Article

Women, Health and Humanitarian Aid in Conflict

Authors:
  • Hospice West Auckland, Te Atatu, Auckland
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Abstract

The burden of political conflict on civilian populations has increased significantly over the last few decades. Increasingly, the provision of resources and services to these populations is coming under scrutiny; we highlight here the limited attention to gender in their provision. Women and men have different exposures to situations that affect health and access to health-care and have differential power to influence decisions regarding the provision of health services. We argue that the role of women in planning is central to the provision of effective, efficient and sensitive health-care to conflict-affected populations.

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... Very little in-depth research, however, has been published examining the interaction between emergency public health policy, as outlined above, and prevailing health beliefs and cultural attitudes to services. While Harrell-Bond (1986), in particular, has been a consistent voice in highlighting the refugees' perspective , most research of this kind has been undertaken in relation to the psychosocial consequences of conflict (Boyden and Gibbs 1997; Bracken and Petty 1998; Summerfield 1999) or reproductive health (Palmer and Zwi 1998) rather than the more standard public health concerns. Nor is there little information about host populations and their perspectives on health, health services and issues of access and quality, yet their needs and views too are central to offering appropriate services. ...
... [1998:159] Despite the development of international policies that support the integration of gender concerns with emergency responses by different agencies (Eade and Williams 1995; Marshall 1995; Palmer et al. 1999; Walker 1996 ), the degree to which gender is considered a critical factor in planning and implementing emergency programs is still contested (Boelaert et. al 1999; Enarson 1998; Giles 1999; Marshall 1995; Palmer and Zwi 1998). From the onset of the emergency response, health data collected through needs assessments and public health surveillance is often not disaggregated by sex (Palmer and Zwi 1998; Toole 1993), an oversight that fails to acknowledge gender-specific vulnerability and may hide it when it exists. ...
... al 1999; Enarson 1998; Giles 1999; Marshall 1995; Palmer and Zwi 1998). From the onset of the emergency response, health data collected through needs assessments and public health surveillance is often not disaggregated by sex (Palmer and Zwi 1998; Toole 1993), an oversight that fails to acknowledge gender-specific vulnerability and may hide it when it exists. In a Somali refugee camp in Kenya, for example, Boelaert et al. (1999) found that no gender-specific morbidity data were routinely collected , apart from hospital admission data. ...
... Very little in-depth research, however, has been published examining the interaction between emergency public health policy, as outlined above, and prevailing health beliefs and cultural attitudes to services. While Harrell-Bond (1986), in particular, has been a consistent voice in highlighting the refugees' perspective , most research of this kind has been undertaken in relation to the psychosocial consequences of conflict (Boyden and Gibbs 1997; Bracken and Petty 1998; Summerfield 1999) or reproductive health (Palmer and Zwi 1998) rather than the more standard public health concerns. Nor is there little information about host populations and their perspectives on health, health services and issues of access and quality, yet their needs and views too are central to offering appropriate services. ...
... [1998:159] Despite the development of international policies that support the integration of gender concerns with emergency responses by different agencies (Eade and Williams 1995; Marshall 1995; Palmer et al. 1999; Walker 1996 ), the degree to which gender is considered a critical factor in planning and implementing emergency programs is still contested (Boelaert et. al 1999; Enarson 1998; Giles 1999; Marshall 1995; Palmer and Zwi 1998). From the onset of the emergency response, health data collected through needs assessments and public health surveillance is often not disaggregated by sex (Palmer and Zwi 1998; Toole 1993), an oversight that fails to acknowledge gender-specific vulnerability and may hide it when it exists. ...
... al 1999; Enarson 1998; Giles 1999; Marshall 1995; Palmer and Zwi 1998). From the onset of the emergency response, health data collected through needs assessments and public health surveillance is often not disaggregated by sex (Palmer and Zwi 1998; Toole 1993), an oversight that fails to acknowledge gender-specific vulnerability and may hide it when it exists. In a Somali refugee camp in Kenya, for example, Boelaert et al. (1999) found that no gender-specific morbidity data were routinely collected , apart from hospital admission data. ...
... the plug of mucus that normally protects the opening to the cervix becomes dislodged during menses and can allow bacteria into the uterus (Cavill, et al., 2012). These health problems will be compounded further in humanitarian crises as women and girls face a number of challenges seeking medical attention, especially for reproductive health issues (Palmer & Zwi, 1998). ...
... Being forced into cramped living conditions, such as in camps or resettlement facilities, may increase the risk of shaming and social rejection when women cannot be effectively segregated. Women have also reported being unable to visit distribution points to gather aid or contribute to consultations, leaving men to do so (who may not be aware of their menstrual management needs), or leaving femaleheaded households stranded and unrepresented altogether (Palmer & Zwi, 1998). ...
Thesis
Menstrual management is a pervasive issue for women globally, and it becomes critical in times of crisis. During these times of crisis and disaster, humanitarian response seeks to provide relief of suffering by meeting essential needs, in a comprehensive and predictable manner. Yet the provision of menstrual management remains largely ad hoc. Through a comprehensive literature review of documents pertaining to menstrual management in emergencies, this paper offers a qualitative analysis of modern humanitarian strategic approaches, to explore the place of menstrual management in emergencies. The core findings are that menstrual management is not fodder for strategy in humanitarian aid, and therefore lacks a ‘home’ in any of the humanitarian approaches to response. It is not fully integrated into either technical strategic implementation, typified by the cluster approach, nor through cultural implementation approaches, typified by gender mainstreaming. This paper also offers some explanations of why such an omnipresent need has, as yet, remained un-championed. This discussion is based on a theoretical framework offered by feminist theory. Supplemented by an understanding of organisations as gendered structures (Acker, 1990), this thesis posits that these cavities in modern humanitarian response are due to the inherent inability and reluctance of the humanitarian system to concern itself with a bodily, female issue such as menstrual management.
... Ikeda [17] argued, due to social isolation women were not able to make information on how to minimize the risk. However, Palmer and Zwi [28] discussed about the involvements of women throughout the whole programme in disaster situation starting from preparedness to finish. They expect, that will increase women's self-esteem, give them access to health services and reduce their exposure to risk [28]. ...
... However, Palmer and Zwi [28] discussed about the involvements of women throughout the whole programme in disaster situation starting from preparedness to finish. They expect, that will increase women's self-esteem, give them access to health services and reduce their exposure to risk [28]. ...
Article
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The aim of the study is to explore the gender issues in disaster and to understand the relationships between vulnerability, preparedness and capacity following a qualitative method on the basis of secondary sources. The study notes that the women living in coastal areas are facing more difficulties due to the complexity of atmosphere where their activities are not properly recognized in disaster planning and management. However, the study showed that women, particularly belong to the poor families are primarily responsible for their domestic roles due to culturally dominated labour division. The study also recommended that women should be involved in emergency planning and disaster management process through ensuring their active participation. The inclusion of greater number of women in the emergency management profession could help in the long term to address disaster risks. Since, the underlying cultural, social, and economic patterns that lead to a low socioeconomic status of women and thereby generate their specific vulnerability to disasters. Though, such initiatives have not addressed like their entire adverse impact on socioeconomic status in recent literature, the present study is an initiative to address the women's involvement in preparedness and capacity building at the community level as well as household level which the vulnerable women are striving with the frequent disasters to sustain in the planet.
... As a result of this civilian involvement, the speci®c challenges facing sections of the population, such as women, are increasingly seen as requiring particular attention (Palmer and Zwi, 1998). The importance of a gendered approach to relief, in which the particular roles and responsibilities of men and women are taken into account in identifying needs and determining appropriate responses, has been recognised over the last decade (Cohen, 1995;UNHCR, 1989). ...
... These statements stand in stark contrast to the views expressed by programme managers. In reality we know little about how con¯ict-aected populations themselves prioritise reproductive health issues as they have for the most part been excluded from the decision making process (Palmer and Zwi, 1998). ...
Article
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Over the past 20 years, shifts in the nature of conflict and the sheer numbers of civilians affected have given rise to increasing concern about providing appropriate health services in unstable settings. Concurrently, international health policy attention has focused on sexual and reproductive health issues and finding effective methods of addressing them. This article reviews the background to the promotion and development of reproductive health services for conflict-affected populations. It employs qualitative methods to analyse the development of policy at international level. First we examine the extent to which reproductive health is on the policy agendas of organisations active in humanitarian contexts. We then discuss why and how this has come about, and whether the issue has sufficient support to ensure effective implementation. Our findings demonstrate that reproductive health is clearly on the agenda for agencies working in these settings, as measured by a range of established criteria including the amount of new resources being attracted to this area and the number of meetings and publications devoted to this issue. There are, however, barriers to the full and effective implementation of reproductive health services. These barriers include the hesitation of some field-workers to prioritise reproductive health and the number and diversity of the organisations involved in implementation. The reasons for these barriers are discussed in order to highlight areas for action before effective reproductive health service provision to these populations can be ensured.
... 2 It is essential, therefore, that national and international policy supports equitable systems which maximise accessibility for all sectors of the population to critical reproductive health services. 3 The devastating effects of war on women, long recognised by those in the relief and development worlds, [4][5][6] are increasingly being documented and brought to the attention of a wider audience. [7][8][9] Still, while food aid, water and sanitation remain vital first responses in humanitarian crises, the role of reproductive health services as an additional priority service is increasingly being recognised. ...
... In the absence of appropriate abortion services, women resort to unsafe means. 5 Provision of emergency obstetric care requires skilled providers with direct access to functioning health facilities where relatively sophisticated procedures can be performed. If the right to health is to be operationalised, governments, assisted by humanitarian agencies where necessary, must establish emergency obstetric services, including post-abortion care, within reach of camps and of the sprawling settlement areas surrounding them, and include transportation to referral sites. ...
Article
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Continued political and civil unrest in low-resource countries underscores the ongoing need for specialised reproductive health services for displaced people. Displaced women particularly face high maternal mortality, unmet need for family planning, complications following unsafe abortion, and gender-based violence, as well as sexually transmitted diseases, including HIV. Relief and development agencies and UN bodies have developed technical materials, made positive policy changes specific to crisis settings and are working to provide better reproductive health care. Substantial gaps remain, however. The collaboration within the field of reproductive health in crises is notable, with many agencies working in one or more networks. The five-year RAISE Initiative brings together major UN and NGO agencies from the fields of relief and development, and builds on their experience to support reproductive health service delivery, advocacy, clinical training and research. The readiness to use common guidance documents, develop priorities jointly and share resources has led to smoother operations and less overlap than if each agency worked independently. Trends in the field, including greater focus on internally displaced persons and those living in non-camp settings, as well as refugees in camps, the protracted nature of emergencies, and an increasing need for empirical evidence, will influence future progress. Résumé Les troubles politiques et civils dans les pays à faibles ressources soulignent le besoin de services spécialisés de santé génésique pour les personnes déplacées. Les femmes déplacées souffrent en particulier d’une mortalité maternelle élevée, de besoins insatisfaits de planification familiale, des complications d’avortements non médicalisés et de la violence sexiste, ainsi que d’IST, notamment le VIH. Les institutions d’aide humanitaire et de développement et les Nations Unies ont préparé du matériel technique et introduit des changements politiques positifs dans les environnements de crise et elles s’efforcent d’améliorer les soins de santé génésique. Des manques importants n’en demeurent pas moins. La collaboration pendant les crises est bonne, beaucoup d’institutions travaillant dans un ou plusieurs réseaux. L’initiative quinquennale RAISE rassemble les principales institutions des Nations Unies et ONG spécialisées dans l’aide humanitaire et le développement, et se fonde sur leur expérience pour soutenir la prestation de services, le plaidoyer, la formation clinique et la recherche en santé génésique. Ces organisations ont accepté d’utiliser des directives communes, de définir conjointement les priorités et de partager les ressources, permettant ainsi de mener des opérations plus harmonieuses et de réduire le nombre d’activités qui se chevauchent. Les progrès futurs seront influencés par les tendances dans ce domaine, notamment la priorité accrue accordée aux personnes déplacées à l’intérieur de leur pays et qui vivent hors des camps, en plus des réfugiés des camps, la durée prolongée des urgences et le besoin croissant de données empiriques. Resumen El continuo descontento político y civil en países con pocos recursos recalca la necesidad continua de proporcionar servicios especializados en salud reproductiva para personas desplazadas. Las mujeres desplazadas en particular afrontan una alta tasa de mortalidad materna, necesidad insatisfecha de planificación familiar, complicaciones después del aborto inseguro y violencia basada en género, así como enfermedades de transmisión sexual, incluido el VIH. Las organizaciones de socorro y desarrollo y organismos de la ONU han elaborado materiales técnicos, realizado cambios positivos a las políticas, específicos a los ámbitos de crisis, y están trabajando para proporcionar mejores servicios de salud reproductiva. Sin embargo, aún existen importantes brechas. La colaboración en el campo de la salud reproductiva en crisis es notable, ya que muchos organismos trabajan en una o más redes. La Iniciativa RAISE de cinco años reúne importantes organismos de la ONU y ONG de los campos de socorro y desarrollo, y se basa en su experiencia para apoyar la prestación de servicios de salud reproductiva, actividades de promoción y defensa, capacitación clínica e investigación. La buena disposición para utilizar documentos de orientación en común, determinar prioridades conjuntamente y compartir recursos ha propiciado mejores actividades y menos traslapo que si cada organismo hubiera trabajado independientemente. Futuros avances serán influenciados por las tendencias en el campo, como un mayor enfoque en las personas desplazadas internamente, aquéllas fuera de los campamentos y los refugiados en los campamentos, la prolongada naturaleza de las urgencias y la creciente necesidad de evidencia empírica.
... It is acknowledged within the literature that in humanitarian situations, women, men, and sexual and gender minorities may be exposed to marginalisation by people in power, aid workers, and social norms, based on overlapping identities (Alessi et al., 2018;Dolan, 2016;Palmer and Zwi, 1998). Conversely, marginalised subgroups show resilience and exploit opportunities to creatively deal with the challenges they face (Ajayi, 2020;D'Errico et al., 2013). ...
Article
Full-text available
For decades, as evidenced in programming and research, the humanitarian community has recognised gender equality and equity as integral to effective programming and response. Drawing upon ninety-nine publications indexed on the Web of Science and Google Scholar, this paper explores available evidence on gender and crisis settings in Africa to synthesise and critically analyse what is being learned. We found that limited research and programming have explicitly aimed to have gender transformative impacts, and those that do fail to adequately declare or reflect on the biases and intricacies of aiming to transform social norms in complex sociocultural contexts. Additionally, this review examines the trend of the body of research, highlighting the affiliation of authors and the geographical areas of focus. Evidence shows that research in this area is dominated by scholars affiliated with institutions in the Global North, raising questions relating to knowledge production and epistemic injustice in Africa.
... They suffer disproportionate effects during and after the war, such as inaccessibility of health and education services and sexual violence [113]. As such, "Gender affects exposure to situations which have an impact on health, dictates who has access to health care services and influences its planning and provision [114]-Pg.2". We found ten studies [52, 61,68,69,73,84,88,92,95,99] explicitly reporting on women. ...
Article
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Conflict can be a primary driver of health inequalities, but its impact on the distribution of social determinants of health is not very well documented. Also, there is limited evidence on the most suitable approaches aiming at addressing health inequalities in post-conflict settings. Thus, we undertook a systematic review of the literature concerning the current knowledge and knowledge gaps about structural determinants of health inequalities and assessed the effects of approaches aimed at addressing health inequalities in post-conflict settings. We performed a systematic search in bibliographic databases such as Web of Science, PubMed, and PsycINFO for relevant publications, as well as institutional websites that are relevant to this topic. The search was initiated in March 2018 and ultimately updated in December 2020. No time or geographical restrictions were applied. The quality of each study included in this review was independently assessed using criteria developed by CASP to assess all study types. Sixty-two articles were deemed eligible for analysis. The key findings were captured by the most vulnerable population groups, including the civilian population, women, children, internally displaced persons (IDPs), and people with symptoms of mental illness. A considerable range of approaches has been used to address health inequalities in post-conflict settings. These approaches include those used to address structural determinants of health inequalities which are accountable for the association between poverty, education, and health inequalities, the association between human rights and health inequalities, and the association between health inequalities and healthcare utilization patterns. However, these approaches may not be the most applicable in this environment. Given the multifactorial characteristics of health inequalities, it is important to work with the beneficiaries in developing a multi-sector approach and a strategy targeting long-term impacts by decision-makers at various levels. When addressing health inequalities in post-conflict settings, it may be best to combine approaches at different stages of the recovery process.
... Other studies have found that women's presence in political life is associated with less corruption (Dollar, Fisman, and Gatti 2001;Esarey andChirillo 2013, 2013;Goetz 2007;Stockemer 2011;Stockemer and Byrne 2011;Sung 2003;Treisman 2007). Further, several studies show that women are often more readily trusted in guiding the distribution of aid in humanitarian situations (Kovács and Tatham 2009;Olivius 2014;Palmer and Zwi 1998). ...
Article
Do donor states reward recipient states for signaling a commitment to expanding the role of women in political decision making? Previous studies show that women are associated with positive outcomes for peace duration and governance. We theorize that donor states reward recipient states that make a commitment to women’s empowerment in political decision making and test our hypotheses using data on the distribution of US foreign aid to recipient states. We find that recipient states that adopt legislative quotas and include more women in their parliaments receive more aid, although a female head of government is not associated with more aid.
... Although various relief agencies distributed aid in the form of temporary housing, food and non-food items, this aid was not available to many displaced mothers due to systemic injustices and gender insensitivities. The literature supports the existence of such injustice as it is reported that humanitarian aid often neglects the notion of cultural and gender-sensitive services, does not always reach the intended communities and is often not equitable (6), which further increases the vulnerability of displaced women and children (7,8). In our study, some families received support from multiple relief and donor agencies and others did not receive any aid as they were not in direct contact with the donor agencies or held less powerful positions in their communities. ...
Article
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Background: During disasters and displacement, affected families often receive humanitarian aid from governmental and nongovernmental organizations and donor agencies. Little information is available on the effects of humanitarian aid on the breastfeeding practices of mothers affected by disaster and displacement. Aims: The aim of this study was to explore the effects of humanitarian aid on the breastfeeding practices of displaced mothers affected by natural disasters in Chitral, Pakistan. Methods: This was qualitative study of residents of four villages of Chitral who had experienced a recent flood and later an earthquake. Data were collected through field observations, analysis of various documents (e.g. aid-agency documents, published reports and newspaper articles) and in-depth interviews with 18 internally displaced mothers living in disaster relief camps in Chitral. Results: Three main themes developed from the data: humanitarian aid as a life saver, insufficient humanitarian aid affecting breastfeeding, and systemic injustices in the distribution of humanitarian aid. Conclusion: Although humanitarian aid facilitated the survival, health and well-being of the displaced mothers and their family members, there were various problems with the humanitarian aid that increased the vulnerability of the displaced mothers and negatively affected their breastfeeding practices. Humanitarian aid must be gender-sensitive, thoughtful, timely, needs-based, equitable and context-specific. A systematic process of aid allocation and restricted donation of formula milk or any other form of breast-milk substitute is recommended during disasters.
... However the response by the government and NGOs, including the Ministry of Health, needs to extend ''beyond improving reproductive function toward advancing the social, economic, and political status of women'' . 24 This begins with more effort to seek women's input in policy, planning and decision-making, even in emergencies, 25 and providing a range of options appropriate to the needs of women in different, albeit difficult, circumstances. ...
Article
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In April and May 2006, internal conflict in Timor-Leste led to the displacement of approximately 150,000 people, around 15% of the population. The violence was most intense in Dili, the capital, where many residents were displaced into camps in the city or to the districts. Research utilising in-depth qualitative interviews, service statistics and document review was conducted from September 2006 to February 2007 to assess the health sector’s response to reproductive health needs during the crisis. The study revealed an emphasis on antenatal care and a maternity waiting camp for pregnant women, but the relative neglect of other areas of reproductive health. There remains a need for improved coordination, increased dialogue and advocacy around sensitive reproductive health issues as well as greater participation of the health sector in response to gender-based violence. Strengthening neglected areas and including all components of sexual and reproductive health in coordination structures will provide a stronger foundation through which to respond to any future crises in Timor-Leste. Résumé En avril et mai 2006, le conflit interne au Timor-Leste a déplacé près de 150 000 personnes, environ 15% de la population. La violence était particulièrement intense à Dili, la capitale, où beaucoup d’habitants ont été placés dans des camps en ville ou dans des districts. Une recherche utilisant des entretiens qualitatifs approfondis, les statistiques des services et une étude de documents, menée de septembre 2006 à février 2007, a évalué la réponse du secteur de la santé aux besoins de santé génésique pendant la crise. L’étude a révélé une priorité aux soins prénatals et à un camp où les femmes enceintes attendaient leur accouchement, mais une relative inattention à d’autres domaines de la santé génésique. Il faut améliorer la coordination, accroître le dialogue et le plaidoyer autour de questions sensibles de santé génésique tout en relevant la participation du secteur de la santé en réaction à la violence sexiste. Le renforcement des domaines négligés et l’inclusion de toutes les composantes de la santé génésique dans les structures de coordination constitueront un fondement plus solide à partir duquel répondre à toute crise future au Timor-Leste. Resumen En abril y mayo de 2006, el conflicto interno en Timor-Leste llevó al desplazamiento de aproximadamente 150,000 personas, un 15% de la población. La violencia fue más intensa en Dili, la capital, donde muchos residentes fueron desplazados a campamentos en la ciudad o a los distritos. Desde septiembre de 2006 hasta febrero de 2007, se realizaron investigaciones con entrevistas cualitativas a profundidad, estadísticas de servicios y revisión de documentos, a fin de evaluar la respuesta del sector salud a las necesidades de salud reproductiva durante la crisis. El estudio reveló énfasis en la atención antenatal y un campo maternidad de espera para las mujeres embarazadas, pero el relativo descuido de otras áreas en salud reproductiva. Aún existe la necesidad de mejorar la coordinación y ampliar el diálogo y las actividades de promoción y defensa en torno a los aspectos delicados de la salud reproductiva, así como incrementar la participación del sector salud en respuesta a la violencia basada en género. Al fortalecer las áreas desatendidas e incluir todos los elementos de la salud sexual y reproductiva en las estructuras de coordinación, se creará una base más sólida a partir de la cual se pueda responder a toda crisis futura en Timor-Leste.
... A second reason why external intervention failed to support existing networks was the unwillingness to include organizations as active participants in postconflict reconstruction, provide public goods, and focus on skills training tailored to the needs of women (Basini 2013;Blattman, Fiala, and Martinez 2012;Duflo and Udry 2004;Palmer and Zwi 1998). An example of how existing policies failed to transform linking social capital into bridging capital is the limited provision of adult literacy and training programs for local women. ...
Article
Why are civil society organizations so often unable to make a difference during the transition to peace? I argue that the contributions of local civil society organizations and women's organizations to postconflict peacebuilding should be understood in terms of the networks that emerge during the peacebuilding process. Horizontal network conditions are essential for successful postconflict reconstruction. Yet external actors often implement policies that strengthen hierarchical links at the expense of such horizontal networks. To explore the types of networks that emerge in postconflict reconstruction, I use semistructured interviews conducted in Liberia. The evidence suggests that emerging horizontal networks are more robust in areas where local communities and women have a tradition of organizing. However, these networks remain fairly unstable. The assistance is mostly channeled centrally, strengthening hierarchical ties and leading to distortions in the distribution of resources.
... Women of minority populations in particular are more vulnerable during crisis and are targets for violence, poor food supply, decreases in income and access to heath care (Palmar and Zwi, 1998). Due to sweeping changes in Egypt caused by the Spring Revolution of 2011, political unrest exists resulting in distrust of acting leaders. ...
Article
The current political instability in the regions of North Africa and the Middle East threaten the safety of disenfranchised, vulnerable populations and the knowledge of health determinants in these people groups. Gender roles and cultural norms of the region place women in a marginalized position resulting in isolation and disconnection from society and the information or resources regarding healthcare. The women of the Zabbaleen community are a unique population in Cairo, Egypt with multiple factors known to contribute to inequities in healthcare. This study reveals barriers that affect healthcare related to issues of cultural behaviors and social determinants of health for the Zabbaleen women. The results provide insight into the perceived and actual barriers to health the women experience. This study reveals information critical to developing interventions in healthcare delivery and services during tumultuous times and future peaceful times. A qualitative constructivist design with personal interviews, participatory observation and field notes was used for this study. Internal barriers of cultural norms of gender, religion and isolation alongside external factors of environment, unique economic conditions and health resources shape the women’s experiences.
... An extensive literature examines the links between gender, conflict, and poverty (Olmsted 1997;Palmer and Zwi 2002;Giles and Hyndman 2004;Bouta et al. 2005;Olmsted 2007). Compared to the amount of work in this literature devoted to refugees, the work on IDPs and in particular victims of conflict induced displacement (CID) is sparse (see for example Daley 1991;Benjamin 2000;de Alwis 2004;Lubkemann 2008). ...
Article
Full-text available
This article analyses forced displacement through a gender lens, focusing on the experiences of women and also of female headed households. It uses a set of qualitative as well as quantitative data, covering internally displaced persons (IDPs) in Sampur, Sri Lanka. The study revealed that women have particular protection and assistance needs that exceed the needs of men. In addition, the coping mechanisms used by displaced women were sometimes found to be more effective than those used by men. Moreover, there are economically significant differences between the ways female and male headships pool resources to cope with displacement. The fieldwork was carried out in August 2007 and in April 2008, at welfare centres in Batticaloa which received the IDPs from Sampur in 2006. This group remains displaced at the time of writing.
... Working with frontline workers (teachers, health care workers, police) to assist them to provide psychological first aid, and to assess when additional mental health services are required, is a crucial activity in the acute phase. Involving women and children in the planning and delivery of services is also important, and helps ensure appropriateness and protection while reinforcing the right to participate in, and influence, service delivery, something not well promoted in most complex emergency settings (Palmer and Zwi 1998; Fustukian and Zwi 2001; Sphere Project 2004). Among the most vulnerable in any emergency are those with pre-existing mental illnesses (Silove et al 2000). ...
Article
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Multiple challenges are present in areas affected by both disaster and conflict. Support to psychosocial recovery and wellbeing is increasingly seen as a core component of responding to disasters and complex emergencies. We consider whether the increased attention and resources directed to psychosocial programs following the tsunami could assist in the promotion of human rights in the fragile settings of north-eastern Sri Lanka and Aceh in Indonesia. We identify ways in which the psychosocial and human rights agendas intersect and consider how progressive psychosocial health programming can assist in the promotion of human rights. We also highlight concerns and cautions arising from too explicit a connection in the absence of a safe environment. We conclude by presenting an emerging research agenda to more thoroughly explore the interface of these important areas of health and social policy response.
... As Palmer and Zwi have noted in their paper on the influences of gender differentials on health in conflict settings: " Gender affects exposure to situations which have an impact on health, dictates who has access to health-care services, and influences its planning and provision " (Palmer and Zwi 1998). They argue that involving women in the planning and delivery of services is essential to redressing this inequity. ...
Article
Issues around health equity in conflict-affected fragile states have received very little analysis to date. This paper examines the main factors that threaten health equity, the populations that are most vulnerable and potential strategies to improve health equity. The methods employed are a review of the published and grey literature, key informant interviews and an analysis of data on social determinants of health indicators. A new conceptual framework was developed outlining types of inequity, factors that influence equity and possible strategies to strengthen equity. Factors that affect equity include displacement, gender and financial barriers. Strategies to strengthen health equity include strengthening pro-equity policy and planning functions; building provider capacity to provide health services; and reducing access and participation barriers for excluded groups. In conclusion, conflict is a key social determinant of health. More data is needed to determine how conflict affects within-country and between-country equity, and better evaluated strategies are needed to reduce inequity.
... Men may have opportunistic sex or visit sex workers [4]. Women may be raped, coerced to trade sex, or enter relationships to secure basic survival [3,5]. However, there is evidence that the impact of conflict on the sexual transmission of HIV is context specific6789, depending on factors such as the prevalence of STIs and HIV in the populations involved and the adequacy of relevant refugee health serv- ices [10]. ...
Article
Full-text available
Providing reproductive and sexual health services is an important and challenging aspect of caring for displaced populations, and preventive and curative sexual health services may play a role in reducing HIV transmission in complex emergencies. From 1995, the non-governmental "Reproductive Health Group" (RHG) worked amongst refugees displaced by conflicts in Sierra Leone and Liberia (1989-2004). RHG recruited refugee nurses and midwives to provide reproductive and sexual health services for refugees in the Forest Region of Guinea, and trained refugee women as lay health workers. A cross-sectional survey was conducted in 1999 to assess sexual health needs, knowledge and practices among refugees, and the potential impact of RHG's work. Trained interviewers administered a questionnaire on self-reported STI symptoms, and sexual health knowledge, attitudes and practices to 445 men and 444 women selected through multistage stratified cluster sampling. Chi-squared tests were used where appropriate. Multivariable logistic regression with robust standard errors (to adjust for the cluster sampling design) was used to assess if factors such as source of information about sexually transmitted infections (STIs) was associated with better knowledge. 30% of women and 24% of men reported at least one episode of genital discharge and/or genital ulceration within the past 12 months. Only 25% correctly named all key symptoms of STIs in both sexes. Inappropriate beliefs (e.g. that swallowing tablets before sex, avoiding public toilets, and/or washing their genitals after sex protected against STIs) were prevalent. Respondents citing RHG facilitators as their information source were more likely to respond correctly about STIs; RHG facilitators were more frequently cited than non-healthcare information sources in men who correctly named the key STI symptoms (odds ratio (OR) = 5.2, 95% confidence interval (CI) 1.9-13.9), and in men and women who correctly identified effective STI protection methods (OR = 2.9, 95% CI 1.5-5.8 and OR = 4.6, 95% CI 1.6-13.2 respectively). Our study revealed a high prevalence of STI symptoms, and gaps in sexual health knowledge in this displaced population. Learning about STIs from RHG health facilitators was associated with better knowledge. RHG's model could be considered in other complex emergency settings.
... [9][10][11][12][13][14] Unfortunately, these women are not always safe from harm after their relocation or after resettlement. 4,12,[15][16][17][18] Investigation of sexual violence affecting these women, its incidence, prevalence, and correlates is critical to the development of effective treatment and prevention strategies. ...
... Armed conflicts may result in an increase in transactional sex, as regular economic forces are skewed by war. Women and girls are exceptionally economically vulnerable, especially those who have lost husbands or fathers in conflict [7]. As a result, some women and girls exchange sex for money or food, entering sex work formally or informally. ...
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In October 2001, a pilot project to design strategies to reduce HIV/AIDS transmission and improve related reproductive health practices was initiated in southern Sudan. A health facility assessment was conducted in order to determine the type and scope of care given to clients with sexually transmitted infections (STIs). It was found that many health care practitioners did not have basic training in STI diagnosis and management, and no practitioner had training in the syndromic approach. Standardized drug kits received by public facilities did not provide enough STI drugs to serve the population. Private drug stores were the only facilities where condoms were available, though condoms were not sold to women who came to purchase them without their husbands. An adequately functioning health system will be difficult to achieve without ongoing training and supervision, adequate supplies and equipment, and proper rebuilding of infrastructure and systems, such as roads, communication, and education.
... However the response by the government and NGOs, including the Ministry of Health, needs to extend ''beyond improving reproductive function toward advancing the social, economic, and political status of women'' . 24 This begins with more effort to seek women's input in policy, planning and decision-making, even in emergencies, 25 and providing a range of options appropriate to the needs of women in different, albeit difficult, circumstances. ...
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In April and May 2006, internal conflict in Timor-Leste led to the displacement of approximately 150,000 people, around 15% of the population. The violence was most intense in Dili, the capital, where many residents were displaced into camps in the city or to the districts. Research utilising in-depth qualitative interviews, service statistics and document review was conducted from September 2006 to February 2007 to assess the health sector's response to reproductive health needs during the crisis. The study revealed an emphasis on antenatal care and a maternity waiting camp for pregnant women, but the relative neglect of other areas of reproductive health. There remains a need for improved coordination, increased dialogue and advocacy around sensitive reproductive health issues as well as greater participation of the health sector in response to gender-based violence. Strengthening neglected areas and including all components of sexual and reproductive health in coordination structures will provide a stronger foundation through which to respond to any future crises in Timor-Leste.
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Introduction During natural disaster a sudden increase in infant mortality and morbidity rates are reported. Breastfeeding practices are essential to prevent malnutrition-related mortalities among infants during disaster and displacement. Methods Findings from the undertaken critical ethnographic study in the disaster relief camps of Chitral, Pakistan, were referred to identify need-based policies to promote, protect, and support breastfeeding among displaced mothers. Results The study identified the need for strategic policies at sociocultural, economic, and geopolitical levels to support breastfeeding and save lives of young children during natural disasters. Conclusion This article will facilitate clinicians, healthcare providers, and national and international agencies to recognize gaps in the existing policies and services targeting breastfeeding mothers during disaster and displacement.
Article
Purpose: To discuss the effects of forced displacement on maternal and child health, highlight the major pitfalls in delivering humanitarian services to this vulnerable group, and underscore the need for multilayered interventions to improve health, protect rights, and reduce vulnerabilities during forced displacements. Methods: A comprehensive literature search was undertaken from databases including Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCOhost, Google Scholar, Scopus, and ProQuest. No restrictions were placed on geographical region, type, and year of publication. The key words used were displacement, children, women, health, challenges, disaster response, emergency medicine, terrorism, maladjustment, morbidity, disaster response, cultural sensitivity, and interventions. Conclusions: Forced displacement negatively affects maternal and child health. The key challenges during forced displacement include food insecurity, lack of shelter, unavailability of clean water and sanitation, poor infrastructure of healthcare services, unavailability of birth attendants and healthcare professionals to manage medical emergencies, inaccessibility to educational and training facilities, and lack of cultural sensitivity of humanitarian workers. The ultimate outcome of forced displacement is a sudden rise in maternal and child mortality and morbidity, maladjustment, psychological issues, altered familial roles, displaced parenting, and vulnerability to exploitation. In view of Bronfenbrenner's socio-ecological framework, multilayered interventions are proposed to improve maternal and child health during forced displacements. Clinical relevance: In view of the effects of forced displacement on maternal and child health and considering the major pitfalls in the delivery of humanitarian services to this vulnerable group, the proposed multilayered interventions can improve health, protect rights, and reduce vulnerabilities surrounding maternal and child health during forced displacements.
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Humanitarian assistance in the 21 st century has been largely defined as a global attempt to rectify large-scale issues and crises around the modern world, primarily in regions of conflict, development, and disaster. The worldwide explosive surge of humanitarian aid organizations has been underpinned by geopolitical and global phenomena that have helped drive and expand their efforts. In order to engage in these initiatives, international aid organizations (IAOs) and state actors have become involved in cross-border discourses that have reshaped the identities of aid recipients and helped form the identities of donors. The practice of identity construction and reconstruction has resulted in a ripple effect that has touched every actor and participant in acts of humanitarian assistance and intervention. This paper identifies the rise of IAOs, those practices which have been employed to mold an other's identity, and the effects of those actions on aid recipients and aid organizations. I find that discursive and representational practices have had direct and indirect consequences on the distribution, reception, and efficacy of aid. I recommend that a more comprehensive approach be taken whereby IAOs are more sensitive in the administrative process to cultural context and become increasingly prominent actors in the resolution of disputes and deadly conflicts.
Chapter
Over three decades after the Alma Ata convention, there are still one billion people living in extreme poverty and lacking basic health needs. Another one to two billion struggle to find their basic needs. Almost half of the world’s poor population live in rural areas , with the highest population in South-East Asia and sub-Saharan Africa . The economic status in most developing countries has had direct and indirect effects on people’s lives and health. If there is good governance , good management and accountability, and if individual countries are financially able to support and sustain their healthcare systems, lives will be changed. Involving the community and households when developing public health policies and strategies, cultivates a sense of ownership and responsibility within the community. The poor rural communities are most often neglected and most of the healthcare policies and strategies are less inclusive and tend to marginalize these poor populations. If governments can introduce ways that are inclusive and support the rural communities in improving their health and livelihoods , there will be an impact in disease prevention and control .
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Objective: to analyze the social vulnerability to sexually transmitted diseases and AIDS (STD, AIDS), in a group of women who arrived to the city of Medellin (Colombia) in forced displacement situation. Methodology: ethnographic qualitative study performed from April to August of 2008 in the city of Medellin. 23 women were interviewed in different health care providing institutions. Results: the abrupt change from their daily life, the social and family networks fragmentation, the gender status, and in some women the sexual violence before, during and after the displacement were related with a higher vulnerability to STD/HIV/AIDS in the studied population. Conclusions: the studied women vulnerability conditions belonging to this group of diseases began before the migration and were present during and after the displacement.
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Sexual and gender-based violence in armed conflicts lacks visibility and is not fully understood as it is often labelled as a woman's-only issue. Its gendered nature extends beyond the actual period ofconflict, into the period of rehabilitation and reconstruc tion, carrying with it many physical and psychological problems. The sufference endured by women both during the following the conflict is strictly related to the rooted structural gender inequalities within societies in general. In situations of conflict women's oppression and abuse further increase their usual subordination. For example, traditional barriers to health care, including the lack of diagnostic equipment and adequate treatment; the insufficiency of premises for the treatment of survivors; the lack of dedicated venues to seek assistance; poor supplies of essential and specific drugs, together with an inadequacy of health personnel, become even more problematic, and all contribute to poor primary health care. Therefore, understanding the roots of unequal gender treatment, and thus the cultural setting of a community; becomes essential when dealing with the phenomenon of sexual violence. In particular, multidimensional and gender-sensitive health responses to sexual violence should be designed, and services taking into account its multifaceted nature should be provided.
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Resettling refugee women may be at greater risk than other women for several harmful reproductive health out- comes as a result of their migration experience. The objec- tive of this study was to determine differences in reproductive health status between refugee women in countries of resettlement and non-refugee counterparts. A systematic review of the literature culled from five elec- tronic databases and web searching of international agen- cies and academic centres focusing on refugees was conducted. Of the forty-one high quality studies identi- fied, fourteen looked at refugees exclusively; only nine of the fourteen focused on the reproductive health of refu- gees; six of the nine directly compared refugee to non-refu- gee women's health. There is a paucity of population- based data to support or refute claims of greater reproductive health risks for resettling refugee women.
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Complex emergencies represent the international response to state disruption and its sustaining infrastructure. Understanding of complex emergencies has arisen from the many post cold war conflicts of the 1990s, though complex emergencies can be catalysed by natural and other disasters. Complex emergencies need to be recognised for the public health disasters they are and for the public health expertise required by civil and military authorities.
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To identify the need for reproductive health care among a community affected by conflict, and to ascertain the priority given by the community to reproductive health issues. Rapid appraisal. This comprised interviews with key informants, in-depth interviews, and group discussions. Secondary data were collated. Freelisting, ranking, and scenarios were used to obtain information. Communities affected by conflict in southern Sudan. Participants: Interviews and group discussions were chosen purposively. Twenty interviews with key informants were undertaken, in-depth interviews were held with 14 women, and 23 group discussions were held. Need for reproductive health care. Perceived priority afforded to reproductive health issues in comparison with other health problems. Reproductive health in general and sexually transmitted diseases in particular were important issues for these communities. Problems in reproductive health were ranked differently depending on the age and sex of the respondents. Perceptions about reproductive health issues in communities varied between service providers, and community leaders. Settled and displaced communities had different priorities and differing experiences of reproductive health problems and their treatment. Rapid appraisal could be used as the first step to involving communities in assessing needs and planning service provision.
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In this paper we argue that a gender analysis is fundamental to health and health planning. We begin with a definition of gender and related concepts including equity and equality. We discuss why gender is key to understanding all dimensions of health including health care, health seeking behaviour and health status, and how a gender analysis can contribute to improved health policies and programming. Despite the many reasons for incorporating gender issues in health policies and programmes many obstacles remain, including the lack of attention to gender in the training of health professionals and the lack of awareness and sensitivity to gender concerns and disparities in the biomedical community. We argue that the key to placing gender values firmly in place in Health for All renewal is a change in philosophy at all levels of the health sector and suggest ways in which such a change can be implemented in the areas of policy, research, training and practical programmes and interventions.
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This article describes the findings of a participatory assessment of Burundian and Rwandan refugees' perceptions of the quality of health services in camps in Ngara, Tanzania. Taking a beneficiary-centred approach, it examines a collaborative effort by several agencies to develop a generic field guide to analyse refugees' views of healthcare services. The objective was to gather information that would contribute to significant improvements in the care offered in the camps. Although the primary focus was on healthcare, several broader questions considered other general apprehensions that might influence the way refugees perceive their healthcare. Findings indicated that while refugees in Ngara were generally satisfied with the quality of healthcare provided and healthcare promotion activities, recognition of some key refugee concerns would assist healthcare providers in enhancing services. With increasing need for refugee community participation in evaluating humanitarian assistance, this assessment has relevance both in the context of Ngara and beyond.
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Until recently, the paucity of empirical data on refugee women has led to widespread generalization about the plight, number and condition of women in refugee communities. Discussion of refugee women tends to focus on their vulnerability and their experience as victims in acts of sexual violence and other forms of abuse. Very few studies document the less dramatic transformation of women's lives which occurs as a direct outcome of forced displacement. Using evidence from primary data collected among Burundi refugees in Tanzania during 1987, the paper contends that contrary to popular perception the sex ratio in African refugee settlements is much more balanced than has been assumed. This has implications for policies which associate deprivation with the predominance of women in African refugee settlements.As men and women come to terms with a redefinition of their access to resources patriarchal tendencies within the pre-migration societies and the male bias of the settlement programme combine to marginalize women from the administrative structures and, more severely, from participating in the wider Tanzanian society. Nevertheless within the restricted space of the settlement, in the absence of alternatives, both men and women have been fully integrated into the market economy as marginalized direct producers. Therefore, they are also subjected to the crises of social reproduction now facing the Tanzanian peasantry. Gender is shown to be an important, but not all encompassing, factor in the reconstruction and control over space as refugees adjust to the new environments.
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Two paradigms that have shaped our understanding of refugee health are identified: the objectification of refugees as a political class of excess people, and the reduction of refugee health to disease or pathology. Alternative paradigms are recommended: one to take the polyvocality of refugees into account, and one to construe refugees as prototypes of resilience despite major losses and stressors. The article is organized into three sections, mirroring the life history of refugees from internal displacement in the country of origin to asylum in a second (usually neighboring) country, and for some, to permanent resettlement in a third country. In each of the three sections, the primary topics that are treated in the literature are identified, and key problems identified for discussion.
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This paper documents health experiences and the public health activities of the Tigray People's Liberation Front (TPLF). The paper provides background data about Tigray and the emergence of its struggle for a democratic Ethiopia. The origins of the armed struggle are described, as well as the impact of the conflict on local health systems and health status. The health-related activities and public health strategies of the TPLF are described and critiqued in some detail, particular attention is focused on the development of the baito system, the emergent local government structures kindled by the TPLF as a means of promoting local democracy, accountability, and social and economic development. Important issues arise from this brief case-study, such as how emerging health systems operating in wartime can ensure that not only are basic curative services maintained, but preventive and public health services are developed. Documenting the experiences of Tigray helps identify constraints and possibilities for assisting health systems to adapt and cope with ongoing conflict, and raises possibilities that in their aftermath they leave something which can be built upon and further developed. It appears that promoting effective local government may be an important means of promoting primary health care.
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In current armed conflicts around the world, over 90 per cent of casualties are civilians. This article reviews medical and anthropological evidence of the psychosocial effects of extreme experiences such as torture, mutilation, rape, and the violent displacement of communities. The consequences for women and children are considered in particular. The author argues that the social development programmes of non-governmental development organisations should be extended to support social networks and institutions in areas of conflict, and ends by giving guidelines for mental health promoters working in traumatised communities.
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This paper outlines the dramatic return to Sudan of 150,000 men, women and children from Itang Refugee Camp in Ethiopia in June 1991. These people were pawns in Sudan's civil war, manipulated by governments, military forces and the media – a state of affairs that the international community failed to deal with effectively. At the time of the return to Sudan, ICRC and the United Nations were working to assist the returnees in two different areas and each had a different access agreement and thus a different impact on the survival of the returnees. The paper focuses on the role of political awareness and negotiation in the protection of refugees and in the organisation of relief in the context of a civil war.
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A uniform analytical methodology was applied to survey data from 17 developing countries with the aim of addressing a series of questions regarding the positive statistical association between maternal education and the health and survival of children under age two. As has been observed previously, the education advantage in survival was less pronounced during than after the neonatal period. Strong but varying education effects on postneonatal risk, undernutrition during the 3-23 month period, and non-use of health services were shown--although a large part of these associations are the result of education's strong link to household economics. Differential use of basic health services, though closely tied to a mother's educational level, does little to explain the education advantage in child health and survival. However, the issue of the actual quality of services measured in the DHS is raised. Other issues concerning the roles of the pattern of family formation and differential physical access to health services are explored and discussed.
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Events in Chile provided an opportunity to evaluate health effects associated with exposure to high levels of social and political violence. Neighborhoods in Santiago, Chile, were mapped for occurrences of sociopolitical violence during 1985-86, such as bomb threats, military presence, undercover surveillance, and political demonstrations. Six health centers providing prenatal care were then chosen at random: three from "high-violence" and three from "low-violence" neighborhoods. The 161 healthy, pregnant women due to deliver between August 1 and September 7, 1986, who attended these health centers were interviewed twice about their living conditions. Pregnancy complications and labor/delivery information were subsequently obtained from clinic and hospital records. Women living in the high-violence neighborhoods were significantly more likely to experience pregnancy complications than women living in lower violence neighborhoods (OR = 5.0; 95% CI = 1.9-12.6; p less than 0.01). Residence in a high-violence neighborhood was the strongest risk factor observed; results persisted after controlling for several sets of potential confounders. Living in areas of high social and political violence increased the risk of pregnancy complications among otherwise healthy women.
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More than 30 million refugees and internally displaced persons in developing countries are currently dependent on international relief assistance for their survival. Most of this assistance is provided by Western nations such as the United States. Mortality rates in these populations during the acute phase of displacement have been extremely high, up to 60 times the expected rates. Displaced populations in northern Ethiopia (1985) and southern Sudan (1988) have suffered the highest crude mortality rates. Although mortality rates have risen in all age groups, excess mortality has been the greatest in 1- through 14-year-old children. The major causes of death have been measles, diarrheal diseases, acute respiratory tract infections, and malaria. Case-fatality ratios for these diseases have risen due to the prevalence of both protein-energy malnutrition and certain micronutrient deficiencies. Despite current technical knowledge and resources, several recent relief programs have failed to promptly implement essential public health programs such as provision of adequate food rations, clean water and sanitation, measles immunization, and control of communicable diseases. Basic structural changes in the way international agencies implement and coordinate assistance to displaced populations are urgently needed.
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The findings from epidemiological data that were collected from emergency camps for Ethiopian refugees during a mass influx of refugees into Eastern Sudan in 1985 are presented. An overall mortality of 8.9 per 10,000 a day was recorded during February 1985, and in children under 5 years of age the rate was 22 per 10,000 a day. The estimated prevalence of malnutrition (calculated as less than 80% of the reference weight for height) ranged from 32% to 52% among children of preschool age. The principal causes of morbidity and mortality were measles, diarrhoea and dysentery, respiratory infections, and malaria. The findings suggest that malnutrition and disease increased in these refugees after they arrived in the camps. Epidemiological assessment is essential to help to maintain the health and nutrition of refugees in emergency camps. PIP The findings from epidemiological data that were collected from emergency camps for Ethiopian refugees during a mass influx of refugees into Eastern Sudan in 1985 are presented. An overall mortality of 8.9/10,000 a day was recorded during February 1985, and in children under 5 years of age the rate was 22/10,000 a day. The estimated prevalence of malnutrition (calculated as less than 80% of the reference weight for height) ranged from 32% to 52% among children of preschool age. The principal causes of morbidity and mortality were measles, diarrhea and dysentery, respiratory infections and malaria. The findings suggest that malnutrition and disease increased in these refugees after they arrived in the camps. Epidemiological assessment is essential to help to maintain the health and nutrition of refugees in emergency camps.
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The relationship between women's social status and the survival chances of their children is explained and illustrated with examples. When women (and girls) have low status, relatively little social investment is made in them, and this is reflected in girls' and boys' differential mortality rates. Several health-related social investment indicators are given, and matched against children's mortality patterns by ecological regions of Africa and Asia. The cultural propensity to invest in girls (nutrition, education, etc.) and their resultant survival chances, are explained by ecology which in past centuries has largely determined agricultural economies that either had a high demand for female labour or did not. In the former, women are more likely to control the wealth they produce and use it for transactions that put others in their social debt, thus growing in social power. Policy implications of planning and implementing primary health care in these different types of societies are explored.
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In the disaster relief programme for Kampuchean refugees in Thailand, epidemiological techniques were incorporated into the health-planning process during the first 2 weeks of the refugee influx. The findings influenced not only health care in the first refugee camp but also the delivery of medical services in subsequent camps. The mortality rate in the first week of refugee settlement was 9.1/10 000/day, and fell to 0.71/10 000/day by the fifth week. Children aged 4 and under had the highest risk of death. Fever/malaria was the main cause of morbidity and mortality. Simple epidemiological techniques, if initiated early in the relief effort, can influence medical decisions and lead to more effective use of health resources.
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Gender differences in health in developing countries have, until recently, received little attention from researchers, health programmes and international development efforts. This paper highlights several issues related to gender and health in the Third World on which information, especially of an empirical nature, is inadequate. These include certain health conditions and diseases for which gender differences remain largely uncharted, gender inequalities in the development of health and contraceptive technology, the lack of gender-sensitivity in the provision of health services, and gender inequalities in health policies, focusing mainly on structural adjustment. Questions urgently requiring research are identified and suggestions are made for improving the gender sensitivity of health policies and interventions.
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This paper examines the underlying assumptions that have led to a lack of attention to women's health, particularly in developing countries, beyond the context of their reproductive roles. It is argued that the peculiar nature of women' responsibilities both in economic production and within the family, may have a profound impact on the extent to which they are affected by tropical diseases and their responses to disease. It is suggested that the gender relations of health are of considerable significance in explaining the differential consequences of tropical disease on women, men and children. The paper proposes a framework for gender-sensitive research on this topic and suggests some new directions for research.
Article
This paper reviews current knowledge about the role that socio-economic and cultural factors play in determining gender differentials in tuberculosis (TB) and tuberculosis control. The studies reviewed suggest that socio-economic and cultural factors may be important in two ways: first, they may play a role in determining overall gender differences in rates of infection and progression to disease, and second, they may lead to gender differentials in barriers to detection and successful treatment of TB. Both have implications for successful TB control programmes. The literature reviewed in this paper suggests the following: Gender differentials in social and economic roles and activities may lead to differential exposure to tuberculosis bacilli; The general health/nutritional status of TB-infected persons affects their rate of progression to disease. In areas where women's health is worse than men's (especially in terms of nutrition and human immunodeficiency virus status), women's risk of disease may be increased; A number of studies suggest that responses to illness differ in women and men, and that barriers to early detection and treatment of TB vary (and are probably greater) for women than for men. Gender differences also exist in rates of compliance with treatment; The fear and stigma associated with TB seems to have a greater impact on women than on men, often placing them in an economically or socially precarious position. Because the health and welfare of children is closely linked to that of their mothers, TB in women can have serious repercussions for families and households. The review points to the many gaps that exist in our knowledge and understanding of gender differentials in TB and TB control, and argues for increased efforts to identify and address gender differentials in the control of TB.
Article
Gender differences in mortality risks in rural Somali communities were studied to assess their relation to literacy, marital status and family economy between January 1987 and December 1989. In all, 6947 person-years form the basis for the demographic analysis and estimations of mortality rates and survival. Both sexes showed similar mortality risks in infancy and early childhood, but females demonstrated a greater risk of dying during their reproductive life than males. Respiratory symptoms, diarrhoea, fever and jaundice dominated the symptoms prior to death Illiteracy in women considerably increased the risk of dying from 15 years and onwards particularly when living with literate men. The life expectancy from 15 years was 58 for a literate male but only 42 years for an illiterate woman living with a literate head of household. Multivariate analyses showed after adjustment for marital status and literacy that an excess female mortality from 15 years, but especially from 45 years, was associated to a household situation, where the woman did not subside on farming but on other, mainly commercial, activities. This vulnerability of females was associated to the recession of the economy in the pre-war situation in Somalia, a backlash hitting women trying to earn their living. To conclude, gender differences in a number of factors in the household-literacy, marital status and especially source of income-were disadvantageous for the women, increasing the mortality risk in this setting.
Article
This paper presents a case for an underlying language of need consistent with public health's commitment to social justice. After examining the problem of human need as it has been conceptualised historically, this paper argues that the problems of needs--a central concern in the modern welfare state--are inherently political. Two ways of conceptualizing need which have dominated the recent discourse on need--namely a therapeutic language of need and rights talk--are examined and found to be unsatisfactory in capturing the sense in which needs and their definition and arbitration are central to the life of the community. What is required for public health is a language of need which speaks to the reciprocity and interdependence which characterise community; such a language is to be found in a "moral economy of interdependence". The paper concludes by discussing what a moral economy of interdependence, as a language of need consistent with the aims of public health, might look like.
Article
PIP A statistical study was made of sex ratios and mortality in Ceylon, Pakistan, and India. Contrary to general expectations, female mortality was higher than male mortality. A greater divergence in the sex ratio was found with increased age. Female emigration and abnormal sex ratios at birth are discounted as explanations of the phenomenon. It is considered that underenumeration of females in the census and higher female mortality rates, especially during the reproductive years and childhood, are responsible for the inverted sex ratio. The projected sex ratios for these countries are not reflected in the model life tables derived from international experience.
Socioeconomic Cultural and Legal Factors Affecting Girls and Women's Health. The World Bank, Department of Population, Health and Nutrition Conflict and the Women of Chad
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Acsadi, G.T.F. and G. Johnson-Ascadi (1993) Socioeconomic Cultural and Legal Factors Affecting Girls and Women's Health. The World Bank, Department of Population, Health and Nutrition, Washington. Achta Djibrine Sy (1993) Conflict and the Women of Chad. In H. O'Connell (ed.) Women and Conflict. Oxfam, Oxford.
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Health Problems and Potentials for Change in a Rural African Community — The Lumadoonka-Buullow Study. Department of Epidemiology and Public Health Gender and Tropical Diseases: A New Research Focus
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Situation and Role of Refugee Women: Experiences and Perspectives from Thailand. Presented at the fifth seminar on adaption and integration of permanent immigrants
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The Health of Women. A Global Perspective Gender and Catastrophe Health and the Social Power of Women
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