TOWARDS A COMPREHENSIVE APPROACH OF SEXUAL AND REPRODUCTIVE RIGHTS AND NEEDS OF WOMEN DISPLACED BY WAR AND ARMED CONFLICT pptx

TOWARDS A COMPREHENSIVE APPROACH OF SEXUAL AND REPRODUCTIVE RIGHTS AND NEEDS OF WOMEN DISPLACED BY WAR AND ARMED CONFLICT A Practical Guide for Programme Officers Marleen Bosmans, Prof..

TOWARDS A COMPREHENSIVE APPROACH

OF SEXUAL AND REPRODUCTIVE RIGHTS

AND NEEDS OF WOMEN

DISPLACED BY WAR AND ARMED CONFLICT

A Practical Guide for Programme Officers

Marleen Bosmans, Prof Dr Marleen Temmerman

International Centre for Reproductive Health, Ghent University

2003

With the support of the Flemish Interuniversity Council, VLIR.

This document is issued for general distribution All rights are reserved Reproductions and

translations are authorised, except for commercial purposes, provided the source is acknowledged.

With this we want to acknowledge

o Marleen Thomas, Leen De Becker, Carla Dauw and Tania Braems at the Belgian Directorate General for Development Cooperation and Nicole Malpas at the

Belgian Technical Cooperation for their enthusiast cooperation and support

o Judy El-Bushra, Florence Tercier Holst-Roness, Samantha Guy, Wilma Doedens, Gabriel Ojeda, Suad Abu-Dayyeh, Manuela Colombini and Henia Dakkak for their critical and constructive comments at the international expert meeting in Ghent

o UNFPA-Jerusalem, the men and women of Juzoor and the women in the Jalazou, Jabalyia and Amari Refugee Camps in the West Bank and the Gaza for their warmhearted cooperation and hospitality during the field study in Palestine.

TABLE OF CONTENT

LIST OF ABBREVIATIONS 5

I INTRODUCTION 6

II PURPOSE AND USE OF THE GUIDE 8

1 Objectives 8

1.1 Overall Objective 8

1.2 Specific Objectives 8

1.3 Target Group 8

1.4 Process 8

1.5 Road Map 9

III GUIDE 12

1 Conflict Analysis 12

2 Displacement 14

3 Stakeholders 16

4 Impact of the Conflict on the SRH Status of Women 18

4.1 Impact on the Political Environment 18

4.2 Impact on the Legal Environment 19

4.3 Impact on the Social and Cultural Environment 20

5 Provision of Comprehensive and High Quality SRH Services 22

5.1 Emergency Phase of Conflict 22

5.2 Stabilized Phase of Conflict 23

6 Conclusions and Recommendations 27

6.1 Conclusions 27

6.2 Recommendations 28

ANNEX 1 Glossary of Terms 29

ANNEX 2 ICPD and ICPD +5 Reproductive Health Indicators 33

ANNEX 3 Reference Addresses 36

ANNEX 4 Bibliography 39

LIST OF ABBREVIATIONS

DGDC Directorate General for Development Cooperation

in Refugee Situations

I INTRODUCTION

Since the International Conference on Population and Development (Cairo 1994) andthe Fourth World Conference on Women (Beijing 1995) the awareness about thesexual and reproductive rights and needs of women affected by war and armedconflict has been steadily growing According to the definition given at the Cairoconference reproductive health includes a wide variety of services such as familyplanning, safe motherhood (including abortion – where legal –, prevention of abortionand post-abortion care), prevention and care of sexually transmitted infectionsincluding HIV/AIDS, education and counselling on human sexuality (with specialattention for violence against women) and active prevention of harmful practices,such as female genital mutilation

Although humanitarian aid programmes are paying more and more attention to theprovision of sexual and reproductive health (SRH) services, the development of acomprehensive approach of SRH still constitutes a real challenge for donors,international humanitarian agencies, national authorities, national and internationalnon-governmental organizations, and community based organizations

The development of this guide is part of an interdisciplinary policy research for theBelgian Development Co-operation into the sexual and reproductive rights and needs

of women displaced by war and armed conflict The basic assumption of the guide isthat sexual and reproductive rights are human rights, and more specifically women’shuman rights, which are an inalienable, integral and indivisible part of universalhuman rights Taking this rights approach as a starting point the promotion andprotection of these rights should be considered in all humanitarian relief operationsand should be a priority of all SRH programmes

A first draft of the guide was based on a preliminary literature review and desk study

It was first tested in a field visit to the Palestinian Occupied Terrotiries Subsequentlyadapted versions were discussed with programme officers at the Belgian DirectorateGeneral for Development Cooperation (DGCD) and at the First International Meeting

organised by UNFPA in Brussels for the Project on “Reproductive Health and Gender Needs of Adolescent Internally Displaced Persons” (Brussels, 7-11 October 2002), a

programme supported by the Belgian DGCD At the ICRH international expert

meeting on “Sexual and Reproductive Needs and Rights of Women Displaced by War and Armed Conflict” (Ghent, 25-27 November 2002) the draft was peer

reviewed A more final version was discussed during a lunch conference organized

by the Belgian Technical Cooperation

As it happens, this kind of guides will always need continuous adapting and updating,but we hope that it will be a useful tool for all involved in the development,implementation , monitoring and evaluation of SRH humanitarian aid programmes inpaving the way for a more comprehensive, gender sensitive and culture sensitiveapproach of displaced women’s SRH

7

II PURPOSE AND USE OF THE GUIDE

? To assure a multidisciplinary, multisectoral and integrated approach of women’ssexual and reproductive rights and needs by including legal, political, economical,social, cultural and health aspects which determine women’s SRH status

? To identify needs and gaps in the approach of sexual and reproductive rights andneeds of women displaced by war and armed conflict

? To guide the development of comprehensive SRH programmes in conflictsituations within a long term perspective

? To gain insight in the contribution of a specific SRH project to the improvement ofthe SRH status of women displaced by war and armed conflict

1.3 TARGET GROUP

This guide has been developed for programme officers in charge of humanitarian aidprogrammes in SRH who are not necessarily medically trained and may not befamiliar with all aspects of SRH of refugees and internally displaced persons

1.4 PROCESS

The development of comprehensive SRH services in conflict situations should beseen as a process evolving from the delivery of emergency aid in SRH to theplanning of more sustainable SRH programmes as the situation stabilizes Obviouslyspecific SRH projects may focus on only one or just a few aspects of SRH but theyshould always be embedded in a coordinated effort to achieve a sustainableimprovement of the SRH of women displaced by war and armed conflict The guide is

has been conceived as a tool 1) for screening SRH humanitarian aid programmes inorder to identify needs and gaps for reaching this goal; 2) for assessing thecontribution of specific projects to coordinated efforts in the field of SRH

The guide focuses on the sexual and reproductive rights and needs of women inemergencies and in the stabilized phase of conflict It is divided into differentchapters comprising a series of topics concerning the different aspects that should betaken into account It does not only include medical aspects of SRH, but equallyemphasizes the need for the development of an enabling political, legal, economical,social and cultural environment The list of topics is not exhaustive and can beadapted to each specific situation It is mainly meant as a supportive and orientingtool in discussions with the counterpart and other stakeholders involved in theprovision of SRH services in the context of humanitarian operations

As the emphasis is on a comprehensive and coordinated approach, the formulation

of the conclusions should focus on the overall SRH related issues as well as on thespecific role and contribution of the counterpart in the kind of SRH services provided,their quality, accessibility and affordability These conclusions can be translated intorecommendations which may contribute to the development of strategies to enhancefull respect of displaced women’s sexual and reproductive rights and needs

- humanitarian organizations:

o active in the field of refugee health

o local, national as well as international

o preferably organizations working on one or moreaspects of SRH

- human rights organizations:

o active in the defense of human rights ofrefugees/IDP, and more specifically of women’s rights

- others:

o other organizations and persons who may be able toprovide important insights in the SRH situation andcare for refugees/IDP in general, and for

refugee/internally displaced women in particular(such as universities and research centres)

3 Programme Organization of the mission agenda: meetings with the

stakeholders involved and visits to the displacedcommunities

4 Interviews Semi-structured and open interviews with a representative

number of key informants among the broad scope ofstakeholders using the guide as a support for thediscussions

5 Focus group

discussions

Semi-structured focus group discussions with displacedwomen and health providers using the guide as a support

7 Feed back Discussion of the preliminary conclusions and

recommendations at a joint meeting with representatives ofthe counterpart and other directly involved stakeholders

8 Report Report of the field visit with final conclusions and

III GUIDE

1 CONFLICT ANALYSIS

Since the end of the Cold War there has been a dramatic increase in the number ofarmed conflicts and wars, most of them taking place in developing countries andmore particularly in Least Developed Countries In these countries the massivedisplacement of people and the vast flow of refugees often provoke devastatingeffects on the already scarce economic and natural resources and put a heavyburden on the often precarious social and medical services Moreover most conflicts

no longer take place between regular armies of recognized states but also involvenon-state actors, such as guerrilla organizations, armed rebel organizations and localmilitia, with all sides intentionally targeting civilian populations and violating theregulations of international humanitarian law

In conflict and displacement different phases can be distinguished: 1) pre-conflict, 2)conflict and emergency, 3) stabilization and 4) return and post-conflict Each one ofthese phases requires different kinds of interventions to be undertaken byhumanitarian organizations although phases may overlap and the transition betweenone phase and the other is not always very clear

When developing SRH programmes it is important to identify the specificcharacteristics of the conflict that may seriously hamper the implementation of SRHprogrammes for refugee and internally displaced women

The following topics in a conflict analysis1 should be considered:

1

REYCHLER Luc, Een wereld veilig voor conflict Handboek voor vredesonderzoek., Garant,

Leuven-Apeldoorn, 1995 (p.215-288)

- Degree of violence: kind of violence (conventional war,terrorist war, guerrilla warfare), kind of weapons used.

- Kind of human destruction: casualties, injured,traumatization, refugees, internal displaced persons,main victims (military, civilians, ethnical groups; women,elderly, children, young men)

- Kind of socio-economical destruction: damage toinfrastructure (buildings, houses, hospitals, roads,energy supplies, transport)

- Kind of ecological destruction: drinking water supply,agricultural production, mines

- Geographical spread of the conflict: capital, main towns,certain areas

- Peace efforts: economical aid, peace keeping forces,care for refugees and internally displaced persons, carefor injured persons

Conflicting parties - Number of parties

- Kind of parties: conflicting states, military forces(national, regional, international), guerrilla, paramilitary,armed groups, armed civilians

Causes - Interests: political, economical power, territorial

autonomy

- Values: cultural, religious, ideological

- Collective identity: ethnicity, nationalism

- Irrational: hatred, revenge, aggression

2 DISPLACEMENT

Forced displacements of people and refugee movements are no longer side effects

of war and armed conflict but are increasingly used as tactics in war Moreover, thesituation of refugees and IDPs is urging humanitarian organizations to revise theirpolicies and programmes and to reconsider them within a long-term strategy as there

is a strong tendency of conflicts to remain unsolved for many years

A difference should also be made between refugees and internally displaced persons(IDP) According to international humanitarian law, refugees cross national bordersand are protected by international legal standards Internally displaced persons alsoflee violence and conflict but as they stay within their country, they should beprotected by national legislation On the whole IPS are subject to hostility of both thehosting community and the public authorities In very few countries IDPs areregistered though many people are reluctant to do so out of fear for persecution.Refugee and IDP communities do not constitute homogeneous, a-political entities.Refugees and IDPs carry their political ideologies, preferences and strives with themand camps and settlements are often used as a battleground to continue powerstruggles and fights Camps can be open or closed People can also live dispersedamong the host population and large self-settlements may gradually turn into camps.Refugee and IDP camps and settlements are not necessarily safe-havens and areoften located in remote regions in the midst of or close to the conflict area oftenhampering access of humanitarian relief aid

Having a clear insight in the kind of displacement, the characteristics of the displacedpopulation and the organization of the displaced communities is extremely important

in order to be able to design appropriate SRH interventions

The following topics should be considered2:

2

OJEDA Gabriel, MURAD Rocío, Salud Sexual y Reproductiva en Zonas Marginales Situación de las Mujeres

Desplazadas.”, Asociación Probienestar de la Familia Colombiana PROFAMILIA, Bogotá, 2001 (p.9-42).

Displacement - Causes (armed conflict, insecurity, forced displacement,

family reunion, employment, health, famine)

- Access to social services, including SRH services

- Special provisions for sole female headed households

Living conditions - Settlement (closed camps, open camps, refugee centres,

dispersed among hosting community)

- Housing (tents, slums, brick houses)

- Access to basic goods and services (water, food, fuel,sanitary provisions)

- Measures to guarantee women’s access to basic goodsand services

- Security and protection (presence of military forces, armedgroups, gangs, civil security patrols)

Management and

organization

- Institutions and authorities in charge (national,international, governmental, non-governmental, communitybased organizations)

- Organization of the displaced population

- Organization of the displaced women

- Participation of the displaced in the management

- Active involvement of women in the management

3 STAKEHOLDERS

The provision of comprehensive SRH services to displaced women in conflictsituations may involve different stakeholders including donors, internationalinstitutions, governments, local authorities, national and international non-governmental organizations (NGO) and local community based organizations (CBO)

At governmental level the organization of SRH programmes for displaced womenshould not only be restricted to the participation of the Ministry of Health, but alsoinvolve other Ministries such as the Ministry of Education (sexual educationprogrammes), the Ministry of Justice (gender based violence), the Ministry of SocialAffairs (social security and assistance to widows and sole female heads ofhousehold) and even the Ministry of Defence (prevention of violence against women,prevention of HIV/AIDS, security) In order to improve the efficiency andeffectiveness of the SRH humanitarian aid programmes, coordination amongstakeholders should be encouraged and supported, and more particularlycoordinating mechanisms for the improvement of the displaced women’s SRH should

be set up

In view of a comprehensive approach of the sexual and reproductive rights andneeds of displaced women, the stakeholders community should not only includeorganizations with a specific medical approach but should also include women’sorganizations and human rights organizations that promote and defend women’shuman rights, and more particularly women’s sexual and reproductive rights

The following topics should be considered:

Identification - Stakeholders involved in humanitarian aid for the displaced

population (donors, international organizations, nationaland local authorities, international and national NGOs, andCBOs including human rights and women’s organizations)

- Stakeholders involved in SRH humanitarian aid

Coordination - Coordinating mechanisms (members, mandate, objectives,

effectiveness, efficiency)

- Participation of national NGOs and authorities

- Participation of national women’s and human rightsorganizations

- Participation and role of the counterpart in thesemechanisms

- Participation of national NGOs and authorities.

- Participation of national women’s and human rightsorganizations

- Participation and role of the counterpart in thesemechanisms

4 IMPACT OF THE CONFLICT ON THE SRH STATUS OF

DISPLACED WOMEN

4.1 IMPACT ON THE POLITICAL ENVIRONMENT

Conflict situations and massive displacement of people may seriously affect thenational and local health system The kind and scope of SRH services that can beprovided in a certain setting are highly dependent on the national health policy in thehost country, and more particularly on the national protocol and guidelines on SRH ofthe host country These protocol and guidelines do not necessarily provide for allSRH related services - including family planning (FP), safe motherhood, sexuallytransmitted infections (STI) and HIV/AIDS, and violence against women

SRH services for displaced women should always respect the existing healthstructures, practices and policies of the host countries or the host community andreinforce them where necessary In this way humanitarian SRH interventions inconflict situations may contribute to the development of a more integrated andcomprehensive SRH policy in the host country in the long term

The following topics should be considered:

National health

policy

- National protocol and guidelines on SRH

- Inclusion of SRH issues such as:

o safe motherhood: antenatal and postnatal care, safedeliveries, emergency obstetric care

o family planning: counselling and delivery of moderncontraceptives

o STI/HIV/AIDS: prevention, treatment, care and support

o gender-based violence: prevention, medical assistance,psychosocial support, referral system for legal aid

- Impact of the conflict/displacement on the implementation(disruption of the policy implementation, initiation of newprogrammes, reinforcement of ongoing programmes)

- International support

- SRH policy (protocol, priorities, mandate).

- Compliance with national SRH policy

- Support to development/reinforcement of national SRHpolicy

4.2 IMPACT ON THE LEGAL ENVIRONMENT

The promotion of women’s sexual and reproductive rights is fundamental forimproving women’s SRH The awareness among stakeholders involved in theprovision of SRH services about the importance of women’s human rights, and moreparticular of women’s sexual and reproductive rights, is gradually growing but is still

no real priority for most of them

Women’s and human rights organizations which pay attention to women’s sexual andreproductive rights can help to gain a better insight in the national regulations andstandards that affect the SRH of women, and more particularly the SRH of thedisplaced women Comprehensive SRH programmes for displaced women shouldinclude support to advocacy and counselling efforts aimed at improving the legalstatus of women as well as support to the development of a legal framework for theprotection of women’s sexual and reproductive rights

The following topics should be considered:

Domestic law - Recognition of women’s rights as human rights in

domestic law

- Legal standards concerning SRH related issues such as:marriage, widowhood, unwanted pregnancies, gender-based violence, harmful traditional practices (such asearly marriage, female genital mutilation, dowry, honourkillings), support to HIV/AIDS infected

Other legal systems - Impact of customary law on displaced women’s SRH

- Impact of tribal law on displaced women’s SRH

- Impact of religious law on displaced women’s SRH

Women’s rights - Collaboration with human rights and women’s rights

organizations

- Support to women’s rights and sexual and reproductiverights initiatives (awareness raising, training, referralsystem for legal aid and counselling, advocacy)

4.3 IMPACT ON THE SOCIO-CULTURAL ENVIRONMENT

Information about the social and cultural environment of displaced women’ SRH isneeded to gain a better insight in the social and cultural factors that affect thedisplaced women’s SRH Culture and customs affect women’s SRH in multiple waysand are highly determinant for their SRH knowledge, needs, beliefs and attitudes.They may also be a main cause of under-utilization of the SRH services provided Intimes of conflict and displacement women may become even more vulnerable in theirSRH as a result of their sex and changing gender-roles in society

In many cultures the deployment of male health staff often constitutes a mainobstacle for women to attend the SRH facilities and the deployment of internationalstaff may be the cause of serious language and communication problems

Active involvement of the displaced community, with special emphasis on the activeparticipation of women, in the needs assessment and the design of SRH services isimportant to ensure that these services are gender sensitive and culturallyacceptable, and that they respond to women’s real needs and can rely on communitysupport

The following topics should be considered:

- Impact of the community

- Impact of the family

- Impact of prevailing gender-relationships: man-women,boy-girl, elderly-young

- Impact of changing gender-relationships