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Fistula, Stigmatization, and Development
›Although obstetric fistula may not be as widely recognized as other maternal health issues, the Fistula Foundation estimates that over two million women and girls in developing countries suffer from this condition today. The World Health Organization has labeled it as “the single most dramatic aftermath of neglected childbirth.”
Obstetric fistula is a devastating condition often resulting from obstructed labor that can cause infections, incontinence, and even paralysis. The condition largely afflicts poor, rural, and illiterate women in developing countries who lack resources and access to emergency care and surgery, and sufferers often face an additional burden of social stigma.
Economic Development and Social Standing
Poor infrastructure and poverty significantly increases the occurrence rate of obstetric fistula. Lewis Wall, in an article for The Lancet, writes that “poverty is the breeding-ground where obstetric fistulas thrive.” Wall cites early marriage, low social status of women, malnutrition, inadequately developed social and economic infrastructures, and lack of access to emergency obstetric services as being major contributors of fistulas in developing countries.
Additionally, “postponing the age of marriage and delaying childbirth can significantly reduce the risk of subjecting young women to the arduous labor that induces fistulas,” wrote Sonny Inbaraj of Inter Press Service News Agency (IPS) in an article about how fistula makes social outcasts of child brides.
In most developing societies where child marriage is common, the social standing of women is defined largely in terms of marriage and childbearing. Child marriages are typically arranged without the knowledge or consent of the girls involved. The norms emphasize a girl’s domestic roles and de-emphasize investments such as education.
Stigmatization of Fistula
There is an undeniable link between fistula and social stigmatization. Rather than receiving assistance from their families and communities, women are often ostracized and in many instances exiled from their communities. This is especially true in developing countries where “the role of women is merely limited to providing sexual satisfaction for their husbands, [and] producing children,” said Dr. Catherine Hamlin, founder of the Addis Ababa Fistula Hospital, in an interview with IPS.
“Many women and girls with fistula endure lives of shame, misery, violence, and poverty,” said Agnes Odhiambo, Africa women’s rights researcher and author of ‘I Am Not Dead, But I Am Not Living‘: Barriers to Fistula Prevention and Treatment in Kenya, in a Human Rights Watch article. Human Rights Watch has focused on fistula, recognizing that birth is a human rights issue. Ignoring the issues of women and girls only diminishes progress on human rights and sends a message that says the rights of women do not deserve adequate attention.
Prevention Efforts
Thus far the fight to end fistula has attracted various government agencies and organizations including USAID, UNFPA, EngenderHealth, Maternal Health Task Force, and the Human Rights Watch. Outstanding individuals have also played a key role in fistula prevention efforts, like Drs. Reginald and Catherine Hamlin, Australian gynecologists who came to Addis Ababa in 1959 for temporary medical work, but after hearing heart-breaking stories from fistula patients, they decided to move to Ethiopia permanently and open the Addis Ababa Fistula Hospital. As the only hospital dedicated exclusively to women with obstetric fistula, the hospital provides care free of change, and has done so since 1974.
Although fistula has gotten some support and attention, the need to scale-up the prevention initiatives has never been greater. As a result of the “poverty and the stigma associated with their condition, most women living with fistulas remain invisible to policy makers both in their own countries and abroad,” wrote Inbaraj on IPS.
“Preventing fistula and restoring women’s health and dignity requires more than good policies on paper,” said Odhiambo at Human Rights Watch. Seriously tackling the issue will require much more than traditional medical and public health interventions – prevention efforts must also take into account underlying social issues, food and economic security.
Sources: The Addis Ababa Fistula Hospital, Campaign to End Fistula, The Center for Global Development, The Fistula Foundation, Human Rights Watch, The Lancet, World Health Organization.
Photo Credit: “Hauwa’u, 25, mother from Rogogo community,” courtesy of flicker user DFID-UK Department for International Development. -
Preparing for the Impact of a Changing Climate on U.S. Humanitarian and Disaster Response
›Climate-related disasters could significantly impact military and civilian humanitarian response systems, so “an ounce of prevention now is worth a pound of cure in the future,” said CNA analyst E.D. McGrady at the Wilson Center launch of An Ounce of Preparation: Preparing for the Impact of a Changing Climate on U.S. Humanitarian and Disaster Response. The report, jointly published by CNA and Oxfam America, examines how climate change could affect the risk of natural disasters and U.S. government’s response to humanitarian emergencies. [Video Below]
Connecting the Dots Between Climate Change, Disaster Relief, and Security
The frequency of – and costs associated with – natural disasters are rising in part due to climate change, said McGrady, particularly for complex emergencies with underlying social, economic, or political problems, an overwhelming percentage of which occur in the developing world. In addition to the prospect of more intense storms and changing weather patterns, “economic and social stresses from agricultural disruption and [human] migration” will place an additional burden on already marginalized communities, he said.
Paul O’Brien, vice president for policy and campaigns at Oxfam America said the humanitarian assistance community needs to galvanize the American public and help them “connect the dots” between climate change, disaster relief, and security.
As a “threat multiplier,” climate change will likely exacerbate existing threats to natural and human systems, such as water scarcity, food insecurity, and global health deterioration, said Vice Admiral Lee Gunn, USN (ret.), president of CNA’s Institute for Public Research. Major General Richard Engel, USAF (ret.), of the National Intelligence Council identified shifting disease patterns and infrastructural damage as other potential security threats that could be exacerbated by climate change.
“We must fight disease, fight hunger, and help people overcome the environments which they face,” said Gunn. “Desperation and hopelessness are…the breeding ground for fanaticism.”
U.S. Response: Civilian and Military Efforts
The United States plays a very significant role in global humanitarian assistance, “typically providing 40 to 50 percent of resources in a given year,” said Marc Cohen, senior researcher on humanitarian policy and climate change at Oxfam America.
The civilian sector provides the majority of U.S. humanitarian assistance, said Cohen, including the USAID Office of Foreign Disaster Assistance (OFDA) and the State Department’s Bureau of Population, Refugees, and Migration. These organizations provide leadership, funding, and food aid to developing countries in times of crisis, but also beforehand: “The internal rationale [of the Office of Foreign Disaster Assistance] is to reduce risk and increase the resilience of people to reduce the need for humanitarian assistance in the future,” said Edward Carr, climate change coordinator at USAID’s Bureau for Democracy, Conflict, and Humanitarian Assistance.
The U.S. military complements and strengthens civilian humanitarian assistance efforts by accessing areas that civilian teams cannot reach. The military can utilize its heavy lift capability, in-theater logistics, and command and control functions when transportation and communications infrastructures are impaired, said McGrady, and if the situation calls for it, they can also provide security. In addition, the military could share lessons learned from its considerable experience planning for complex, unanticipated contingencies with civilian agencies preparing for natural disasters.
“Forgotten Emergencies”
Already under enormous stress, humanitarian assistance and disaster response systems have persistent weaknesses, such as shortfalls in the amount and structure of funding, poor coordination, and lack of political gravitas, said Cohen.
Food-related aid is over-emphasized, said Cohen: “If we break down the shortfalls, we see that appeals for food aid get a better response than the type of response that would build assets and resilience…such as agricultural bolstering and public health measures.” Food aid often does not draw on local resources in developing countries, he said, which does little to improve long-term resilience.
“Assistance is not always based on need…but on short-term political considerations,” said Cohen, asserting that too much aid is supplied to areas such as Afghanistan and Iraq, while “forgotten emergencies,” such as the Niger food crisis, receive far too little. Furthermore, aid distribution needs to be carried out more carefully at the local scale as well: During complex emergencies in fragile states, any perception of unequal assistance has the potential to create “blowback” if the United States is identified with only one side of a conflict.
Engel added that many of the problems associated with humanitarian assistance will be further compounded by increasing urbanization, which concentrates people in areas that do not have adequate or resilient infrastructure for agriculture, water, or energy.
Preparing for Unknown Unknowns
A “whole of government approach” that utilizes the strengths of both the military and civilian humanitarian sectors is necessary to ensure that the United States is prepared for the future effects of climate change on complex emergencies in developing countries, said Engel.
In order to “cut long-term costs and avoid some of the worst outcomes,” the report recommends that the United States:
Cohen singled out “structural budget issues” that pit appropriations for protracted emergencies in places like Iraq, Afghanistan, and Darfur against unanticipated emergencies, like the 2010 earthquake in Haiti. Disaster-risk reduction investments are not a “budgetary trick” to repackage disaster appropriations but a practical way to make more efficient use of current resources, he said: “Studies show that the return on disaster-risk reduction is about seven to one – a pretty good cost-benefit ratio.”- Increase the efficiency of aid delivery by changing the budgetary process;
- Reduce the demand by increasing the resilience of marginal (or close-to-marginal) societies now;
- Be given the legal authority to purchase food aid from local producers in developing countries to bolster delivery efficiency, support economic development, and build agricultural resilience;
- Establish OFDA as the single lead federal agency for disaster preparedness and response, in practice as well as theory;
- Hold an OFDA-led biannual humanitarian planning exercise that is focused in addressing key drivers of climate-related emergencies; and,
- Develop a policy framework on military involvement in humanitarian response.
Edward Carr said that OFDA is already integrating disaster-risk reduction into its other strengths, such as early warning systems, conflict management and mitigation, democracy and governance, and food aid. However, to build truly effective resilience, these efforts must be tied to larger issues, such as economic development and general climate adaptation, he said.
“What worries me most are not actually the things I do know, but the things we cannot predict right now,” said Carr. “These are the biggest challenges we face.”
“Pakistan Floods: thousands of houses destroyed, roads are submerged,” courtesy of flickr user Oxfam International. -
Rosemarie Calvert, Center for a Better Life
Winning Hearts and Minds: An Interview with Chief Naval Officer Admiral Gary Roughead
›May 23, 2011 // By Wilson Center StaffThe original version of this article, by Rosemarie Calvert, appeared in the Center for a Better Life’s livebetter magazine.
Few people understand “smart” power as well as Chief Naval Officer (CNO) Admiral Gary Roughead. To this ingenious, adept leader of the world’s largest and most powerful navy, it’s not just about military strategy or political science; it’s about heart. It’s about the measure of a man with regard to honor, courage and commitment. And, it’s about appreciation and respect for the natural world. As one of the U.S. Defense Department’s most powerful decision-makers, Roughead has helped mold a new breed of sailor who understands that preventing war is just as important as winning war – that creating partners is more important than creating opponents. Add mission mandates such as humanitarian assistance, disaster relief, and environmental stewardship, and it’s clear why Roughead and his brand of smart power are having a profound impact on international peace, national security, and natural security.
Engendering Environmental Advocacy
“You don’t live on the ocean and not love it. My appreciation for the environment came from a very early age – from just loving to be on the water. It’s something that’s had a very strong impact on me,” explains Roughead, who grew up in North Africa where his father worked in the oil business. He and his family lived along an uninhabited area of coastline where his father’s company built a power plant and refinery to process and transport Libya’s huge oil field finds to offshore tankers.
“We were the first people to move there; I was still in grammar school. The beauty in being the first was that the coastline was absolutely pristine. Even before school, I would get up and go skin diving. There were beautiful reefs, and fish were everywhere. The vegetation was just incredible. The company built an offshore loading area a few miles off the beach with 36-inch pipes pumping crude oil out to where these big supertankers would come in. Back then, there wasn’t a high regard for the environment, so when storms would kick-up and ships got underway in a hurry, they would just cast them off and all that oil would go into the ocean.
“Fast forward about five years, and the last time I went skin diving I didn’t see a living thing. The vegetation was dead. At that time I was visiting my folks on summer leave from the Naval Academy. There were periods when I would skin dive and then surface after being down about 35-40 feet, and my lungs would be ready to burst. I’d look up, having moved from my original location, and see this massive oil slick. And, I’d go, ‘Oh gosh…no!’ But, you didn’t have any choice. I would come home and actually have to clean the oil off with kerosene because it was caked on me.
“I saw and experienced environmental devastation, and it had an effect on me. Being at sea all the time – I love going to sea and seeing everything about it – drove me to the views I have. I really do think there’s compatibility between the Navy and the environment. We have things we must accomplish, but we can do them cleanly and responsibly. That’s what we’ve tried to demonstrate to those who have different views – that there has to be compatibility between the two.”
Continue reading on the Center for a Better Life.
Rosemarie Calvert is the publisher and editorial director of livebetter magazine and director of the Center for a Better Life.
Photo Credit: Adapted from “USS Nitze underway with ships from U.S. Navy, Coast Guard and foreign navies,” courtesy of flickr user Official U.S. Navy Imagery. -
The Walk to Water in Conflict-Affected Areas
›May 18, 2011 // By Wilson Center StaffConstituting a majority of the world’s poor and at the same time bearing responsibility for half the world’s food production and most family health and nutrition needs, women and girls regularly bear the burden of procuring water for multiple household and agricultural uses. When water is not readily accessible, they become a highly vulnerable group. Where access to water is limited, the walk to water is too often accompanied by the threat of attack and violence.
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Momentum Magazine
Where Does It Hurt? Climate Vulnerability Index
›The original version of this article appeared in the University of Minnesota’s Momentum Magazine. Text by Mary Hoff, page layout by Todd Reubold.
The punch climate change packs varies from one country, region, or continent to another. DARA, a Madrid-based humanitarian advocacy organization, recently partnered with the Climate Vulnerable Forum, comprising countries particularly vulnerable to climate change, to create Climate Vulnerability Monitor 2010, an atlas of vulnerability. This infographic presents a small portion of the picture the Climate Vulnerability Monitor paints.
Vulnerability is grouped into four categories: health impacts, weather disasters, habitat loss and economic stress. Circles on the left side of each set indicate relative magnitude of vulnerability in 2010. Circles on the right indicate the same for 2030.
See the full “Where Does it Hurt?” infographic on the Momentum site or download the Climate Vulnerability report from DARA.
Image Source: Climate Vulnerability Monitor 2010: The State of Climate Crisis, published in December 2010 by DARA (daraint.org). Used with permission. -
David Biello, Momentum Magazine
Coping with Change: Climate Adaptation Today
›May 2, 2011 // By Wilson Center StaffThe original version of this article, by David Biello, appeared in the University of Minnesota’s Momentum Magazine.
The view from space offers a clarity about our changing planet less visible from the ground: spring thaw coming sooner year after year, the iconic snows of Kilimanjaro and glaciers across the globe dwindling – and a great green wall of vegetation spreading across the region just south of Africa’s Sahara Desert.
This arid expanse, known as the Sahel, stretches from the Atlantic Ocean to the Red Sea. It has undergone a remarkable transformation since farmers in nations across the region began to allow trees to grow amidst their crops.
In some places it was by accident, as seeds sprouted from manure spread as fertilizer in Niger. In others it was by design, such as the “green dam” against the desert started in Algeria in 1971. But the result has been the same: improved harvests of millet, sorghum, and other staple crops in a region gripped by perennial drought.
Such “agroforestry” boosts yields by returning vital nutrients to the soil in the form of decaying leaves, shading crops from the harshest sun, and recharging underground water reserves. The trees also provide an additional source of income: wood for fires and construction. And they have another even more important benefit: They may help some of the poorest farmers in the world adapt to climate change – while potentially removing as much as 50 billion metric tons of carbon dioxide from the atmosphere, according to agronomist Dennis Garrity, head of the Nairobi-based World Agroforestry Centre.
“The transformation of agriculture into agroforestry is well underway,” Garrity says. “Agricultural systems incorporating trees increase overall productivity and incomes in the face of more frequent droughts, and agroforestry systems provide much greater carbon offset opportunities than any other climate mitigation practice in agriculture.”
Climate change is already worse than anticipated by the UN Intergovernmental Panel on Climate Change. Extreme precipitation events, such as last spring’s flooding in Nashville, Tenn., or last winter’s drought in China, have become more frequent. Sea ice extents have reached record lows in the Arctic. And 2010 marked the end of the hottest decade in recorded history.
Not only that, but the 0.7-degree-Celsius uptick in global average temperatures we’ve seen so far is only half the warming that can be expected from the concentrations of greenhouse gases already in the atmosphere, according to a 2010 report from the U.S. National Research Council. And as warming continues, according to the NRC report, the world can expect (among other things) a drop in the yield of cereal crops due to higher temperatures, an increase in heavy rainfall, and a rise in ocean levels.
In other words, whatever measures might be adopted to reduce emissions of greenhouse gases, the world will still need to adapt to a changing climate. Indeed, that process has already begun.
Continue reading on the University of Minnesota’s Momentum Magazine site.
Photo Credit: Deep in the Sahel, the dwindling Lake Chad borders Niger, Chad, and Nigeria. Courtesy of flickr user NASA Goddard Photo and Video. -
The U.S. Government’s Response to Disasters: Myth, Mistakes, and Recovery
›“Major crises and disasters have massively changed over the last generation,” said Dr. Frederick Burkle, senior public policy scholar at the Woodrow Wilson Center and senior fellow and scientist at the Harvard Humanitarian Initiative. “We have to start a new narrative of what we need to do to address [them].”
To discuss the emerging and persistent challenges of disaster prevention, preparedness, response, and recovery, Burkle was joined by Paul Born, co-founder and director of the Tamarack Institute for Community Engagement; Leonard Doyle, Haiti country spokesperson at the International Organization for Migration; Arif Hasan, adviser at the Orangi Pilot Project and founder and chairman at the Urban Resource Centre; and Dr. Eliane Ubalijoro, adjunct professor at McGill University and member of the Presidential Advisory Council for Rwandan President Paul Kagame.
“Retrieving the Wisdom of Those in Need”
Unfortunately, disaster responses often fail to “listen and gain a corner on the obvious,” said Born, discussing the need for community engagement and healing in times of disaster and conflict.
After Hurricane Katrina, for example, the formal disaster response failed to use hundreds of available buses to evacuate people, leaving thousands of people stranded in the floods. “If people were engaged, had a role to play, knew what to do, were part of a team, would this have made a difference? Would those buses have been deployed to help people?” asked Born.
Effective disaster response must utilize “the assets, the skills, and the knowledge that are present,” concluded Born. For example, when the systems in place by the Philippine government in the village of Talba failed to give proper warning to evacuate from a volcanic eruption, “it was a parallel warning system, developed by the community, that warned people, on time, to vacate the area and avoid any loss of life,” said Born. Community preparedness and engagement led to better utilization of available humanitarian assets and mitigated what could have been a much more severe disaster.
The Changing Nature of Humanitarian Emergencies
Increasingly, humanitarian crises are the result of unconventional warfare, causing major challenges for the humanitarian community, said Burkle. Rather than refugees, “what we are beginning to see today is an unprecedented number of internally displaced people.”
Many of the displaced migrate to urban settings, contributing to rapid urbanization which is straining water, sanitation, and public health infrastructure. In these settings, he said, there is sometimes only one latrine for every 200 people, new and infectious diseases are rampant, and high rates of violence and rape are common, putting women particularly at risk.
“It is a lot more than population size – it’s really density of population,” said Burkle. In Mumbai, for example, there is an average of 30,000 people per square kilometer, but there are major areas of the city with over one million people per square kilometer.
“People moving to the cities are still remaining in extreme poverty,” said Burkle. While the majority of the poor once lived in low-income fragile states, recent population data indicates that 72 percent of the world’s poor now live in middle income countries like India, Indonesia, and China. “It’s a total reversal – we’ve spent almost 20 years crafting our foreign aid budgets and policy around this…we have to start a new narrative about what we are going to do.”
“The other issue that I don’t think we hear about, but certainly the young people in the audience will be dealing with on a daily basis, are the biodiversity crises,” said Burkle. “Of the 34 biodiverse areas, 23 have experienced prolonged conflict,” which has had major impacts on the availability of water, food, and energy in these regions, said Burkle.
Moving forward, “we have to change the humanitarian community; we have to have more accountability and more accreditation, leading to a blueprint for professionalizing the humanitarian field,” concluded Burkle.
Community and Communication in Haiti
A little over one year after the devastating earthquake in Haiti, 680,000 people remain internally displaced, said Doyle. “About half the population has moved out of the camps, and there is some congratulations to be given to the humanitarian community for organizing that,” he said. “But, when you look at the statistics…only a tiny fraction of these people have reached what you would call durable solutions such as sustainable housing.”
“There is clearly a problem… why has more progress not taken place given the number of international organizations there and the generosity of the funding?” asked Doyle.
“People have a right to communicate and there is a benefit in that communication,” said Doyle. To help make this possible in the Haitian displacement camps, he and his colleagues at the International Organization of Migration (IOM) set up 140 suggestion boxes. The response was amazing, he said, and with the help of a local Haitian organization, IOM has begun broadcasting some of the over 5,000 letters received on a daily radio show.
“We need to help create respectful conversations in countries where we do so much hard work but see so much of it go nowhere,” said Doyle. Information from the letters has been compiled into reports detailing the major challenges faced by people including a lack of jobs, education, and housing. These letters are being used as a monitoring and accountability mechanism through which Haitians can tell NGOs and donors the successes and failures of projects being implemented in their communities. “Through this communication you can see what the community needs, rather than what the experts tell you the community needs,” he said.
Engaging Local Communities
“Regions are sometimes so badly devastated [after a disaster], that to rehabilitate their agriculture, transport, water supply systems, is a very daunting task,” said Hasan. His home country of Pakistan faced all of these challenges after heavy rains and subsequent flooding wiped out 3,000 villages and affected over 20 million people last year.
“Without a governance system, you cannot provide rehabilitation or relief,” Hasan said, citing an added challenge for disaster response in many developing countries. Often the needs of the people are not translated in to policy actions, he said, and “there is a big difference between what people want and what politicians want.”
Hasan offered some insights on how the development community can work with local communities to improve disaster response, pointing out that “pre-disaster situations determine the effectiveness of relief and rehabilitation.” Existing mechanisms to provide development assistance can be used to efficiently deliver goods and services in emergencies, he said. By fostering “true partnerships” international NGOs can help communities and governments should manage reconstruction and relief efforts after disasters using local materials, labor, and technologies, he said. Engaging communities in reconstruction “can be a really important healing process.”
Recovery and Resilience
“When you have a community that has been reduced to ashes, how can you retrieve hope so that transformation can happen?” asked Ubalijoro, stressing the importance of building community resilience after disasters. “We’ve been talking about disasters, but it’s important to remember how we learn to dream again together.”
Baskets of Hope is a project that aims to help Rwandan women recover from the genocide by providing training and jobs weaving baskets that are sold internationally. In addition to providing a source of income, the project also provides information about health and nutrition. With this multi-pronged approach, Baskets of Hope helps families to recover and move forward. “There’s an interesting relationship between weaving these baskets that are allowing these women to have economic empowerment and what it requires after a time of trauma to reweave the fabric of society,” said Ubalijoro.
Youth who have survived man-made or natural disasters are particularly vulnerable, said Ubalijoro. She and her colleagues work to link Rwandan youth with Holocaust survivors so that they can share their memories, pictures, and stories with one another. “Retrieving the wisdom from those who have gone through the unimaginable and having them share their experiences shows youth that even though they’ve lost everything, there are ways to move forward.”
Sources: Conservation International, Institute of Development Studies, International Organization for Migration, USAID.
Photo Credit: “Pakistan Floods” courtesy of flickr user IRIN Photos. -
Watch: Frederick Burkle on Lessons from Haiti and Professionalizing Humanitarian Assistance
›April 20, 2011 // By Schuyler Null“Haiti – in terms of coordination – was a debacle,” said Frederick Burkle, senior fellow with the Harvard Humanitarian Initiative and a visiting scientist at the Harvard School of Public Health. Burkle, who is also a senior public policy scholar at the Wilson Center, said that after the 2010 earthquake, “the large majority of people who showed up were under the age of 30 and this was their first disaster event.”
As a result, “best practices did not necessarily occur,” Burkle said. “Ninety-five percent of the work is probably done by 45 of the major NGOs,” but, he said, the number of “mom-and-pop shows” and other small NGOs in “The Republic of NGOs” is in the thousands.
Non-healthcare providers ended up providing services that they were not trained to provide – even amputations, Burkle said. “We certainly relish the humanitarian spirit of those who show up, but we have to have some coordination to ensure that best practices occur and that it goes in the right direction.”
“The professionalization blueprint really calls for courses, curriculum, and best practice standards,” said Burkle. The Harvard Humanitarian Initiative is working with the UN Office for the Coordination of Humanitarian Affairs, World Health Organization, and others to provide these resources.
“There’s a movement afoot within the humanitarian community itself to finally professionalize the humanitarian profession,” Burkle said, spurred on, in part, by the poorly coordinated responses to events like the Haiti earthquake.
Showing posts from category humanitarian.