Conflicts
Wars, civil wars, and internal conflicts take an enormous toll on innocent people living in conflict areas. The Active Learning Network for Accountability and Performance in Humanitarian Action (ALNAP) describes three of the common consequences during conflict and post-conflict as deliberate personal violence, deprivation, and limited movement and restricted access.
Deliberate violence against civilians – including murder – is all too commonly a central policy of armed groups. Children are coerced into becoming soldiers or sex-slaves, and many people are spared from death, but are left maimed or seriously injured. Sexual violence is particularly rampant, which in addition to the humiliation and social impact it causes, is also used to deliberately spread HIV.
“(I've seen cases of sexual violence) from a six-year-old girl to a 75-year-old woman,” said Jason Stearns, senior analyst for central Africa with International Crisis Group, speaking about DRC. “Rape has become part of a culture of violence... The traditional moral structure of society is falling apart.”[1]
Despite the horrific nature of these atrocities, ALNAP’s report on Protection states that, “it is impoverishment, dispossession, destitution, disease, and sheer exhaustion that are responsible for the bulk of civilian deaths in war.”[2] A population’s suffering is directly connected with “the deprivations caused by war – what people have taken away from them.”[3] These deprivations are often caused by deliberate assaults on economic assets and livelihoods, and on strategies of displacement.
At present, worldwide conflicts have caused approximately 24.5 million people to flee their homes to become internally displaced persons (IDPs) within their own countries. There are an additional 9.2 million refugees who have fled to other countries.[4] However, unlike most refugees, IDPs have little legal or physical protection, and are often outcasts in their own countries.[5] They flee to areas where services are limited or non-existent, and where the provision of basic health essentials becomes a major challenge.
“We have too often been too late with too little support,” said UNHCR High Commissioner António Guterres. “The treatment of people internally displaced by conflict has been the biggest failure of the international humanitarian community.”[6]
Medair works closely with IDPs in overcrowded camps throughout Africa, providing health care access, safe water and sanitation, and psychosocial care for conflict-affected people and survivors of sexual violence. It also helps communities with resettlement when conflicts end. In fact, Medair is active in three countries that are in the top five for the largest number of IDPs in the world, with Sudan heading that list at an estimated 4.7 million.[7] In addition to IDPs caused by conflict, there are an additional 25 million IDPs in the world due to natural disasters.[8]
“We failed these people for too long,” said Jan Egeland, the United Nations Emergency Relief Coordinator. “While over the years we have managed to save millions of lives, our response system has [also] been plagued by severe gaps. The needs of the internally displaced were often the first to fall between the cracks.”[9]
The third consequence for civilians as a result of conflicts is that their movement becomes much more restricted. Curfews are imposed, and there are roadblocks and travel restrictions. Fear is also a major factor which limits people’s movement, either fear of a direct attack or from a concealed one like a landmine. Restricted movement makes it difficult for people to work in their fields, earn a living, or receive health care or social services.
Medair has intervened in several countries where the effects of conflict have led to high general population vulnerability, including DRC, Sudan, Uganda, and Afghanistan.
Democratic Republic of Congo (DRC)
In 2003, DRC’s five-year conflict – dubbed “Africa’s World War” – officially came to an end. However, the disarmament process of militias and rebel groups continues to this day, with violent conflicts still common.
5.4 million people have died since 1998 from violence and war-related illness according to aid agency International Rescue Committee (IRC), which calculated in 2007 that 45,000 people were dying every month.[10] Richard Brennan of IRC has stated, “Congo is the deadliest conflict anywhere in the world over the past 60 years.”[11]
“It's the worst humanitarian tragedy since the Holocaust,” said John O'Shea, chief executive of Irish relief agency GOAL. "The greatest example on the planet of man's inhumanity to man.”[12]
The deadly war continued until 2003, with conflicts between various groups and violence against civilians still continuing. Sexual violence is particularly devastating to the population, and there are ongoing reports of atrocities being committed. Within this harrowing environment, 1.1 million people have become IDPs.[13] The largest UN peacekeeping force in the world is stationed here, with 17,000 troops, but there are huge challenges in trying to control a country as massive as DRC, which lacks the most basic transportation infrastructure.
“There are few places on earth where the gap between humanitarian needs and available resources is as large – or as lethal – as in Congo,” said Jan Egeland, former U.N. Under-Secretary-General for Humanitarian Affairs.[14]
Medair has been providing vital aid in remote corners of DRC for 10 years, particularly in the most conflict-affected northeast of the country. In 2007, Medair provided health care access for over one million beneficiaries. As the disarmament process continues, Medair is rebuilding vital infrastructure, including 17 new and 7 restored health centres in 2006, which stimulated the return of displaced people to their original villages. The Medair team also rehabilitated a 111 kilometre road, to improve access to otherwise isolated communities.
“Medair trains people in our organisation to take care of victims of sexual violence,” said Alphonsine Unwang, joint co-ordinator of SFVS. “What struck me most about Medair is that it stayed during the war, when other health centres and NGOs either closed or left the country. For this reason, it is the most respected organisation in the entire region.”
Sudan
Conflicts between various armed groups have caused enormous internal strife in Africa’s largest country. A 21-year civil war between the north and the south officially ended with the signing of the Comprehensive Peace Agreement (CPA) in 2003, but conflicts continue in western Darfur, where the UN reports that 200,000 have died and 2.5 million have been displaced since 2003.[15] In total, there are an estimated 4.7 million IDPs in Sudan, which is the highest number in the world, and it may be even higher since most of Sudan’s IDPs do not live in camps, making them harder to monitor. Accurate figures from southern Sudan are also difficult to obtain.[16]
Southern Sudan was devastated by the cumulative effects of Africa’s longest running civil war, recurrent famine, economic sanctions, lack of investment and development, and general poor governance. Approximately two million people died, four million people became Internally Displaced Persons (IDPs), and up to eight million people in the south were without access to basic services such as health care and education.
“In education, literacy, and child malnutrition, southern Sudan ranks at the bottom of the world, and is near the bottom in all other social indicators,” said Larry Thompson of Refugees International.[17]
With a volatile mixture of ethnic groups, age-old grievances, and widespread weaponry, stability in southern Sudan has proven elusive under the CPA. Large numbers of refugees and displaced people from the civil war are now starting to return home. This has brought about increased tensions in their communities, and attempts to enforce disarmament have led to renewed inter-tribal hostilities.
Other areas of the country, away from the capital, also suffered from chronic neglect, lack of investment, and poor governance. In the western region of Darfur, these grievances led to the onset of a rebellion in late 2002. With attempts at both political and military solutions failing, the conflict rapidly escalated. The Darfur Peace Agreement signed in May 2006 did not result in a significant improvement to the situation on the ground.
Natural disasters have compounded the widespread suffering caused by the conflicts, with both flooding and drought experienced in the past year. Disease outbreaks and food shortages are commonplace.
Given the size of Sudan and the scope of problems facing its suffering population, Medair runs two programmes in the country, one in the northern states and one in the south. In the northern states, Medair provides multisectoral aid in three areas: South Kordofan, West Darfur, and Khartoum State.
In 2006, Medair supported 43 health facilities and two mobile units in Sudan’s northern states, providing primary health care access to approximately 370,000 people. Reproductive health was a major focus, including the training of midwives, the implementation of safe delivery areas, and providing care for survivors of gender-based violence (GBV). The teams also provided access to safe drinking water for over 110,000 people.
In southern Sudan -- where less than 25 percent of the population have access to safe water, and less than 40 percent of the population live within one day’s walk of a basic health facility – Medair provided aid to 280,000 vulnerable people in 2006, Medair’s efforts are designed to fill the most severe gaps, increasing access to health services and clean drinking water, and providing emergency assistance as needed.
Uganda
In 2006, Jan Egeland called northern Uganda the world’s terrorism epicentre, saying, “Nowhere in the world do we have large areas where between 80 and 90 percent of the population are terrorised into camps by violence.”[18]
For two decades, the rebel Lord’s Resistance Army (LRA) has been waging a vicious war in northern Uganda, creating what the UN called one of the world’s most neglected humanitarian crises.[19] At the height of the conflict, one thousand people were dying every week from disease, poor living conditions, and violence, and 1.7 million people were displaced from their homes.[20]
The LRA are particularly known for their civilian massacres and for the abduction of over 20,000 children to be used as soldiers or sex-slaves.[21] Reuters AlertNet reports that child soldiers have been estimated to make up 80 percent of the LRA’s forces.[22] The LRA generated a constant fear among civilians that new attacks would be forthcoming. People were moved into camps close to army bases, in order to receive increased protection. IDP camps grew around existing villages, but their populations increased so dramatically that essential services became scarce, including health services and access to clean water. It was also difficult to cultivate land because of the dangers of leaving the secure camp area.
In September of 2006, a landmark ceasefire was established between the LRA and the Ugandan government, causing a substantial improvement in security. LRA attacks on civilians have stopped for the moment, and there is increased freedom of movement. An estimated 700,000 IDPs have left the overcrowded mother camps to return home, or to establish new settlements. [23]
However, there are still significant problems facing the population. As people return home or resettle, they are once again without basic services such as health care, schools, safe water, and infrastructure. Furthermore, they are spread out over a much wider area, so it is difficult for aid agencies to keep up with their needs. In addition, tribal conflicts persist in the northern Karamoja District, so that people moving away from mother camps live with the constant threat of looting and violence.
Since 2000, Medair has been in Uganda providing access to safe drinking water, sanitation, and health services for hundreds of thousands of people uprooted by the country’s violent conflicts. Last year, Medair provided aid to over 236,000 vulnerable beneficiaries in northern Uganda. With the relative improvement in security conditions, Medair is now in the post-conflict phase of its operations. Medair will now focus on capacity building in smaller communities, training returnees to operate and manage their own facilities, and enabling people to develop self-sufficiency.
Afghanistan
Violent conflicts have turned Afghanistan into a frequent war zone over the past 25 years. More than one million people were killed during the 10-year Soviet occupation in the 1980s. In 2001, an oppressive Taliban regime was toppled by US-led troops. Currently, there are over 40,000 international troops in the country, engaged in combat with insurgents.[24] All too often, this combat has a tragic impact on the civilian population.
Afghanistan is now one of the most heavily mined countries in the world. Over the last two years, there has been a disturbing increase in the use of Improvised Explosive Devices (IEDs) targeted at civilians, internationals, coalition forces, the Afghan military, and police forces. The population is increasingly frustrated with the number of civilian casualties, and there is a growing backlash against internationals working in Afghanistan. Reuters AlertNet reports that dozens of aid workers have been injured, kidnapped or killed since the Taliban government was toppled.[25] Large areas have been rendered off-limits to humanitarian agencies.
“Afghans consistently rank insecurity as their top concern,” says Human Rights Watch. “Resurgent Taliban forces have managed to contest the government's control over much of the southern part of the country, curtailing the delivery of desperately needed development and reconstruction assistance.”[26]
The entrenched history of violent conflict has led to massive neglect and underdevelopment throughout the country. In remote areas, there is very limited access to primary health care, and 70 percent of households have no access to safe drinking water. The average life expectancy is 42 (WHO), and the country has some of the highest recorded maternal mortality rates in the world.[27]
In many conflict areas, Medair provides most of our aid to displaced people who are living in temporary settlements. However, in Afghanistan, Medair mostly works with people living in remote villages who are isolated from basic services by the country’s insecurity and by its very limited infrastructure.
In mountainous Badakhshan province, Medair works in four of the most inaccessible districts, which are only accessible by horse or foot in the winter months. Badakhshan is undoubtedly one of the most underdeveloped and remote regions of Central Asia. It has the highest level of incidence of natural disasters, with frequent occurrences of flooding, landslides, and earthquakes. Basic health care was almost non-existent here until 2002, but in the past five years, Medair has been the driving force behind dramatic improvements in Badakhshan. Medair now runs four clinics and 40 health posts across the province, and in 2006, it provided primary health care to 200,000 people.
Medair has also begun providing aid in the central highlands, where the consecutive periods of warfare, the insecurity around the region, and the rugged terrain have isolated the area from humanitarian assistance. The lack of safe water supply, road access, and health clinics challenge the health of the isolated communities, while years of drought and lack of development have created the worst food insecurity in the country.
[1]Reuters AlertNet, October 2007
www.alertnet.org/db/crisisprofiles/ZR_CON.htm
[2]Protection - An ALNAP Guide for Humanitarian Agencies.
Hugo Slim and Andrew Bonwick, 2005
[3]ibid
[4]UNHCR, Forgotten No Longer, 2005
www.unhcr.org/publ/PUBL/43d4e7602.pdf
[5]ibid
[6]ibid
[7]IDMC (Internal Displacement Monitoring Centre), Sept 2007
www.internal-displacement.org 8025708F004CE90B/(httpPages)/ 22FB1D4E2B196DAA802570BB005E787C?OpenDocument&count=1000
[8]UNHCR, Forgotten No Longer, 2005
www.unhcr.org/publ/PUBL/43d4e7602.pdf
[9]ibid
[10]IRC Special Report: Congo
www.theirc.org/special-report/congo-forgotten-crisis.html
[11]Reuters AlertNet, October 2007
www.alertnet.org/db/crisisprofiles/ZR_CON.htm
[12]ibid
[13]ibid
[14]Seize the Moment to Help End Congo's Suffering.
Jan Egeland. UN Under-Secretary General for Humanitarian Affairs and Emergency Relief Coordinator
ochaonline.un.org/OchaLinkClick.aspx?link=ocha&DocId=1004210
[15]Reuters AlertNet, March 2007
www.alertnet.org/db/crisisprofiles/SD_CON.htm
[16]IDMC, Internal Displacement Monitoring Centre, September 2007
www.internal- displacement.org/idmc/website/ countries.nsf/ (httpEnvelopes)/CA38A0F0F269546F802570B8005AAFAD?OpenDocument
[17]Reuters AlertNet, March 2007
www.alertnet.org/db/crisisprofiles/SD_PEA.htm
[18]IRIN, Interview with Jan Egeland, April 2006
www.irinnews.org/report.aspx
[19]Afrol News
www.afrol.com/articles/14806
[20]Reuters AlertNet, August 2007
www.alertnet.org/db/crisisprofiles/UG_VIO.htm
[21]ibid
[22]ibid
[23]Real-time evaluation of UNHCR's IDP operation in Uganda.
UNHCR, August 2007
[24]Reuters AlertNet, October 2007
www.alertnet.org/db/crisisprofiles/AF_REC.htm
[25]ibid
[26]ibid
[27]ibid
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