10. Fragile states and humanitarian situations

Comments

1. John Moor says:

   August 12, 2010 at 3:41 pm

   I have no experience of working in countries involved in civil conflict. I find it hard to understand how DFID can initiate “development” where there is strife.
   (I worked in Botswana for 13 years)
2. Merrill Wolf says:

   October 7, 2010 at 3:12 pm

   Humanitarian responses to crisis situations commonly fail to address women’s complete reproductive health needs, and ensuring access to safe pregnancy termination is particularly apt to be overlooked or outright rejected by aid agencies. This is especially tragic given the high incidence of sexual violence and inconsistent access to contraception in such settings. Although there has been some recent progress in this area, at least on paper (inclusion of abortion in the Interagency Working Group’s guidelines on RH In crisis situations), it has yet to translate into improved access to such care for women in conflict situations. More advocacy and investment in making services available on the ground is needed.
3. Robert Gillespie says:

   October 8, 2010 at 10:51 am

   Make it very clear that having children is a choice and not a right. There is nothing more miserable in this world than an unwanted or neglected child. Explain that it is the responsibility of the parents to be sure they can look after and financially support any children they create – not the state’s.
4. Steven Fouch says:

   October 19, 2010 at 4:46 pm

   There is disturbing evidence of violence against women in humanitarian situations – the publicity given to severe abuse in DRC is widely recognised but there are likely to be similar, undocumented situations where rape and transmission of STIs during times of conflict occur to the detriment of maternal health.

   UNAIDS and World Vision have reviewed the rationale for including HIV within humanitarian relief. It should be recognised that it is not only the military who are involved in sexual violence. Jewkes et al (in the Lancet 2010 376, 41-48) describe the problem of intimate partner violence and HIV in South African women. It seems likely that where the culture of violence against women is strong, as in DRC for example, there will be many cases of women being raped by neighbours and partners.

   Heal Africa, a church based NGO in Kigoma, DRC has extensive experience of dealing with trauma against women and has shown that the support of church based volunteers is crucial in the support of women who need emotional and spiritual support as much as medical assistance. Emergencies, with their associated problems of translocation and difficulty in access to neonatal health services, require much greater attention to the health of women and their neonates. Water, shelter, sanitation and food are often provided, but specific women- and child-focused services are, in practice, often neglected.

   Christian Medical Fellowship (CMF) urges DFID to put greater emphasis on inclusion of services for women in humanitarian response. In practical terms, as it is in many cases the INGOs, and their associated church partners, who will provide the humanitarian relief and services. CMF therefore urges DFID to ensure that specific maternal health and perinatal health targets are written into the Terms Of Reference for contracts with INGOs.
5. Chris says:

   October 20, 2010 at 12:44 am

   I think focussing on the maternal and neonatal aspects are the key. I don’t see a need for reproductive intervention in a disaster zone. How many earthquake victims are really sitting there thinking “gee, I hope the UK government sends us that crate of condoms pretty quickly, the party’s really getting started here…”.
6. Sandra Mutuma says:

   October 20, 2010 at 3:59 pm

   Action Against Hunger set up makeshift tents in battered neighborhoods of Port-au-Prince after the Haitian earthquake to provide mothers and their infants with a safe environment for breastfeeding (‘baby tents’), as well as medical, nutritional, and psychological support. DFID could consider supporting similar initiatives for pregnant and lactating women. Breastfeeding is an affordable and important way to optimize maternal and child health (both physical and emotional) during emergencies.

   We recommend that DFID follow the operational guidelines set out in the ‘Infant and Young Child Feeding in Emergencies’ modules (IFE Core Group, accessible from http://www.ennonline.net). The key points here are to ensure that implementing agencies have the appropriate policies and training in place to safeguard the health of children and mothers in emergencies. Breastfeeding and adequate complementary feeding need to be facilitated and integrated into other programmes; rations need to consider the appropriate energy and nutrient requirements of mothers, infants and young children; free distribution of breastmilk substitutes should be discouraged and strictly controlled by technical specialists who can assess the local context and advise accordingly.

   We also suggest DFID support the findings of the Management of Acute Malnutrition in Infants (MAMI report, available at http://www.ennonline.net/pool/files/ife/mami-project-summary-report-final-041209.pdf ), which is relevant for both emergency and non-emergency settings. Key points include the fact that infants under 6 months are commonly overlooked in food aid and nutrition programmes; psychosocial support should be integrated into all programmes; the coverage of programmes targetting infants with malnutrition should be increased through community approaches; and breastfeeding should be promoted through the creation of safe spaces (e.g. baby tents).

   Increasing hostility to foreign agencies or the legitimization of aid agency workers as targets by hostile forces may require increased remote support (technical and financial) of national actors to address the issues at hand. Good capacity building, training communication and logistics infrastructures are required to enable national actors to deliver services where external agents are unwelcome.
7. Dr. Sultana Mustafa Khanum says:

   October 20, 2010 at 11:18 pm

   DFID can provide health services in conflict affected areas through non- state health service providers and the United Nations.