Category Archives: Human Rights

Attacks on Health Care Workers in Syria and the Weakening of the International Community

Before the conflict began, Syria’s health care system was one of the most advanced in the Middle East with chronic diseases ranking as the most common health concern, vaccination coverage rates at 95%, and their pharmaceutical industry producing over 90% of the country’s medicines. Five years later, the conflict has nearly decimated the health care system and today nearly half of the country’s public hospitals and primary health care systems are closed or only partly functioning, almost two-thirds of health care workers have left the country, domestic production of medicines is down by two-thirds, and the vaccination coverage rate has dropped by half. Correspondingly, life expectancy has dropped by nearly 14 years.

Since the Syrian conflict began in 2011, Physicians for Human Rights has documented 382 attacks on 269 different medical facilities and 757 deaths of medical workers. The patterns of attacks clearly demonstrate that health care facilities and workers are being deliberately targeted. When health care workers are attacked, innocent civilians are deprived of the life-saving interventions needed for both routine and emergency care. In Aleppo alone, a health care facility is targeted every 17 hours and a health care worker every 60 hours. These alarming statistics make Aleppo one of the most dangerous places in the world to be a health care worker. APHA Executive Director Dr. Georges Benjamin noted the dire state of the Syrian health care system in a letter to the UN Security Council last December, but the situation has only worsened since then.

According to a recent report in September of this year, there were only 30 doctors serving the estimated 250,000 residents trapped in rebel-held eastern Aleppo. There are currently no more hospitals functioning at full capacity in eastern Aleppo. With the huge upswing of Syrian military activity these past few days, it is likely there are far less doctors or hospitals left. To make matters worse, humanitarian aid to eastern Aleppo has been severely restricted. Since humanitarian operations started over two years ago, the UN has conducted 420 convoys to deliver medical supplies and food to eastern Aleppo however as of late, they have not been able to make their deliveries. Health care cannot exist without health care workers, supplies, and facilities.

International humanitarian law and medical neutrality have been established to protect health care facilities and workers to ensure that they can continue to provide care during armed conflict and not be prosecuted for providing services to protesters or opposition fighters. But when health care facilities and workers are purposefully targeted and humanitarian aid is withheld, there is a clear violation of international humanitarian law that should be punished accordingly as a war crime. Though the violations in Syria are some of the most flagrant, these deliberate attacks on health care facilities and workers, used as a weapon of war, occur in many other parts of the world as well. In Yemen, over 600 health facilities have been targeted since fighting began in 2014. Médecins Sans Frontières (Doctors Without Borders) has gone so far as to call attacks on health care facilities and workers during times of war as the new normal. Additionally, health workers in Bahrain were arrested, imprisoned, tortured, and charged with crimes for caring for protesters and documenting police brutality in response to the Arab Spring uprising in 2011.

Although news outlets and humanitarian organizations worldwide have brought a lot of attention to these tragedies, bringing awareness to these atrocities is not enough to stop it. It is the responsibility of the international community to help put an end to such blatant threats to human rights. The UN’s Responsibility to Protect gives permission to the international community to intervene and protect populations when a state fails to prevent and halt genocide and mass atrocities. However, the operationalization of this doctrine has proven to be disappointing. Although most actors in the international community agree that something should be done, they have been unable to agree on exactly what must be done. No-fly zones have been suggested and temporary ceasefires have been adopted to ensure delivery of humanitarian aid but both are merely stopgap measures. These are not enough to put a stop to such unnecessary human suffering and should not be the final solution.  

As the war approaches its sixth year, the future of Aleppo looking bleak, and current estimates of the death toll in Syria surpassing 470,000, the need for for the international community to help put a permanent end to the war could not be more dire. However, given the international community’s long track record of ineffectual measures, it is unclear how they will proceed. One thing is for certain, it’s about time for the international community to ask themselves whether the decisions (or indecisions) they’ve made with Syria and other conflicts have been consistent with the principles of the Responsibility to Protect doctrine. Human lives are at stake and from a human rights standpoint, this should take precedence over any personal or state interests.

The Year of the Girl

The United Nations declared October 11th the International Day of the Girl Child.  Everywhere I looked for this post’s inspiration, I saw story after story of the daily violence perpetrated against girls worldwide. I had to ask myself, why just a day?  Aren’t girls – roughly half of the world’s population – deserving of much more consideration? I say that we declare 2017 the YEAR of the Girl and devote our efforts to address the following issues.

Female Genital Mutilation

Female genital mutilation, or FGM, is a global concern. Some 200 million girls and women in 30 countries have undergone FGM, usually between infancy and 15 years of age. In many countries, FGM is a deeply entrenched cultural practice that has seen little decrease in the decades since foreign aid workers have been campaigning for is abolition. The risks might be high – infection, infertility, and complications of childbirth – but the perceived social benefits outweigh the physical costs. Bettina Shell-Duncan, an anthropology professor working as part of a five-year research project by the Population Council, has witnessed this conflict firsthand among the Rendille people of Northern Kenya:

One of the things that is important to understand about it is that people see the costs and benefits. It is certainly a cost, but the benefits are immediate. For a Rendille woman, are you going to be able to give legitimate birth? Or elsewhere, are you going to be a proper Muslim? Are you going to have your sexual desire attenuated and be a virgin until marriage? These are huge considerations, and so when you tip the balance and think about that, the benefits outweigh the costs.

Despite cultural ties, FGM is decreasing in some African countries as evidenced by rates from the prior generation.  However, with prevalence as high as 81% (Egypt), 79% (Sierra Leone), and 62% (Ethiopia), there is still much work to be done.

prevalence

For example, with prevalence at 60-70%, FGM in Iraqi Kurdistan is a “hidden” epidemic.  Prevalence of this practice elsewhere in Iraq is 8%.  Outlawed in 2011 by the Kurdistan Regional Government under the Family Violence Law, FGM has continued largely unabated due to poor implementation and push-back from religious leaders.  You can read the Human Rights Watch harrowing report about FGM in Iraqi Kurdistan here.

Rape and Child Marriage

Last Friday, the BBC reported on a bill under consideration by the Turkish Parliament that would clear a man of statutory rape if he married his victim.  This bill is evidence of increasing violence against Turkish women.  Between 2003 and 2010, the murder rate of women increased by 1,400%.  Of course, the bill isn’t couched in terms of legalizing rape, but as a loophole for those offenders who know not the errors of their ways:

The aim, says the government, is not to excuse rape but to rehabilitate those who may not have realised their sexual relations were unlawful – or to prevent girls who have sex under the age of 18 from feeling ostracised by their community.

If passed, the bill would release 3,000 men from prison as well as legitimize child rape and marriage. Per Girls Not Brides, Turkey has one of the highest child marriage rates in Europe with 15% of girls married before the age of 18. Globally 34% of women are married before the age of 18 and every day 39,000 girls join their ranks. According to a study recently published in the International Journal of Epidemiology, child marriage comes with health and social consequences. Along with unintended pregnancies, infant and maternal mortality, and HIV, girls who are married suffer from social isolation, power imbalance, and experience higher lifetime rates of physical and sexual intimate partner violence.

Coming-of-age “Cleansing” Rituals

Practiced in parts of Africa, girls as young as 12 are forced to have sex as part of a sexual cleansing ritual.  The men, known as “hyenas,” are paid by parents to usher girls through the transition between girlhood and womanhood.  Girls are coerced into this practice through familial and societal pressure.  It is believed that great tragedy will befall the family and community should she not comply.  The use of a condom is prohibited.

A BBC radio broadcast found that communities believe the spread of HIV to be a minimal risk since they can pick men they know are not infected. One Malawian hyena, Eric Aniva, has been charged with exposing hundreds of girls and women to HIV. Aniva knew of his HIV status but did not disclose to his customers.

Forty percent of the global burden of HIV infections are in Southern Africa. Thirty percent of new infections in this area are in girls and women aged 15-24. Young women contract HIV at rates four times greater than male peers and 5-7 years earlier, linked to sexual debut or sexual cleansing rituals.

Let’s face it: Girls around the globe are being short-changed. Though progress has been made, there is still much work to be done. The Sustainable Development Goals have promised to “end all forms of discrimination against all women and girls everywhere” by 2030. Others attest that it will take at least another century for women to reach wage equity in the United States.  However it happens, rest assured it will take more than a day.

Female sterilization not an answer to global contraception

The last week of September marks two days dedicated to improving reproductive health: World Contraception Day  (September 26) and Global Day of Action for Access to Safe and Legal Abortions  (September 28).  Both days are committed to improving the reproductive health and choices of women worldwide. With the vision of making every pregnancy a wanted pregnancy, World Contraception Day aims to help the estimated 225 million women in developing countries who have an unmet need for contraception.

Reports such as the UN’s 2015 Trends in Contraceptive Use Worldwide include somewhat promising data, such as 64% of married or in-union women use a modern contraceptive method. This figure is lower in developing countries, including 17 countries in Africa where modern contraceptive use is below 20%.

Sterilization is the most widely used form of birth control, accounting for a third of modern contraceptive use. Sterilization is heavily weighted toward female sterilization, 18.9% versus 2.4% male sterilization globally.  In certain countries, the prevalence of female sterilization as modern contraception is much higher.  Female sterilization of sexually active women aged 15 to 49 is most prevalent in Latin America.  The Dominican Republic leads the pack at 47%  followed closely by Colombia, Costa Rica, El Salvador, and Puerto Rico.  China (29%) and India (36%) are also front runners.

unmetneedandunintendedpregnancy

Sterilization is a popular choice in the developed countries of Europe and North America, though male sterilization tends to be more prevalent than in the developing world. When practiced safely, sterilization offers many benefits because it is a one-time procedure with no follow-up or maintenance.  While sterilization might be the best choice for some individuals or couples, unsafe, involuntary, or otherwise coercive female sterilizations are altogether too common and an affront to human rights.

China’s “one child” policy  – perhaps one of the more infamous anecdotes in mandated family planning – has relied on sterilization to meet its goals.  In the heyday of the 1980s, neighbors became informants on so-called “out-of-plan” pregnancies.  Offending families were fined and possessions stolen, and local bureaucrats oversaw countless forced abortions and sterilization. 1983 alone saw over 20 million sterilizations. China’s Communist Party has recently relaxed its one-child policy  to allow each couple two children, but many in China, including activist Chen Guangcheng don’t see the difference as stated in this tweet:

This is nothing to be happy about. First the #CCP would kill any baby after one. Now they will kill any baby after two. #ChinaOneChildPolicy

Lesser known is an Uzbekistan policy that assigns gynecologists a sterilization quota of up to 4 per month.  In a report by the BBC, rural women who have had two or more children are the main target of this campaign.  It is estimated in 2011 alone that 70,000 Uzbek women were sterilized, some voluntarily and some involuntarily.  Unlike China’s policy to slow population growth, Uzbekistan’s goal is to manipulate its once abysmal infant mortality ratings.  Fewer infants means fewer infant deaths, and Uzbekistan’s infant mortality rate in 2012 is half of what it was in 1990.

India has received much attention for its sterilization camps.  The name alone conjures images of the Nazi eugenics movement.  In 1951, with Malthusian ideology in mind, an Indian demographer set out across rural India to complete a census.  His prediction – that India’s population would reach 520 million people by 1981 – was both incorrect (India’s population in 1981 was 683 million ) and the catalyst for a mass sterilization program.  This led to compulsory sterilization in 1976  that lasted for 21 months and effectively sterilized 12 million men and women, often rural, poor, and of low caste.  Employment, wages, and even running water were withheld from individuals and whole villages until 100% compliance was met.

Today, while technically voluntary, sterilization in India is incentivized. In the past, men were promised transistor radios in exchange for a vasectomy.   Male sterilization is now considered culturally unacceptable.  Women are the target of sterilization campaigns and can receive up to $23 US – a month’s income – to submit to a tubal ligation.

sterilization

Women undergo sterilization operations at the Cheria Bariarpur Primary Health Centre in the Begusarai District of Bihar. A few dozen women were sterilized in one day. Although India officially abandoned sterilization targets years ago, unofficial targets remain in place, according to people working on the ground. One Primary Health Centre doctor says the targets in themselves are not necessarily the problem, arguing instead that itÕs the lack of a good healthcare infrastructure in some places that makes it difficult to safely meet those targets. SARAH WEISER

Indian women arrive at sterilization camps by the jeep load.  In makeshift operating theaters –  with no electricity and running water – neither gloves nor equipment are changed between the five-minute operations.  Expired antibiotics given to some women are found laced with rat poison.  In 2014, Dr. R.J. Gupta, self-described as performing 300 tubal ligation in one day, was arrested after women he and an assistant sterilized either died or were hospitalized.  The current government regulation is that no one doctor should perform more than 30 sterilizations a day.  On the day in question, Gupta’s six-hour spree resulted in 83 tubal ligation.  It is believed that Gupta was trying to reach a government-set target of 220,000 sterilizations in one year.

On September 14th of this year, India’s Supreme Court ordered a close of all sterilization camps within three years.  That is an unsettling time span in which over a half a million more women could be sterilized and many more deaths and hospitalizations could occur.  Even after the dissolution of government-sanctioned sterilizations camps, women will continue to be subject to this dangerous procedure.

What are low cost, accessible, and humane forms of birth control for the developing world?  A promising alternative might be Sayana® Press, a lower-dose presentation of the three-month injectable contraceptive Depo-Provera® in the Uniject™ injection system.

sayana_press

A village health worker counsels a client in family planning and administers Sayana Press. Phiona Nakabuye (left), village health worker trained by PATH’s Sayana Press pilot introduction program, with Carol Nabisere (right), age 18, who chose to receive Sayana Press after being counseled in the various forms of contraception, Kibyayi village, Mubende district.

Original trials of the injectable contraceptive were successful in Florida, New York, and Scotland, and the same seems to be holding true in Uganda.  Most women were able to self-administer the drug after just one training session and again at the next dose, three months later.  Designed for single use, Sayana® Press reduces reliance on needles and needle sharing  which is essential in the fight against HIV/AIDS and women only need to travel to a clinic once to get a year’s supply.

There is so much to consider when it comes to global family planning.  It would be remiss not to mention the impact that the HIV/AIDS epidemic has on sterilization rates in some regions of the world and you can read more here, here, and here.  Organizations such as USAID have been implicated  for funding so-called fertility reduction programs that include mass sterilization.  What can be done to ensure all women have access to contraception?

@USAID Video: Just Bring a Chair

In today’s video, USAID shares a message of hope amidst the horrors experienced by 2.4 million Syrian refugee children.  Along with displacement from home, Syrian children experience an interruption in education from which they might never recover.  Ms. Maha, a principal for a girls’ school in Jordan, answered the desperate pleas of Syrian parents as she welcomes us and their children into her school with the sentiment: “Just Bring a Chair.”

Video Description:

“In Jordan, where the Syrian crisis has led to around 635,000 additional people taxing already overburdened schools, hospitals and social services, some people still find reasons to open their arms and make it work. Ms. Maha is one of those people.”

Without access to education, the future is bleak for many of the youngest Syrian refugees.  A recent report by Human Rights’ Watch found that nearly one-third of refugees in Jordan are between the ages of 5 and 17.  Of these children, 56% are not enrolled in school.  Lebanon is also struggling to accommodate the inundation of refugee students.  Soon, school-aged Syrian children could outnumber their Lebanese peers.

Unfortunately, the problems do not end once children are in school.  A report by UNICEF highlights the unique educational concerns of refugee children, citing violence while traveling to and from school, abusive teachers and classmates, and separation anxiety while at school.  The same report finds that even when the school is located within the refugee camp, 75% of children do not attend.

So what’s the solution?  I think an inclusive environment like Ms. Maha creates in her school is key.  Money for teachers, educational materials, and space are paramount for educating this generation of Syrian youth.  2015 saw fundraising efforts by members of the UN fall short of the $8.4 billion goal.  Will 2016 see more Syrian children returning to classrooms?

Read Ms. Maha’s story here.

One Humanity

The World Humanitarian Day is today August 19th, 2016 and the theme for this year is “One Humanity”. The day was designated in 2003 to honor the lives of 22 humanitarian workers who were killed in  a terrorist attack in Baghdad, Iraq.

Currently, there are 130 million people who are living in crisis and face impossible choices. All wars, conflicts and internal displacements disrupt the strong social, economic and cultural support systems that people have built and cultivated over the years. This decimation of all forms of support has a direct impact on people’s mental and physical health. The consequences also extend to our colleagues who put their lives in danger to serve people in many conflict zones. You will recall the loss of lives from the many acts of violence against hospitals and clinics.

As global/public health professionals, it is our duty to take a stand and commit today to move the needle on the 7 core commitments that were identified at the World Humanitarian Summit that happened in May 2016.

Source: LEARN, World Humanitarian Summit

At a minimum, we can do these few things listed below, learn more about these here (scroll down to the bottom of the page):

  • Support the Agenda for Humanity
  • Take the Humanitarian Quiz and see the impossible choices people face
  • Tweet your country’s leader and ask them to commit to action
  • Donate to the UN’s Emergency Response Fund
  • Sign Up to Messengers of Humanity so you can stay involved
  • Start Impossible Choices to walk in the shoes of a refugee

If you are in the mood to learn about some of the horrendous choices people in conflict zones have to make, take the “Would You Rather” quiz here.

This post has been cross posted to my own blog as well.

APHA’s Georges Benjamin writes a letter on health workers in Syria

APHA Executive Director Georges Benjamin has written a letter to the members of the UN Security Council to enforce a resolution to end attacks targeting health care workers in Syria. You can read the text below.


Dear United Nations Security Council members:

On behalf of the American Public Health Association, a diverse community of public health professionals who champion the health of all people and communities, I write to call on the United Nations Security Council to enforce resolution 2139 to put an end to the attacks on health workers and facilities in Syria.

In over four and a half years of conflict in Syria, nearly 700 health workers have been killed and more than 300 medical facilities have been attacked. According to well-documented reports, the Syrian government is responsible for over 90 percent of these assaults. The disruption of health services is being used as a weapon of war. This year, by the end of October, attacks on medical facilities in Syria had already surpassed the number of attacks for any other year since the conflict began in 2011.

The attacks have decimated the country’s health system. In Aleppo, only 10 hospitals remain of the 33 hospitals that were functioning in 2010. About 95 percent of doctors have been detained, killed or have fled leaving one doctor for every 7,000 residents. There are shortages of medicine and necessities such as clean water and electricity. Hospitals are overwhelmed with patients needing emergency care for conflict-related injuries and patients are dying from treatable conditions.

In February 2014, the United Nations Security Council unanimously passed resolution 2139 demanding that all parties immediately end all forms of violence. The resolution strongly condemned attacks on hospitals and demanded that all parties respect the principle of medical neutrality, and that medical personnel, facilities and transport must be respected and protected. Passing the resolution was a critical first step, but now almost two years have passed since it was adopted and the attacks have continued. We urge the Security Council to take immediate steps to ensure that the resolution translates into meaningful progress to protect health workers and their patients in Syria.

Sincerely,

Georges C. Benjamin, MD
Executive Director

More HIV discrimination from the ROK government: Korea disqualifies students with HIV from receiving scholarships

A few regular readers might be familiar with the Korean government’s ongoing misrepresentation of its HIV-related immigration restrictions: while it continues to receive undeserved recognition from the UN for being a country free of HIV-related travel restrictions, it mandates HIV tests for native-speaking English teachers, EPS workers (manual laborers), and entertainment workers. Despite claims from KCDC and Korea’s ministry of foreign affairs that immigration restrictions have been lifted, one English teacher won a discrimination case with the UN CERD earlier this year, and another case is pending with the ICCPR. Our Section was even successful in pushing through a resolution on immigration restrictions tied to HIV status at this year’s APHA Annual Meeting that called Korea out specifically for its double-talk.

Now there more evidence of discrimination to add to the list. The Korean Government Scholarship Program, which provides funding and airfare for non-Koreans interested in pursuing post-graduate degrees at a Korean university, is open to a small number of foreign nationals each year and is actively advertised on Korean embassy websites and even featured on several university websites for current undergraduates who might be interested. The program “is designed to provide higher education in Korea for international students, with the aim of promoting international exchange in education, as well as mutual friendship amongst the participating countries,” and the payment includes tuition, airfare, a monthly allowance, a research allowance, relocation (settlement) allowance, a language training fee, dissertation printing costs, and medical insurance. Which sounds lovely, except:

Applicants must submit the Personal Medical Assessment (included in the application form) when he/she apply for this program, and when it’s orientation, an Official Medical Examination will be done by NIIED. A serious illness (For example, HIV, Drug, etc) will be the main cause of disqualification from the scholarship.

It is also worth noting that pregnancy can disqualify candidates as well.

The best part is that this information is not even hidden: a Google search on the above line pulls up dozens of results, and the restrictions on prominently featured on the websites of Korean embassies to the US, the UK, Australia, Malaysia, plus the Korean Education Center in New York, GWU’s Sigur Center for Asian Studies, and even Seoul National University (DOC), the most prestigious university in the country.