Photo: David Swanson/IRIN

Health workers and their patients caught in crossfire

BANGKOK,  – As Mohammed Mohammedi lay trapped in the car with his co-worker, pinned down by heavy gunfire, they promised each other that whoever made it out alive would tell the other’s family. Now, 12 years after he was captured and beaten by militias in Somalia while carrying out a polio vaccination campaign, he realizes this was a “futile promise”. 

“If you ask someone at WHO [World Health Organization], ‘What is the extent of the problem?’ [of attacks on health facilities and workers],” said Rudi Coninx, with the Emergency Risk Management and Humanitarian Response team at WHO. “If they were honest they would say, ‘I don’t know.’ as nobody collects these data in a systematic way.”

Mohammedi said he was released after clans who knew the polio vaccination health staff paid the militias. If he or his co-worker had died, there was no international mechanism, then or now, to record that he had been hurt while doing his job as a health worker.

“One of the first victims of war is the healthcare system itself,” wrote Marco Baldan, the chief war surgeon at the International Committee of the Red Cross (ICRC) in an August 2011 agency report, which noted that violence against healthcare is “one of the most crucial yet overlooked humanitarian issues of today”.

Less than one year after launching this report, and a campaign to document and rein in violence against healthcare facilities and workers, the agency suspended its work in Pakistan after one of its programme managers was kidnapped and killed while travelling home in an ICRC vehicle. 

Mohammedi, a WHO polio operation and technical officer now working in Pakistan, told IRIN that regardless of the precautions, humanitarians always face danger. “An agreement with the war-lords, clan, [or] military leader is the best valid agreement, though even that is not a 100 percent guarantee of a person’s safety.”

Fighting often hampers access for health workers in two of the four countries where polio is still endemic – Pakistan and Afghanistan.

Despite international conventions in place to protect health facilities, workers and marked vehicles, as long as they maintain a “neutral function and treat all patients equally, irrespective of political, religious or ethnic affiliation”, the Geneva Convention carries little authority with militias, said Mohammedi.

“Free access is not and will never be possible if the agreements are made by people sitting around a table outside of conflict areas. The militias have a different way of thinking – the only agreement for a militia at war is to kill… For the militia, a prisoner of war is still the enemy.”

The Geneva Convention forms a major part of negotiating access for the medical humanitarian NGO, Médecins Sans Frontières (MSF), but it is difficult when “non-state actors” never agreed to it in the first place, said Michiel Hoffman, a Brussels-based operational advisor to MSF.

Somalia is the only country where MSF is forced to use private guards to protect its health facilities, which is not ideal, but necessary, Hoffman told IRIN. “It is hard to provide healthcare when there is a general disregard for everyone’s lives,” he said. “To have any weapons near a health structure makes them the target of conflict.”

Health facilities have become even more vulnerable as soldiers increasingly enter hospitals to “settle scores”, said Robin Coupland, an ICRC medical advisor, in a January 2012 WHO bulletin.

From a review of internal and public sources, ICRC documented 655 violent events affecting healthcare in 16 countries in conflict from 1 July 2008 to December 2010, of which 41 percent were reported only in internal agency reports.

Documenting the extent of the problem is the first step to start doing something about it, said Coninx.

The “compounded cost” of violence on healthcare, such as healthcare staff fleeing, inventory stock-outs and curtailed vaccination campaigns are also hard to measure, ICRC noted.

On 21 January 2012, WHO’s executive board passed a resolution committing the agency to collecting and distributing data on attacks on health workers, facilities, vehicles and patients in the next two years.

UN member states will vote on this proposal on 25 May 2012 at the ongoing World Health Assembly in Geneva.

pt/he source www.irinnews.org

BAGHDAD,  – Iraq is drawing detailed maps of areas contaminated by landmines and unexploded ordnance (UXO), but is unlikely to clear these areas by a 2018 deadline, says a government official.

“Lack of detailed maps for landmines was one of the major problems and it delayed our mine-clearance efforts because the previous regime planted them randomly,” Deputy Environment Minister Kamal Hussein Latif told IRIN.

“We have teamed up with the ministries of interior and defence since 2011 to start our own survey which will help to identify the exact contaminated areas,” he said.

Despite this, Latif added, the country will not meet the 2018 deadline to clear all landmines and UXO. Iraq set itself the target in 2008 when it joined the Ottawa Convention, under which it committed not to use, produce, acquire or export landmines.

The first province to be mine-mapped is Thi Qar, 400km south of Baghdad, where 98sqkm are confirmed as hazardous. Teams will continue work this year in the most contaminated southern provinces of Basra, Maysan, Muthana and Wasit.

“These areas represent almost 80 percent of the contaminated areas nationwide,” the deputy minister said. “The maps, which we plan to have ready by the end of the year, will help us draw up the best plans and the budget, and identify the number of teams needed and the time required to clear each area.”

Many of Iraq’s landmines date back to the 1960s when fighting began between the Baghdad government and pro-independence Kurdish rebels in the north. The 1980-88 Iraq-Iran war, the 1991 Gulf War and the 2003 US-led invasion added to the problems.

The largest contaminated area stretches for hundreds of kilometres along the border with Iran. Large quantities of UXO also remain scattered throughout cities and towns. Today, Iraq is one of the most mine-contaminated countries in the world with landmines and UXO covering 1,730sqkm, according to the UN Development Programme (UNDP). Around 1.6 million Iraqis in 1,600 communities, or one in every 20 Iraqis, are affected.

Up to 90 percent of contaminated land is agricultural, with many landmines also found around major oil fields.

A recent survey conducted by the UN Inter Agency Information and Analysis Unit found that per capita income is lower in mine-contaminated areas; education achievement is lower in mine-contaminated areas; households in districts with mines are more food insecure; residents of districts with mines rate services such as education and electricity access poorer than those without mines, according to the Office for the Coordination of Humanitarian Affairs.

In 2011, some 30 mine-related incidents were reported with 33 percent of cases fatal. According to UNDP, about 60 percent of reported landmine incidents involved people aged 25-44, while 47 percent of reported UXO incidents involved children aged 5-14.

Frustrated by the slow pace of demining, the government also plans to involve private deminers. “If I work according to the Defence Ministry approach we will need 25 more years and that’s why we want the private sector to get involved,”  said Latif.

sm/eo/cb
source www.irinnews.org

Photo: Lindsay Mackenzie/IRIN

Despite recent violence, many in Yemen are more concerned about making ends meet (file photo)

SANA’A,  – A devastating suicide bomb in the Yemeni capital, Sana’a, may have grabbed international media headlines and highlighted known security problems, but ordinary people are quietly fighting more mundane battles to make ends meet.

Three months after Yemen’s new government took office, frustration is growing, with people in Sana’a saying the pace of economic reform is not fast enough.

“Eighty percent of my income goes on education, food, and medicine for my family,” said Adel Aklan, an unemployed resident of Sana’a. “The government should subsidize basics like wheat, sugar, rice, medicine.

Nuha El Arashi, a college student, told IRIN: “We can barely afford our necessities. Before, it was easy to afford things like milk, bread, water, and vegetables. Nowadays we can hardly afford these, and we avoid all the luxuries. Before, it was cheap and easy to get around in a taxi, but fares have now doubled because the cost of fuel is so high.”

For the last two decades Yemen’s economy was largely driven by oil, but this is quickly running out, according to an April report by the Carnegie Endowment for International Peace. But with 70-80 percent of government revenue still coming from oil, Yemenis are vulnerable to shifts in international commodity prices and domestic oil output, according to think-tank Chatham House.

It said the 2011 political crisis created high levels of inflation and disrupted supplies of basic goods. “There is a need to reinforce existing social protection mechanisms and bolster humanitarian aid to ensure the availability of, and access to, basic commodities for the country’s most vulnerable people,” it said in a recent brief.

Walking around Sana’a it is easy to find disgruntled people: Fawzia, an Ethiopian-born woman working in a khat market, told IRIN: “Tribes are closing roads. Electricity is always out. Even if you stayed in Yemen 100 years, you wouldn’t see a change.”

Unemployment

“Structural unemployment is a very real problem in Yemen, because we can’t send our workers to the Gulf states, because we don’t have the right kind of workers, even for our own businesses,” said Ali El Waafi, an economist and former member of parliament.

“There are jobs [in Yemen], but those who are not working cannot do these jobs because they lack training and education… We need two to three years of training in the short term so that we can have competent workers for our own businesses, then we can send them to the Gulf states.”

Wilfried Engelke, a senior economist at the World Bank, said the exact level of unemployment was difficult to gauge. Some estimates put it at around 20 percent, and up to 50 percent among the youth. Other studies indicate higher figures, he said.

Mostafa Nasr, an economist at the Studies and Economic Media Centre in Sana’a, suggested that the only jobs being created were ministerial jobs.

Food insecurity

A survey conducted in November and December by aid agencies found that 44 percent of Yemeni households could not buy enough food to feed their families. Since 2009, food insecurity has doubled, according to the European Commission. Furthermore, one in three Yemenis has gone into debt to buy food for their family, according to an April report.

A food security specialist in Sana’a, who preferred anonymity, said the price of staple foods rose 50 percent between January and April 2011 and remained at record highs throughout much of the year. Fuel price rises also hiked food prices.

“Even without increasing food and fuel prices, the depreciating rial would still make the daily household budget stretch less far,” said the specialist. A year of high food prices and a depreciated currency would adversely affect food security for the most vulnerable, he added.

A restaurant worker in Sana’a’s historic old city, Saeed El Usheri, said increasing fuel prices had reduced profits and many former clients had lost their jobs and could no longer afford to eat out.

“We used to have 30-40 clients here daily. Now we’ve got 12-15 a day, maybe. It’s a drop of 60 percent at least. Customers used to come and buy a whole lunch. Now they just buy a sandwich or something small and go, because that’s all they can afford.”

El Usheri said his salary of 30,000 rials a month (US$140 dollars) was not enough to cover all his expenses.

sk/eo/cb
source www.irinnews.org