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Abstract: OneResponse is a collaborative inter-agency website designed to enhance humanitarian coordination within the cluster approach, and support the predictable exchange of information in emergencies at the country level. The website will support Clusters and OCHA fulfill their information management responsibilities as per existing IASC guidance. Key characteristics of the site include:
- A global entry page, where all global cluster guidance materials located on www.humanitarianreform.org is currently being migrated.
- Country or emergency specific content will be hosted on the field level site.
- A specific disaster site will be created within 24 hours, during the onset of a new emergency.
- A low-bandwidth version of the site is available, to enable access and exchange of information in poor connectivity environments.
- Information can be categorized as either public or private. This allows sensitive information to be made accessible only to cluster specific working groups.
- Clusters will directly manage their own content on the site.
- OCHA owns the website and is responsible for its management.
Abstract: Key facts and figures for Sudan with a focus on Darfur as of June 2011. Categories include:
- Geography and demographics Area Sudan
- Map and focus areas
- Human Development (HDI, Sudan)
- Economy, Budget and Aid
- GDP / govt revenue ($bn, Sudan)
- Aid ($bn, Sudan)
- Health
- Acute respiratory infections (incidents / 10,000 population, Darfur)
- Nutrition
- Food security
- Cereal production (‘000 MT, Darfur)
- Population
- Urbanization (%,Sudan)
- Min. food basket (SDG / day, Darfur)
- Education
- Water and sanitation
- Environment
- Conflict and fatalities (Darfur)
- Fatalities Darfur
- UN & Partners Work Plan 2011
- Displacement and refugees
- Villages affected (Darfur, cum. total)
- UNAMID
Abstract: This publication draws attention to one of the most crucial yet overlooked humanitarian issues of today: violence against health care. Attacking health-care structures and personnel, and ambulances – as well as deliberately obstructing the efforts of the wounded to find help – are common features of conflicts throughout the world.
In Sri Lanka and Somalia, hospitals have been shelled; in Libya and Lebanon, ambulances have been shot at; in Bahrain, medical personnel who treated protesters are on trial; and in Afghanistan, the wounded languish for hours in vehicles held up in checkpoint queues. From Colombia to Gaza, and from the Democratic Republic of the Congo to Nepal, there is a lack of respect for the neutrality of health-care facilities and personnel, and medical vehicles, among both those attacking them and those who misuse them for military gain.
The ICRC has been documenting violence against health-care facilities and personnel, and against patients, since 2008 in 16 countries where it is working. The number of incidents that have been recorded is striking. But statistics represent only the tip of the iceberg: they do not capture the compounded cost of violence – health-care staff leaving their posts, hospitals running out of supplies and vaccination campaigns coming to a halt. These knock-on effects dramatically limit access to health care for entire communities, many of whose members may be suffering from chronic or war-related health problems.
Abstract: Scores were killed in Syria as security forces backed by tanks launched an assault on the restive central city of Hama and other towns and cities, at the end of a month which saw hundreds of thousands take to the streets as daily anti-regime protests continued to spread. Syrian rights groups reported that more than 1,600 people have been killed and at least 12,000 arrested since the unrest began in March.
In Yemen violence escalated in Arhab, a mountainous area northeast of the capital Sanaa, where at least 40 were killed at the end of the month in clashes between government forces and armed tribesmen loyal to the opposition.
The UN declared a state of famine in Somalia's Bakool and Lower Shabelle regions, both controlled by Islamist militant group Al-Shabaab, following the worst drought in half a century and protracted instability.
There were hopes for political reconciliation in Burundi, as opposition parties welcomed President Pierre Nkurunziza's 30 June Independence Day speech inviting opposition leaders to return from exile and resume talks with the government.
In Malawi security forces used live ammunition to disperse thousands of anti-government protesters from 20-21 July, leaving at least eighteen people dead.
At least one presidential guard was killed on 19 July during two separate attacks on the home of Guinea's President Alpha Condé. Security forces arrested 38 people in connection with the attacks, including 25 military personnel. Most of those arrested have links with former junta leader Sekouba Konaté.
Ethnic violence flared in Pakistan's second city and commercial hub Karachi, leaving more than 200 people dead. July was the deadliest month in decades for clashes between supporters of the mainly Pashtun Awami National Party and the Muttahida Qaumi Movement, representing the Urdu-speaking majority.
In Afghanistan, the Taliban stepped up their assassination campaign against government officials and key allies of President Hamid Karzai. Ahmed Wali Karzai, the president's half-brother and influential governor of volatile Kandahar province, was killed by his own bodyguard on 12 July, while the mayor of Kandahar city and a top adviser to the president died in separate suicide attacks later in the month.
Tensions soared in Kosovo late month after Kosovo special police attempted to take control of two customs posts in the north to enforce a new ban on imports from Serbia, triggering a violent response from Kosovo Serbs.
Abstract: Background
In 2004, Afghanistan pioneered a balanced scorecard performance system to manage the delivery of primary health care services. This study examines the trends of 29 key performance indicators over a 5-year period between 2004 and 2008.
Methods and Findings
Independent evaluations of performance in six domains were conducted annually through 5,500 patient observations and exit interviews and 1,500 provider interviews in >600 facilities selected by stratified random sampling in each province. Generalized estimating equation models were used to assess trends in BSC parameters. There was a progressive improvement in the national median scores scaled from 0–100 between 2004 and 2008 in all six domains: patient and community satisfaction of services 65.3–84.5, p<0.0001 ; provider satisfaction 65.4–79.2, p<0.01 ; capacity for service provision 47.4–76.4, p<0.0001; quality of services 40.5–67.4, p<0.0001; and overall vision for pro-poor and pro-female health services 52.0–52.6. The financial domain also showed improvement until 2007 84.4–95.7, p<0.01, after which user fees were eliminated. By 2008, all provinces achieved the upper benchmark of national median set in 2004.
Conclusions
The BSC has been successfully employed to assess and improve health service capacity and service delivery using performance benchmarking during the 5-year period. However, scorecard reconfigurations are needed to integrate effectiveness and efficiency measures and accommodate changes in health systems policy and strategy architecture to ensure its continued relevance and effectiveness as a comprehensive health system performance measure. The process of BSC design and implementation can serve as a valuable prototype for health policy planners managing performance in similar health care contexts.
Abstract: This policy brief focuses on a case study. It is suggested that an environmental disaster during the summer of 2010 in the Black Sea region triggered in winter 2011 a food crisis in the Arab World; in turn, this led to massive riots, revolts, political instability, a NATO operation and, alas, an oil crisis that accentuates an already suffering global economy. Coextensively, it may be suggested that an environmental crisis triggered a political crisis, which escalated in a series of conflicts that are of major concern for traditional security structures in Europe and beyond. In sum, the argument is made that as a result of this experience, the human security agenda must have a direct effect on our traditional security agenda. The question addressed at this point is how these interrelated chains of events affect the security establishment and our notions of a ‘high strategy.’
Abstract: This report is the culmination of a six-month project commissioned
by the Women’s Refugee Commission and co-funded by the United
Nations High Commissioner for Refugees (UNHCR) to address the
rights and needs of displaced persons with disabilities, with a
particular focus on women (including older women), children and
youth. Based on field research in five refugee situations, as well as
global desk research, the Women’s Refugee Commission sought to
map existing services for displaced persons with disabilities, identify
gaps and good practices and make recommendations on how to
improve services, protection and participation for displaced persons
with disabilities. The objective of the project was to gather initial
empirical data and produce a Resource Kit that would be of
practical use to UN and nongovernmental organization (NGO) field
staff working with displaced persons with disabilities.
Abstract: Three decades of civil war and cold war powers interference have resulted in an extremely painful
situation for children in Cambodia. They suffer from the physical and psychological scars of conflict, from
displacement and exploitation, from insufficient health care and environmental insecurity, from a political
culture of corruption which diverts funds from their educational and health objectives and from a brutalisation of
the society which endangers their freedom from fear. This study attempts to review the vast range of threats to
which Cambodian children may be subject and to use the Human Security approach to highlight how
interdependent these threats are, thus using the academic revolution introduced by this paradigm in threat
assessment. But it has also attempts to exploit the more controversial “operational” side of HS in sketching
personal insights on how the dealing with these respective threats may be improved, notably through more
coordinated responses.
Abstract: Background
Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context.
Methods
In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff.
Results
Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65%) were male and the median age was 22 (interquartile range, 17-30). 1460 (70%) of interventions were emergent. Trauma accounted for 76% (1585) of all surgical pathology; gunshot wounds accounted for 89% (584) of violent injuries. Operative mortality (0.5% of all surgical interventions) was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists.
Abstract: Background: Despite the serious consequences of conflict for reproductive
health, populations affected by conflict and its aftermath face tremendous
barriers to accessing reproductive health services, due to insecurity,
inadequate numbers of trained personnel and lack of supplies. Family
planning is often particularly neglected.
Methods: In six conflict-affected areas in Sudan, northern Uganda and the
Democratic Republic of Congo, household surveys of married or in-union
women of reproductive age were conducted to determine baseline measures
of family planning knowledge, attitudes and behaviors regarding
contraception. Health facility assessments were carried out to assess baseline
measures of family planning services availability. Data were double-entered
into CSPro 3.2 and exported to SAS 9.2, which was used to calculate
descriptive statistics. The studies’ purposes were to guide program activities
and to serve as a baseline against which program accomplishments could be
measured.
Results: Knowledge of modern contraceptive methods was low relative to
other sub-Saharan African countries, and use of modern methods was under
4 percent in four sites; in two sites with prior family planning services it was 12 percent
and 16.2 percent. From 30 percent to 40 percent of women reported they did not want a child
within two years, however, and an additional 12 percent to 35 percent wanted no
additional children, suggesting a clear need for family planning services. The
health facilities assessment showed that at most only one-third of the facilities
mandated to provide family planning had the necessary staff, equipment and
supplies to do so adequately; in some areas, none of the facilities were
prepared to offer such services.
Conclusions: Family planning services are desired by women living in crisis
situations when offered in a manner appropriate to their needs, yet services
are rarely adequate to meet these needs. Refugee and internally displaced
women must be included in national and donors’ plans to improve family
planning in Africa.
Abstract: The paper investigates the effect of child malnutrition on the risk of mortality in
Burundi, a very poor country heavily affected by civil war. We use anthropometric data from
a longitudinal survey - 1998-2007. We find that undernourished children, as measured by the
height-for-age z-scores - HAZ - in 1998 had a higher probability to die during subsequent
years. In order to address the problem of omitted variables correlated with both nutritional
status and the risk of mortality, we use the length of exposure to civil war prior to 1998 as a
source of exogenous variation in a child’s nutritional status. Children exposed to civil war in
their area of residence have worse nutritional status. The paper finds that one year of exposure
translates into a 0.15 decrease in the HAZ, resulting in a 10 percent increase in the probability to die
for the whole sample as well as a 0.34 decrease in HAZ per year of exposure for boys only,
resulting in 25 percent increase in the probability to die. We show the robustness of our results.
Food and income transfer programs during civil war should be put in place to avoid the longterm
effects of malnutrition.
Abstract: The aim of this paper is to study the short and long-term fertility effects of mass violent conflict on different population sub-groups. The authors pool three nationally representative demographic and health surveys from before and after the genocide in Rwanda, identifying conflict exposure of the survivors in multiple ways. The analysis finds a robust effect of genocide on fertility, with a strong replacement effect for lost children. Having lost siblings reduces fertility only in the short term. Most interesting is the continued importance of the institution of marriage in determining fertility and in reducing fertility for the large group of widows in Rwanda.
Abstract: Key facts and figures for Sudan with a focus on Darfur as of June 2011. Categories include:
- Geography and demographics
Area Sudan
- Map and focus areas
- Human Development (HDI, Sudan)
- Economy, Budget and Aid
- GDP / govt revenue ($bn, Sudan)
- Aid ($bn, Sudan)
- Health
- Acute respiratory infections (incidents / 10,000 population, Darfur)
- Nutrition
- Food security
- Cereal production (‘000 MT, Darfur)
- Population
- Urbanization (%,Sudan)
- Min. food basket (SDG / day, Darfur)
- Education
- Water and sanitation
- Environment
- Conflict and fatalities (Darfur)
- Fatalities Darfur
- UN & Partners Work Plan 2011
- Displacement and refugees
- Villages affected (Darfur, cum. total)
- UNAMID
Abstract: Hardly a day passes without media
reports of yet another unanticipated
crisis producing enormous human
suffering. While generalizations may
be premature in this confusing era after the
Cold War, these human survival crises
appear to share some common features.
First, most are intranational -- conflicts
between contending groups within a country
-- rather than between nations. Violence and
conflict erupt among ethnic, religious, and
other groups divided by long-standing historical
fissures, exacerbated by still poorly
understood political, economic, and social
forces. Most of the deaths and suffering are
inflicted upon civilian populations rather
than combatants; indeed, innocent people are
often the primary target of conflict rather
than mere by-products of war. Threats to
human survival and well being are more
often silent and invisible, greater than even
that reported in the mass media, stemming
from the collapse of social and material life
support systems. Malnutrition and common
infectious diseases, in addition to injury due
to violence, are the major causes of death and
suffering.
Especially destructive is the migration of
international refugees or, increasingly, of displaced
persons within national boundaries.
Effective interventions, moreover,
require both the motivation to act and effective
access to the affected population. Such
access may be extremely complicated in contemporary
crises due to political, logistical,
institutional, ethical, and financial factors. The frontier research agenda of humanitarian
intervention, therefore, is to develop policies
for overcoming these constraints to access.
Two among several such policy issues considered
in this paper are rapid humanitarian
assessments and the institutional capabilities
for humanitarian action.
Abstract: Background:
1. The Human Rights Council convened a special session on human rights in the
Syrian Arab Republic on 29 April 2011. During the special session the Council adopted
Resolution S-16/1. This resolution requested that the High Commissioner provide a
preliminary report on the situation of human rights in the Syrian Arab Republic to the
Council at its seventeenth session. The present report is submitted in response to this
request.
2. The period addressed in this preliminary report is 15 March to 15 June 2011.
During this period, the Office of the High Commissioner for Human Rights (OHCHR) was
unable to deploy staff on the ground in Syria and, until recently, to other countries where
Syrian refugees had fled. This hampered the process of gathering information directly from
victims of human rights violations, eyewitnesses and others. Therefore, much of the
information contained in this report is based on information received from United Nations
partners, human rights defenders, national and international human rights organizations,
civil society organizations, media sources and other individuals, including a small number
of victims of human rights violations and eyewitnesses from Syria.
3. Resolution S-16/1 also requested the High Commissioner to urgently dispatch a
mission to the Syrian Arab Republic to investigate all alleged violations of international
human rights law and to establish the facts and circumstances of such violations and of the
crimes perpetrated, with a view to avoiding impunity and ensuring full accountability. In
addition to addressing the current human rights situation in the Syrian Arab Republic, the
present preliminary report provides an update on the status of the work of the fact-finding
mission established by the High Commissioner in light of the Council’s request.
Abstract: This analysis documents the national development and humanitarian situation in Yemen and identifies the core issues contributing to Yemen's ongoing fragility. Designed as a collaborative process and as a product this analysis will form a coherent and integrated evaluation of existing national priorities and needs in Yemen with the framework of the Millennium Development Goals and the other commitments, goals and targets of the Millennium Declaration, in addition to the declarations and programs of action adopted through major UN conventions and at international conferences and summits.
Abstract: The global war on drugs has failed, with devastating consequences for
individuals and societies around the world. Fifty years after the initiation of the
UN Single Convention on Narcotic Drugs, and 40 years after President Nixon
launched the US government’s war on drugs, fundamental reforms in national
and global drug control policies are urgently needed.
Vast expenditures on criminalization and repressive measures directed at
producers, traffickers and consumers of illegal drugs have clearly failed to
effectively curtail supply or consumption. Apparent victories in eliminating one
source or trafficking organization are negated almost instantly by the
emergence of other sources and traffickers. Repressive efforts directed at
consumers impede public health measures to reduce HIV/AIDS, overdose
fatalities and other harmful consequences of drug use. Government
expenditures on futile supply reduction strategies and incarceration displace
more cost-effective and evidence-based investments in demand and harm
reduction.
Abstract: Background
Human African trypanosomiasis (HAT), or sleeping sickness, is a fatal neglected tropical disease if left untreated. HAT primarily affects people living in rural sub-Saharan Africa, often in regions afflicted by violent conflict. Screening and treatment of HAT is complex and resource-intensive, and especially difficult in insecure, resource-constrained settings. The country with the highest endemicity of HAT is the Democratic Republic of Congo (DRC), which has a number of foci of high disease prevalence. We present here the challenges of carrying out HAT control programmes in general and in a conflict-affected region of DRC. We discuss the difficulties of measuring disease burden, medical care complexities, waning international support, and research and development barriers for HAT.
Discussion
In 2007, Medecins Sans Frontieres (MSF) began screening for HAT in the Haut-Uele and Bas-Uele districts of Orientale Province in northeastern DRC, an area of high prevalence affected by armed conflict. Through early 2009, HAT prevalence rate of 3.4% was found, reaching 10% in some villages. More than 46,000 patients were screened and 1,570 treated for HAT during this time. In March 2009, two treatment centres were forced to close due to insecurity, disrupting patient treatment, follow-up, and transmission-control efforts. One project was reopened in December 2009 when the security situation improved, and another in late 2010 based on concerns that population displacement might reactivate historic foci. In all of 2010, 770 patients were treated at these sites, despite a limited geographical range of action for the mobile teams.
Summary
In conflict settings where HAT is prevalent, targeted medical interventions are needed to provide care to the patients caught in these areas. Strategies of integrating care into existing health systems may be unfeasible since such infrastructure is often absent in resource-poor contexts. HAT care in conflict areas must balance logistical and medical capacity with security considerations, and community networks and international-response coordination should be maintained. Research and development for less complicated, field-adapted tools for diagnosis and treatment, and international support for funding and program implementation, are urgently needed to facilitate HAT control in these remote and insecure areas.
Abstract: Background: In recent years, vigorous debate has developed concerning how
conflicts contribute to the spread of infectious diseases, and in particular, the role of
post-conflict situations in the epidemiology of HIV/AIDS. This study details the agespecific
mortality patterns among the population in the central provincial capital of
Beira, Mozambique, during and after the Mozambican civil war which ended in 1992.
Methods: Data was collected from the death register at Beira’s Central Hospital
between 1985 and 2003 and descriptively analyzed.
Results: The data show two distinct periods: before and after the peace agreements in
1992. Before 1992 (during the civil war), the main impact of mortality was on
children below 5 years of age, including still births, accounting for 58% of all deaths.
After the war ended in 1992, the pattern shifted dramatically and rapidly to the 15-49
year old age group which accounted for 49% of all deaths by 2003.
Conclusions: As under-5 mortality rates were decreasing at the end of the conflict,
rates for 24-49 year old adults began to dramatically increase due to AIDS. This
study demonstrates that strategies can be implemented during conflicts to decrease
mortality rates in one vulnerable population but post-conflict dynamics can bring
together other factors which contribute to the rapid spread of other infectious diseases
in other vulnerable populations.
Abstract: At least 8,885 villagers in 118 villages in Lu Thaw Township, Papun District have either exhausted their
current food supplies or are expecting to do so prior to the October 2011 harvest. The 118 villages are
located in nine village tracts, where attacks on civilians by Burma’s state army, the Tatmadaw, have
triggered wide scale and repeated displacement since 1997. As tens of thousands of civilians in northern
Karen State have been displaced, over-population in hiding areas where civilians can more effectively
avoid attacks has created shortages of arable land, depleted soil fertility and reduced potential crop
yields. Civilians forced to cultivate land or live near Tatmadaw camps, meanwhile, have faced recent
attacks, including indiscriminate shelling and attacks on food supplies, buildings and livelihoods. These
existing obstacles to food security were compounded by an unusually dry rainy season in 2010, coupled
with other environmental factors, causing the 2010 harvest to fail. The impact of acute food shortages on
the civilian population is magnified by budgetary constraints of local relief organisations, which can
access the affected area but are currently unable to provide emergency assistance to many of those
facing food shortages. This regional report is based on research conducted by KHRG researchers in Lu
Thaw Township in February and March 2011, including 41 interviews with villagers and village and village
tract leaders in the affected areas. This research was augmented by interviews with members of local
relief organisations in February, March and April 2011.
Abstract: Addressing increasing concerns about public health equity in the context of violent
conflict and the consequent forced displacement of populations is complex. Important
operational questions now faced by humanitarian agencies can to some extent be clarified
by reference to relevant ethical theory. Priorities of service delivery, the allocation
choices, and the processes by which they are arrived at are now coming under renewed
scrutiny in the light of the estimated two million refugees who fled from Iraq since 2003.
Operational questions that need to be addressed include health as a relative priority,
allocations between and within different populations, and transition and exit strategies.
Public health equity issues faced by the humanitarian community can be framed as issues
of resource allocation and issues of decision-making. The ethical approach to resource
allocation in health requires taking adequate steps to reduce suffering and promote
wellbeing, with the upper bound being to avoid harming those at the lower end of the
welfare continuum. Deliberations in the realm of international justice have not provided a
legal or implementation platform for reducing health disparities across the world,
although norms and expectations, including within the humanitarian community, may be
moving in that direction.
Despite the limitations of applying ethical theory in the fluid, complex and highly
political environment of refugee settings, this article explores how this theory could be
used in these contexts and provides practical examples. The intent is to encourage
professionals in the field, such as aid workers, health care providers, policy makers, and
academics, to consider these ethical principles when making decisions.
Abstract: This report is a comprehensive, in-depth examination of human rights issues in Pakistan in 2010 in the areas of law and law-making; administration of justice; law and order; jails and prisoners; freedom of movement; freedom of thought, conscience and religion; freedom of expression; freedom of assembly; freedom of association; women; children; labour; education; health; housing; environment; and refugees.
Abstract: Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible—not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classification systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specific perinatal certificates and revised International Classification of Disease codes, are needed. A simple, programme-relevant stillbirth classification that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment.
Abstract: Background
Maternal mortality can be particularly high in conflict and chronic emergency settings, partly
due to inaccessible maternal care. This paper examines associations of refugee-led health
education, formal education, age, and parity on maternal knowledge, attitudes, and
practices among reproductive-age women in refugee camps in Guinea.
Methods
Data comes from a 1999 cross-sectional survey of 444 female refugees in 23 camps.
Associations of reported maternal health outcomes with exposure to health education
(exposed versus unexposed), formal education (none versus some), age (adolescent
versus adult), or parity (nulliparous, parous, grand multiparous), were analysed using
logistic regression.
Results
No significant differences were found in maternal knowledge or attitudes. Virtually all
respondents said pregnant women should attend antenatal care and knew the importance
of tetanus vaccination. Most recognised abdominal pain (75%) and headaches (24%) as
maternal danger signs and recommended facility attendance for danger signs. Most had
last delivered at a facility (67%), mainly for safety reasons (99%). Higher odds of facility
delivery were found for those exposed to RHG health education (adjusted odds ratio 2.03,
95%CI 1.23-3.01), formally educated (adjusted OR 1.93, 95%CI 1.05-3.92), or grand
multipara (adjusted OR 2.13, 95%CI 1.21-3.75). Main reasons for delivering at home were
distance to a facility (94%) and privacy (55%).
Conclusions
Refugee-led maternal health education appeared to increase facility delivery for these
refugee women. Improved knowledge of danger signs and the importance of skilled birth
attendance, while vital, may be less important in chronic emergency settings than
improving facility access where quality of care is acceptable.
Abstract: Syrian security forces in at least two towns prevented medical personnel and others from reaching wounded protesters on April 8, 2011, and prevented injured protesters from accessing hospitals, Human Rights Watch said today. Human Rights Watch, which interviewed 20 witnesses from three Syrian towns, urged Syrian authorities to allow injured protesters unimpeded access to medical treatment and to stop using unjustified lethal force against anti-government protesters.
"To deprive wounded people of critical and perhaps life-saving medical treatment is both inhumane and illegal," said Sarah Leah Whitson, Middle East director at Human Rights Watch. "Barring people from needed medical care causes grave suffering and perhaps irreparable harm."
Blocking access to necessary medical treatment for people who have been injured violates the government's obligations to respect and protect the right to life and not to subject anyone to inhuman treatment, Human Rights Watch said.
