Photo: Prince Collins/IRIN

Many survivors of sexual violence never come forward to seek help

NAIROBI,  – People who have suffered sexual violence in countries facing humanitarian crises need much more accessible, comprehensive and confidential care than is currently available, says a new report by the international medical charity, Médecins Sans Frontières (MSF).

“We find that the specific emergency care needed for victims of rape is either very rare or completely absent in the countries where we operate,” said Thilde Knudsen, MSF’s sexual and reproductive health advisor. “The damage cannot be completely undone; some level of psychological impact is likely to remain for life.”

In the report, Shattered Lives, released on 5 March,  MSF highlights its experience with sexual violence in Burundi, Colombia, the Democratic Republic of Congo, Liberia and South Africa.

As part of the comprehensive care required for sexual violence victims MSF lists counselling, post-exposure prophylaxis to prevent HIV-infection, treatment for other sexually transmitted infections, such as Hepatitis-B, tetanus injections for those physically injured, and emergency contraception.

“With the right package of timely medical care, coupled with trauma counselling and social and legal support, the damage can be limited and the victim helped to survive,” Knudsen stressed.

MSF also said aggressive awareness-raising campaigns were necessary to break social taboos and encourage survivors of sexual violence – including male survivors, who often went unrecognised and untreated – to report.

“Our teams hear painful stories of horrible abuse every day,” said Meinie Nicolai, operational director of MSF in Belgium. “There can be no excuse for sexual violence, no matter how prevalent these violations may be in some of the places where we work.”

kr/oa/he source.irinnews.org

Photo: Flickr/Yilud

Hoping for a better future

PORT MORESBY, – Yangpela is Papua New Guinea’s (PNG) only youth-friendly hotline, run by the sexual and reproductive health NGO, Marie Stopes, in a cramped office in the capital, Port Moresby.

Not quite knowing what burning question to ask, and feeling a bit of a fraud, IRIN/PlusNews dialled the toll-free number.

The phone was answered after just three rings. “I don’t like using condoms,” this reporter said. “Why?” came the gentle but unexpected reply. “Because they don’t feel nice,” I stammered. “If you don’t like using condoms, then it’s better you stick to one partner and you will be okay.”

Colis Gamoga, the young man at the other end of the phone, was slick. The hotline, launched in September and supported by the UN Children’s Fund (UNICEF) gets about 17 calls a day, mostly young people anxious for information and advice. Over the course of his four-hour shift, Gamoga does his best to steer them right.

PNG has one of the highest prevalence rates of HIV and sexually transmitted infections (STIs) in the Asia-Pacific region; a lack of awareness about safer sex, especially among the youth, is one of the contributory problems.

“All of this is preventable,” said Jet Riparip, the head of Marie Stopes in PNG, “but there is a lack of correct information, and a lot of myths and rumours.”

One common notion, for example, is that pregnancy occurs only after the sixth time of having sex with the same partner, so young people are advised by their peers and elders to change partners regularly.

“Basic facts about sex and reproduction remain widely misunderstood,” notes an Asia Development Bank report. “However, monitoring what is being taught is essential, as copious examples are available of health educators and others in positions of ‘authority’ giving out incorrect information” to discourage “unwanted” behaviour.

Researchers note that pornography is readily available and shared among teens, from magazines to communal viewing of hardcore movies – not the most appropriate models for sex education.

Given PNG’s difficult terrain, its deep valleys and forested highlands, many communities are isolated, and access to public health is a significant challenge. If the long walk to a clinic for a check-up or to treat an STI is not off-putting enough, a moralising attitude by medical staff can be the final deterrent to young people, as several studies have pointed out.

Christian churches play a powerful role in PNG, and some health workers reflect those values. “Some staff openly show youth that they do not approve of their life style, and respondents said youth believe they do not get proper treatment as a punishment,” a Save the Children survey found.

We have to survive. The boys turn to petty crime and the girls have to sell themselves. Everybody knows that

The Marie Stopes centre includes a full-time doctor, and provides HIV and STI testing and counselling, but Riparip deliberately keeps the facility as low-key as possible. “We don’t call it a clinic because we don’t want people to be scared to enter our door … The receptionist doesn’t ask you why you are there, and we stress privacy and confidentiality.”

Around 40 percent of PNG’s population is of school-going age, but less than 15 percent are enrolled in secondary school – and only one-third of those pupils are girls, noted the Asian Development Bank report. The low rate of formal schooling complicates HIV awareness, and sharply increases the vulnerability of girls in particular.

Multiple-partner sex

Normally, HIV epidemics are centred on sex workers and their clients before expanding into the general population. But the combined prevalence of commercial, transactional and multiple-partner sex in PNG has meant that the general population has been exposed far faster, a UNICEF report points out.

A lack of job opportunities for women and the general cultural acceptance that men can have multiple partners narrows options and deepens dependency. “A small sample in Papua New Guinea shows that two in three women aged 15 to 24 accept cash or gifts in exchange for sex,” the UNICEF study said.

A survey of child sexual exploitation in PNG included this testimony from a young girl: “We have to survive. The boys turn to petty crime and the girls have to sell themselves. Everybody knows that. That’s why no one says anything and accepts the cash, food and other things that we can bring home.”

The evidence of trans-generational sex is in the HIV statistics. According to the UNICEF report, “Twice as many girls and women between the ages of 15 and 29 are getting infected than boys and men of the same age, but more men than women above the age of 30 are acquiring the virus.”

Widespread sexual violence is yet another factor in the vulnerability of women and young girls. The World Health Organization has said that nearly half of reported rape victims in PNG were under the age of 15, while 13 percent were under the age of seven.

The deep-seated poverty and violence confronting young people in PNG seems guaranteed to stifle any gains made in HIV prevention, but Gamoga and his Yangpela colleague, Idau Ghou, believe they make a difference each day – even if it is just to listen on the end of the phone, or to persuade a client to see a doctor and get a check up.   

“So many people text [SMS] back or call back and thank us for what we’ve done – they’ve been through medical treatment and are well now,” Ghou told IRIN/PlusNews.

oa/he source.www.irinnews.org

Photo: Kristy Siegfried/IRIN

There are 180,000 orphaned children in Lesotho

JOHANNESBURG,  – This month, 5,000 orphans and vulnerable children in three districts of Lesotho will start benefiting from a new government scheme to alleviate the poverty preventing them from going to school, having enough to eat and staying healthy.

About 55 percent of the estimated 180,000 orphaned children in the tiny mountain kingdom, which has the third highest HIV prevalence in the world, have lost one or both parents to the virus.

“It is well known that when people have this disease, the tendency is to be in denial for some time and in the meantime to spend a lot of money going from one traditional healer or doctor to the next,” said Limakatso Chisepo, director of the Department of Social Welfare. “By the time they die, family resources are depleted.”

Now, help is at hand for children who are “the neediest of the needy” as the government starts rolling out a Child Grants Programme, with funding from the European Commission and technical assistance from UNICEF.

As part of a pilot phase, 1,250 households identified and nominated by their communities will receive their first quarterly payment of 360 maloti (US$38) in April. “The amount [of the grant], though very small, we’re convinced does make a difference in the life of a child,” Chisepo told IRIN/PlusNews.

Mohemmad Farooq, a UNICEF child protection specialist who helped design the programme, said the grant was not meant to cater for 100 percent of a child’s needs.

“There’s a fear people may get addicted to social grants and abandon their own struggle,” he said. As the programme is eventually expected to reach about 60,000 children, the grant also had to be an amount that the Lesotho government could afford to eventually take over and keep paying.

Farooq said the decision to give cash instead of food parcels or other types of support was based on global experience suggesting that cash grants gave households more flexibility. “Your priority might be medicine or clothes; when people are given in-kind support, they often sell it to get cash for less than its worth.”

A pilot cash-transfer scheme run by Christian relief organisation World Vision in 2008, experimented with giving some households food parcels, some an equivalent amount of cash, and a third group a combination of food and cash. Jonathan Moyo, a commodities officer at World Vision, said households that received the combination benefited most.

“The downside of giving cash only is that people spend it on other things like school fees and funerals, and end up going hungry,” he said. “You also have to look at the availability of markets in the area and make sure they don’t have to spend money on travelling long distances to buy food.”

Chisepo admitted that it would be difficult to make sure households actually spent the money on children, but community committees would be set up to monitor the children’s well-being and handle complaints.

The committees will also determine which households qualify for the grants. “In this country more than 60 percent of the population is living below the poverty line,” said Farooq, “but we can only cover maybe 25 percent of those who qualify, so we had to come up with a mechanism.”

In neighbouring South Africa, where monthly child support grants were introduced over 10 years ago, studies have shown that children in poor households who received the grant were more likely to be enrolled in school and have better access to food and healthcare.

ks/he/kn

source.www.irinnews.org

Photo: Colin Crowley/Save the Children

Two infants outside Save the Children’s treatment centre for malnourished children in Kutayu Village, Mandera

NAIROBI,  – Alarming levels of malnutrition are being recorded in children between six and 59 months old in the north-eastern region of Mandera, which is grappling with successive droughts, high food prices and a scarcity of water, according to humanitarian officials.

Malnutrition levels have increased significantly in the past year, according to independent survey findings from January to March by Action Against Hunger (ACF), Islamic Relief (IR), and Save the Children (SCUK).

“Currently, the rate of Global Acute Malnutrition [GAM] stands at an average 30 percent, twice the [UN] World Health Organization’s accepted emergency threshold of 15 percent,” according to a 7 April joint statement by the international NGOs. “Equally, the rate of Severe Acute Malnutrition [SAM] is at an average of 5 percent.”

“Even without the data, the sheer number of new malnutrition cases is alarming and indicates the emergency has become acute,” said Yesuf Abdella of IR.

About 200,000 people in Mandera, which has a population of about 325,000, are already relying on food aid, according to Titus Mung’ou, Kenya Red Cross Society (KRCS) communications manager.

Children at risk

According to the statement, at least 20,628 children, 32.6 percent of the total child population in Mandera, are acutely malnourished: “Of these, 4,624 are severely malnourished and at risk of death if no urgent intervention is found.” Admissions to supplementary feeding and out-patient therapeutic programmes have risen by at least 40 percent.

Worst affected are pastoralist divisions of Takaba and Dandu, north-west of Mandera, where GAM levels of up to 32.3 percent have been recorded.

By comparison, in 2006, when the region was facing drought, the rate was 27.7 percent, Lindsay Spainhour, ACF nutrition medical coordinator, told IRIN. “This has heightened the alert, there is an impending emergency.”

Food prices

A lack of water and pasture as well as livestock migration have reduced milk availability. About 75.6 percent of residents surveyed in Takaba and Dandu reported they were not getting milk from their camels or cows. The area is far from the main markets, increasing vulnerability.

Photo: Save The Children

Four-year old Abdi Aziz is nearly four kilogrammes underweight

Since January, the price of milk has gone up by about 30 shillings (US$0.37), Spainhour said.

Although sporadic rains have been reported in the past few days, Mandera remains largely parched. “Everyone is waiting for the rains,” she said. Past long rains failure has also destabilised communities’ livelihoods, leading to pastoralism being abandoned in places like Malkamari and Eymole.

According to Spainhour, additional funding is needed to expand the treatment programme for children: “We need to scale up our treatment activities to mitigate mortality from malnutrition.”

ACF has 14 nutrition sites in Mandera as well as a stabilisation centre at the Mandera hospital to treat severely malnourished children with medical complications.

“… We need help now or the situation will continue to deteriorate. The need for immediate action is critical if we are to effectively respond to this crisis…” said Catherine Fitzgibbon, country director for SCUK. On 2 April SCUK launched a £5 million (about $7.3 million) emergency appeal for Kenya.

aw/mw source.irinnews.org

Photo: FAT/Government of Togo

Togo Armed Forces undertake image campaign (file photo)

LOME, 9 April 2009 (IRIN) – Four years after a massive military crackdown during a presidential election in Togo, the army is trying to change its image by offering for the first time free health care in some of the country’s poorest regions, according to its medical unit.

After a week of delivering free health care in the country’s northern Kara district from 31 March until 4 April, the army’s chief of surgery, Badjona Songne, told IRIN that health care is one way to overcome the army’s abusive reputation. “Before these [military] medical campaigns, the army has always been seen by locals as a symbol of repression – a brute force.”

As part of a 2006 peace process, Togo’s government agreed to create a truth and reconciliation commission to examine alleged human rights abuses that date back to independence in 1956. Of the more than 25,000 people recently surveyed by the UN Office of the High Commissioner for Human Rights in Togo, 70 percent said they wanted the commission to be able to punish offenders.

Health needs 

FACTS on Kara’s children
	25.2% chronic malnutrition
	7.6% acute malnutrition
Source: UNICEF, 2008

The government estimates that in 2006 three-quarters of the nearly 50,000 people living in the country’s northern Kara district earned less than the US$300 government-calculated annual minimum required to cover basic needs. A quarter of Kara’s children suffer from chronic malnutrition, and more than seven percent of all children have acute malnutrition, according to a 2008 joint UN-government survey.

Military surgeon Songne told IRIN the 1,200-strong military force delivering health care, backed by 100 vehicles and a plane, was “overwhelmed” with requests. “The patients were so numerous that we could not assist everyone.”

Songne said the army, in coordination with the Ministry of Health, conducted 27,000 free consultations, performed 132 operations – of 484 requests – and vaccinated 15,000 people against yellow fever, meningitis and measles, at a cost of $130,000 funded by the Ministry of Defence.

The World Health Organization (WHO) representative in Togo, Kadri Tankari, told IRIN he sees no problem with the military delivering health care. “In most African countries the national health systems are very weak and Ministries of Health [government]-based institutions cannot do it alone.”

He said given the “magnitude” of health problems in Togo, the military working with the Health Ministry can help. “Military-owned facilities could provide useful support especially in remote areas,” Tankari said.

According to the government in 2006 almost seven of every 100 babies died in childbirth, 49 percent of births were unattended and there was less than one doctor per 10,000 residents – the minimum recommended by WHO to guarantee basic health service.

…Reconciliation is a process that consists of many elements and not just isolated acts …

Togo’s army surgeon Songne told IRIN he would like to see local leaders turning to the military for free care, which he said the military will continue to offer in location s to be determined. “We want, for example, one day a canton chief to get up a nd say ‘these hernias and goitres [lymph node swelling] – I no longer want to see them in my canton.’” He said it is his “dream” that civilians would come to trust the army.

For Ajavon Zeus, president of the NGO Collective of Associations against Impunity in Togo (CASIT), establishing trust is a long process. “Reconciliation is a process that consists of many elements and not just isolated acts.” Zeus told IRIN that CASIT is preparing hundreds of lawsuits related to alleged military abuses during the 2005 crackdown.

pt/ea/np

source.www.irinnews.org