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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.
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.
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.
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.
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.
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.
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.
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.”
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.”
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.
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.
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.
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.
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.
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.
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.
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