis situations around the world, providing services to address complications of pregnancy and delivery, the transmission of sexually transmitted infections including HIV/AIDS, adolescent health, violence against women, and access to condoms and other contraceptives.

Read the full report.

Impact of Armed Conflict on Women and Girls

Subtitled “A UNFPA Strategy for Gender Mainstreaming in Areas of Conflict and Reconstruction,” this report summarizes the findings and presentations from a consultative meeting held in Bratislava, Slovakia. The purpose of the meeting was to examine and explore the impact of armed conflict on women and girls, and to formulate strategies and tools to ensure that reproductive health programmes accurately reflect their needs, by addressing them through a comprehensive, gender-sensitive approach.

Read the full report.

HIV/AIDS and Conflict: Research in Rwanda, Burundi and Eastern DRC

This report for Save the Children UK, commissioned by UNAIDS and UNICEF, describes humanitarian organizations’ response to HIV/AIDS in emergency settings. The report identifies strategies for increasing the pool of available resources for HIV/AIDS programs in emergency settings, and makes recommendations for maximizing the effectiveness of inter-agency response.

Read the full report.

Or read a summary of the report.


CONFERENCE

RHRC Conference 2003: Reproductive Health from Disaster to Development

October 7-8, 2003 -- Brussels, Belgium

Sponsored by the Reproductive Health for Refugees Consortium, UNFPA and UNHCR, this conference will focus on applied research, program findings and use of data to improve reproductive health programs serving populations in crisis throughout the world. The Conference 2003 registration fee is US $150. After August 1, 2003 the fee will be $175.

Register or read more about the conference.
 

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