rh in conflict settings

8/7/2019 RH in conflict settings

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Women s Health DuringWomen s Health DuringTimes of Armed Conflict Times of Armed Conflict

Dr. Amani ElkhatimDr. Amani Elkhatim

SHSSHS-- AUW AUW


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Women HealthWomen Health

4 http://www.who.int/features/factfiles/women/en/index.html


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What is Reproductive Health (RH)? What is Reproductive Health (RH)?

A state of complete physical, mental andsocial wellbeing, and not merely theabsence of disease or infirmity, in allmatters relating to the reproductivesystem and its functions and processes.

Implies that people are able to have asatisfying and safe sex life and that theyhave capability to reproduce and thefreedom to decide, if, when and how oftento do so.


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What s emergency situation? What s emergency situation?

A serious disruption of the functioning of a society, causing widespread human,

material, or environmental losses whichexceed the ability of the affected societyto cope using its own resources.

Acute phase: CMR > 1/10,000/day


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I ntroductionI ntroductionB etween 1998 and 2007, there were 34 major armedconflicts all but three internal and about fourtimes that armed conflicts in total.

Far more civilians than soldiers become casualties inthese conflicts, many of them women and girls.

Armed conflict threatens women s rights includingreproductive rights and health, and can exacerbateculturally rooted gender inequalities.

Women also occupy different roles in wartime, someas combatants, and many fill the spaces in economicand political life left by men


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Why is RH essential in crisisWhy is RH essential in crisis

situations? situations? RH is a human right RH is a serious public health issue andsignificant cause of morbidity andmortality (MDG 3: gender equality, 4 + 5:MCH, 6: HIV)

Part of the protection mandate


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RH is a human right, including:RH is a human right, including:

T he right to RH careT he right to health in generalT he right to reproductive choiceT he right to family planning


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RH needs continue in fact, increaseRH needs continue in fact, increase

during crisisduring crisisRisk of sexual violence may increase duringsocial instabilityST I/HIV transmission may increase in areas of high population densityLack of FP increases risks associated withunwanted pregnancy and unsafe abortionMalnutrition and epidemics increase risks of pregnancy complicationsChildbirth occurs on the wayside duringpopulation movementsLack of access to comprehensive emergencyobstetric care increases risk of maternal death


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I mpact on womenI mpact on womenT he fact that women bear childrenexposes them to a range of potential

problems that men do not experience.T he reasons for women's greatervulnerability are not only physical but alsosocial.During conflict and displacement,women's physical and social vulnerabilityincreases.


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I mpact on womenI mpact on women

Stress and malnutrition endanger the healthof pregnant and lactating women and theirchildren.

T he extended network of family support during pregnancy and lactation is lost.

T raumatized women may have no practicalor emotional support.Young, single, widowed or disabled womenmay be at particular risk of sexual violence.


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I mpact on womenI mpact on womenT he breakdown of family and social networks canleave many households headed by women, who maybe forced to offer sex in exchange for food, shelter orprotection.

Women's authority to control their own reproductivelives may be eroded by the social changes associatedwith conflict and displacement.

Women may be pressured to become pregnant toreplace the depleted population.

Access to health care facilities that meet reproductive health care needs is often lacking.


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I nappropriate institutional responses toreproductive health needs

Apart from traditional maternal and childhealth services, the reproductive health of women, men and adolescents is frequentlyneglected among refugees and internallydisplaced persons.

It may not be considered a priority, and insome instances reproductive healthproblems may even be compounded byinappropriate institutional responses


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I nappropriate institutional responses to

reproductive health needsIn the emergency phase, attention is necessarilyfocused on acute life-saving interventions. Lessvisible problems such as S T Is, HIV/AIDS, femalegenital mutilation, the complications of unsafeabortion, gender-based and sexual violence andother traumas are frequently neglected.

Even later the less visible problems may continueto be neglected in the stabilization phase.

T he gender approach needed for successful RHinterventions may be lacking at institutional level,or it may be disregarded in an emergency

situation.


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I nappropriate institutional responses to

reproductive health needsDifferent relief agencies may provide different verticalservices for different population groups. T his will meet some, but not all, RH care needs.

Relief workers may be neither aware of RH needs nor

trained to meet those needs and may not have theknowledge, skills or attitudes develop and plan an integrated programme of reproductive health care

Relief workers may be reluctant to raise sensitive issues relatingto reproductive health. Few health personnel may haveexperience in dealing with the victims of sexual violence.

Services may sometimes be provided in ways that do not respectthe dignity of the recipients and their right to make free andinformed choices. Alternatively, there may be opposition to the

provision of some reproductive health services for religious or cultural reasons.


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RH Response in Conflict RH Response in Conflict

Emergency

Phase:

MISP

Post Emergency:

Comprehensive servicesSafe MotherhoodGB VST I/HIVFamily Planning


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What s the M ISP ? What s the M ISP ?

B asic, limited RHMinimum

For use in emergency, without site specific needs assessment

I nitial

Services to be delivered to the populationServ ice

Supplies and activities,coordination and planning

P ackag e


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Elements of conflict situations andpossible gender dimension

P re-conflict situationsElements of

conflict situations Possible gender dimensions

Increased mobilisationof soldiers

Increased commercial sex trade (including child prostitution)around military bases and army camps.

Nationalist propaganda used toincrease support formilitary action

Gender stereotypes and specific definitions of masculinity andfemininity are often promoted. T here may be increased pressureon men to 'defend the nation.'

Mobilisation of pro-peace activists andorganisations

Women have been active in peace movements both generallyand in women-specific organisations. Women have often drawnmoral authority from their role as mothers. It has also beenpossible for women to protest from their position as motherswhen other forms of protest have not been permitted byauthorities.

Increasing humanrights violations

Women's rights are not always recognized as human rights.Gender-based violence may increase.


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D uring conflict situations 1Elements of

conflict situations

Possible gender dimensions

Psychological trauma,physical violence,casualties and death

Men tend to be the primary soldiers/combatants. Yet, in variousconflicts, women have made up significant numbers of combatants. Women and girls are often victims of sexualviolence (including rape, sexual mutilation, sexual humiliation,forced prostitution and forced pregnancy) during times of armed conflict.

Social networksdisrupted anddestroyed - changes in

family structures andcomposition

Gender relations can be subject to stress and change. T hetraditional division of labour within a family may be underpressure. Survival strategies often necessitate changes in the

gender division of labour. Women may become responsible foran increased number of dependants.

Mobilisation of peoplefor conflict. Everydaylife and work disrupted.

T he gender division of labour in workplaces can change. Withmen's mobilisation for combat, women have often taken overtraditionally male occupations and responsibilities. Womenhave challenged traditional gender stereotypes and roles bybecoming combatants and taking on other non-traditional roles.


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D uring conflict situations 2Elements of


Material shortages(shortages of food,health care, water,fuel, etc)

Women's role as provider of the everyday needs of the familymay mean increased stress and work as basic goods are moredifficult to locate. Girls may also face an increased workload.Non-combatant men may also experience stress related to theirdomestic gender roles if they are expected, but unable, toprovide for their families.

Creation of refugeesand displacedpeople

People's ability to respond to an emergency situation isinfluenced by whether they are male or female. Women and menrefugees (as well as boys and girls) often have different needsand priorities.

Dialogue and peacenegotiations

Women are often excluded from the formal discussions giventheir lack of participation and access in pre-conflict decision-making organisations and institutions.


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During reconstruction and rehabilitation 1

Elements of conflict situations Possible gender dimensions

Political negotiationsand planning toimplement peaceaccords

Men's and women's participation in these processes tends tovary, with women often playing only minor roles in formalnegotiations or policy making.

Media used tocommunicate messages

Women's unequal access to media may mean that theirinterests, needs and perspectives are not represented anddiscussed.

Use of outsideinvestigators,peacekeepers, etc.

Officials are not generally trained in gender equality issues(women's rights as human rights, how to recognize and dealwith gender-specific violence).Women and girls have been harassed and sexually assaultedby peacekeepers.

Holding of elections Women face specific obstacles in voting, in standing forelection and in having gender equality issues discussed aselection issues.


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D uring reconstruction and rehabilitation 2Elements of


Internalinvestments in

employment creation, healthcare, etc

Reconstruction programmes may not recognize or givepriority to supporting women's and girls' health needs,

domestic responsibilities or needs for skills training andcredit

Demobilisation of combatants

Combatants often assumed to be all male. If priority isgranted to young men, women do not benefit from landallocations, credit schemes, etc.

Measures toincrease thecapacity of andconfidence in civilsociety

Women's participation in community organizations andNGOs is generally uneven. T hese organizations often lack the capacity and interest in granting priority to equalityissues.


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GU IDELINES GU IDELINES FO R A SSI G N M ENT FO R A SSI G N M ENT

Title: Situation analysis: status and needsStudents will be divided into small groups (3-4students)Each group will make situation analysis to

identify the variation in the status and needsof women and men according to the state of the conflict in each region:

DarfurKassala and Gadarif South SudanNouba MountainB lue Nile

T he report submission will be next week.

rh in conflict settings

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