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Health Services for Women, Children and Adolescents in Conflict Affected Settings: Experience from North and South Kivu, Democratic Republic of Congo

Citation:

Altare, Chiara, Espoir Bwenge Malembaka, Maphie Tosha, Christopher Hook, Hamady Ba, Stéphane Muzindusi Bikoro, Thea Scognamiglio, Hannah Tappis, Jerome Pfaffmann, Ghislain Bisimwa Balaluka, Ties Boerma, and Paul Spiegel. 2020. "Health Services for Women, Children and Adolescents in Conflict Affected Settings: Experience from North and South Kivu, Democratic Republic of Congo." Conflict and Health 14.

Authors: Chiara Altare, Espoir Bwenge Malembaka, Maphie Tosha, Christopher Hook, Hamady Ba, Stéphane Muzindusi Bikoro, Thea Scognamiglio, Hannah Tappis, Jerome Pfaffmann, Ghislain Bisimwa Balaluka, Ties Boerma, Paul Spiegel

Abstract:

Background: Insecurity has characterized the Eastern regions of the Democratic Republic of Congo for decades. Providing health services to sustain women’s and children’s health during protracted conflict is challenging. This mixed-methods case study aimed to describe how reproductive, maternal, newborn, child, adolescent health and nutrition (RMNCAH+N) services have been offered in North and South Kivu since 2000 and how successful they were. 
 
Methods: We conducted a case study using a desk review of publicly available literature, secondary analysis of survey and health information system data, and primary qualitative interviews. The qualitative component provides insights on factors shaping RMNCAH+N design and implementation. We conducted 49 interviews with government officials, humanitarian agency staff and facility-based healthcare providers, and focus group discussions with community health workers in four health zones (Minova, Walungu, Ruanguba, Mweso). We applied framework analysis to investigate key themes across informants. The quantitative component used secondary data from nationwide surveys and the national health facility information system to estimate coverage of RMNCAH+N interventions at provincial and sub-provincial level. The association between insecurity on service provision was examined with random effects generalized least square models using health facility data from South Kivu. 
 
Results: Coverage of selected preventive RMNCAH+N interventions seems high in North and South Kivu, often higher than the national level. Health facility data show a small negative association of insecurity and preventive service coverage within provinces. However, health outcomes are poorer in conflict-affected territories than in stable ones. The main challenges to service provisions identified by study respondents are the availability and retention of skilled personnel, the lack of basic materials and equipment as well as the insufficient financial resources to ensure health workers’ regular payment, medicaments’ availability and facilities’ running costs. Insecurity exacerbates pre-existing challenges, but do not seem to represent the main barrier to service provision in North and South Kivu. 
 
Conclusions: Provision of preventive schedulable RMNCAH+N services has continued during intermittent conflict in North and South Kivu. The prolonged effort by non-governmental organizations and UN agencies to respond to humanitarian needs was likely key in maintaining intervention coverage despite conflict. Health actors and communities appear to have adapted to changing levels and nature of insecurity and developed strategies to ensure preventive services are provided and accessed. However, emergency non-schedulable RMNCAH+N interventions do not appear to be readily accessible. Achieving the Sustainable Development Goals will require increased access to life-saving interventions, especially for newborn and pregnant women.

Keywords: health services, health system, conflict, population displacement, North Kivu, South Kivu, Democratic Republic of Congo, maternal, newborn, child, reproductive health

Topics: Age, Youth, Conflict, Gender, Women, Girls, Boys, Health, Reproductive Health, International Organizations, NGOs, Sustainable Development Goals (SDGs) Regions: Africa, Central Africa Countries: Democratic Republic of the Congo

Year: 2020

Delivering Water, Sanitation and Hygiene Interventions to Women and Children in Conflict Settings: A Systematic Review

Citation:

Als, Daina, Sarah Meteke, Marianne Stefopulos, Michelle F. Gaffey, Mahdis Kamali, Mariella Munyuzangabo, Shailja Shah, Reena P. Jain, Amruta Radhakrishnan, Fahad J. Siddiqui, Anushka Ataullahjan, and Zulfiqar A. Bhutta. 2020. "Delivering Water, Sanitation and Hygiene Interventions to Women and Children in Conflict Settings: A Systematic Review." BMJ Global Health 5 (Suppl 1).

Authors: Daina Als, Sarah Meteke, Marianne Stefopulos, Michelle F. Gaffey, Mahdis Kamali, Mariella Munyuzangabo, Shailja Shah, Reena P. Jain, Amruta Radhakrishnan, Fahad J. Siddiqui, Anushka Ataullahjan, Zulfiqar A. Bhutta

Abstract:

Background: Access to safe water and sanitation facilities and the adoption of effective hygiene practices are fundamental to reducing maternal and child morbidity and mortality globally. In armed conflict settings, inadequate water, sanitation and hygiene (WASH) infrastructure poses major health risks for women and children. This review aimed to synthesise the existing information on WASH interventions being delivered to women and children in conflict settings in low-income and middle-income countries (LMICs) and to identify the personnel, sites and platforms being used to deliver such interventions. 
 
Methods: We conducted a systematic search for publications indexed in four databases, and grey literature was searched through the websites of humanitarian agencies and organisations. Eligible publications reported WASH interventions delivered to conflict-affected women or children. We extracted and synthesised information on intervention delivery characteristics, as well as barriers and facilitators. 
 
Results: We identified 58 eligible publications reporting on the delivery of WASH interventions, mostly in Sub-Saharan Africa. Non-Governmental Organization (NGO)/United Nations (UN) agency staff were reported to be involved in delivering interventions in 62% of publications, with the most commonly reported delivery site being community spaces (50%). Only one publication reported quantitative data on intervention effectiveness among women or children. 
 
Discussion: This review revealed gaps in the current evidence on WASH intervention delivery in conflict settings. Little information is available on the delivery of water treatment or environmental hygiene interventions, or about the sites and personnel used to deliver WASH interventions. Limited quantitative data on WASH intervention coverage or effectiveness with respect to women or children are important gaps, as multiple factors can affect how WASH services are accessed differently by women and men, and the hygiene needs of adolescent girls and boys differ; these factors must be taken into account when delivering interventions in conflict settings.

Keywords: hygiene, maternal health, public health, treatment, systematic review

Topics: Conflict, Gender, Women, Girls, Boys, Health, Infrastructure, Water & Sanitation, International Organizations, NGOs Regions: Africa

Year: 2020

Applying a Gender Lens to Reduce Disaster Risk in Southern Africa: The Role of Men’s Organisations

Citation:

Forbes-Biggs, Kylah. 2020. "Applying a Gender Lens to Reduce Disaster Risk in Southern Africa: The Role of Men’s Organisations." In How Gender Can Transform the Social Sciences, edited by Marian Sawer, Fiona Jenkins, and Karen Downing, 169-76. Cham: Palgrave Macmillan.

Author: Kylah Forbes-Biggs

Abstract:

Gender inequality has been a pervasive problem in Southern Africa. It challenges development and welfare, dissuades good governance practices and entrenches social vulnerabilities that contribute to increased disaster and climate risk. The decisive shift towards focusing on women and girls not only in development but also in disaster risk management has been successful in bringing critical issues to the fore at national and international levels. Yet it can overlook the needs of men and boys and hence forego opportunities for more inclusive discussion and collaboration. The case is being made in Southern Africa to involve men’s organisations in promoting social justice. Creating spaces for dialogue in this way will promote understanding of gendered vulnerability and disaster risk.

Keywords: men's organisations, gender inequality, vulnerability, disaster risk, open dialogue, Southern Africa

Topics: Development, Environment, Environmental Disasters, Gender, Men, Boys, Gendered Power Relations, Gender Equality/Inequality, Governance Regions: Africa, Southern Africa

Year: 2020

Sexual Violence Against Men in Global Politics

Citation:

Zalewski, Marysia, Paula Drumond, Elisabeth Prugl, and Maria Stern, eds. 2018. Sexual Violence Against Men in Global Politics. Abingdon: Routledge.

Authors: Marysia Zalewski, Paula Drumond, Elisabeth Prugl, Maria Stern

Annotation:

Summary: 

“Sexual violence against men is an under-theorised and under-noticed topic, though it is becoming increasingly apparent that this form of violence is widespread. Yet despite emerging evidence documenting its incidence, especially in conflict and post-conflict zones, efforts to understand its causes and develop strategies to reduce it are hampered by a dearth of theoretical engagement. One of the reasons that might explain its empirical invisibility and theoretical vacuity is its complicated relationship with sexual violence against women. The latter is evident empirically, theoretically, and politically, but the relationship between these violences conjures a range of complex and controversial questions about the ways they might be different, and why and how these differences matter.

It is the case that sexual violence (when noticed at all) has historically been understood to happen largely, if not only, to women, allegedly because of their gender and their ensuing place in gender orders. This begs important questions regarding the impact of increasing knowledge about sexual violence against men, including the impact on resources, on understandings about, and experiences of masculinity, and whether the idea and practice of gender hierarchy is outdated. This book engages this diverse set of questions and offers fresh analysis on the incidences of sexual violence against men using both new and existing data. Additionally, the authors pay close attention to some of the controversial debates in the context of sexual violence against men, revisiting and asking new questions about the vexed issue of masculinities and related theories of gender hierarchy.

The book will be of great interest to students and scholars of sex, gender, masculinities, corporeality, violence, and global politics, as well as to practitioners and activists.” (Zalewski, Drumond, Prugl, and Stern 2018)

Table of Contents: 

INTRODUCTION - Sexual Violence Against Men in Global Politics

Marysia Zalewski, Paula Drumond, Elisabeth Prügl, and Maria Stern

"Tribulations" – Poem by Nziza D.Harouna

SECTION 1: PROVOCATIONS

1. Provocations in Debates about Sexual Violence against Men

Marysia Zalewski

2. Battle-Induced Urotrauma, Sexual Violence, and American Servicemen Chris Hendershot

3. Masculinity, Men and Sexual Violence in the U.S. Military

Elizabeth Mesok

4. Languages of Castration – Male Genital Mutilation in Conflict and Its Embedded Messages

Henri Myrttinen

5. Medical Approaches to Sexual Violence in War, in Guidelines and in Practice

Caroline Cottet

6. The Political Economy of Sexual Violence Against Men and Boys in Armed Conflict

Sara Meger

Reflections

Reflections on Sexual Violence Against Men and Boys in Global Politics
Paul Higate and Nivi Manchanda

Homo Interruptus
Paul Kirby

Can Our Intellectual Curiosity on Gender Cause Harm?
Madeline Rees

Gender, Sex and Sexual Violence Against Men
Laura J. Shepherd

Not for the Faint of Heart: Reflections on Rape, Gender, and Conflict
Lara Stemple

SECTION 2: FRAMING

7.  Uncovering Men’s Narratives of Conflict-Related Sexual Violence

Michele Leiby

8. Sex, Violence and Heteronormativity: Re-visiting Performances of Sexual Violence against Men in Former Yugoslavia

Paula Drumond

9. “Only a Fool…" Why Men Don’t Disclose Conflict-Related Sexual Violence in an Age of Global Media

Chris Dolan

10. Masculine Subjectivities in United Nations Discourse on Gender Violence (1970-2015): Perpetrators, Allies, and Victims

Gizeh Becerra

11. Sexual Violence or Torture? The Framing of Sexual Violence against Men in Armed Conflict in Amnesty International and Human Rights Watch Reports

Thomas Charman

12. Conflict-Related Sexual Violence against Men and the International Criminal Jurisprudence

Patricia Viseur Sellers and Leo Nwoye

Reflections

Familiar Stories, the Policing of Knowledge and Other Challenges Ahead
Maria Eriksson Baaz

Reflections on the Slippery Politics of Framing
Harriet Gray

Male Victims: A Blind Spot in Law
Charu Hogg

Sexual Violence against Men and Boys in the Congo
Ilot Muthaka

SGBV Against Men and Boys as a Site of Theoretical and Political Contestation
Jill Steans

"People you May Know" – Poem by Kevin Kantor

Topics: Conflict, Gender, Men, Boys, Masculinity/ies, Gendered Power Relations, Gender Hierarchies, Justice, International Tribunals & Special Courts, Post-Conflict, Sexual Violence, Rape, SV against men, Torture, Violence Regions: Africa, Central Africa, Europe, Balkans, Central Europe, Eastern Europe Countries: Bosnia & Herzegovina, Croatia, Democratic Republic of the Congo, Macedonia, Montenegro, Serbia, Slovenia

Year: 2018

Sexual Violence against Men and Boys in Conflict and Forced Displacement: Implications for the Health Sector

Citation:

Chynoweth, Sarah K., Julie Freccero, and Heleen Touquet. 2017. "Sexual Violence against Men and Boys in Conflict and Forced Displacement: Implications for the Health Sector." Reproductive Health Matters 25 (51): 90-4. 

Authors: Sarah K. Chynoweth, Julie Freccero, Heleen Touquet

Abstract:

Sexual violence against men and boys is commonplace in many conflict-affected settings and may be frequent in relation to forced displacement as well. Adolescent boys, forming the majority of unaccompanied minors globally, are a particularly vulnerable group. Yet sensitised health services for adult and adolescent male sexual violence survivors are scarce, and barriers to accessing care remain high. We describe current challenges and gaps in the provision of health care for male survivors in settings affected by conflict and forced displacement, and provide suggestions on how to improve service provision and uptake.

Keywords: sexual violence, humanitarian, men and boys, male, health

Topics: Conflict, Displacement & Migration, Forced Migration, Gender, Men, Boys, Health, Humanitarian Assistance, Sexual Violence, SV against men

Year: 2017

Male and LGBT Survivors of Sexual Violence in Conflict Situations: A Realist Review of Health Interventions in Low-and Middle-income Countries

Citation:

Kiss, Ligia, Meaghen Quinlan-Davidson, Laura Pasquero, Patricia Ollé Tejero, Charu Hogg, Joachim Theis, Andrew Park, Cathy Zimmerman, and Mazeda Hossain. 2020. "Male and LGBT Survivors of Sexual Violence in Conflict Situations: A Realist Review of Health Interventions in Low-And Middle-income Countries." Conflict and Health 14 (1): 1-26.

Authors: Ligia Kiss, Meaghen Quinlan-Davidson, Laura Pasquero, Patricia Ollé Tejero, Charu Hogg, Joachim Theis, Andrew Park, Cathy Zimmerman, Mazeda Hossain

Abstract:

Conflict-related sexual violence (CRSV) against women and girls has been the subject of increasing research and scholarship. Less is known about the health of men, boys and lesbian, gay, bisexual, transgender (LGBT) and other gender non-binary persons who survive CRSV. This paper is the first systematic realist review on medical, mental health and psychosocial support (MHPSS) interventions that focusses on male and LGBT survivors of CRSV. The review explores the gender differences in context, mechanisms and outcomes that underpin interventions addressing the health and psychosocial wellbeing of male and LGBT survivors. The aim is to contribute to the design and delivery of gender-sensitive and, when needed, gender-specific approaches for interventions that respond to specific needs of different groups of all survivors. We conducted a systematic search of academic and grey literature to identify medical and MHPSS interventions that included men, boys and LGBT survivors. We identified interventions specifically targeting women and girls that we used as comparators. We then purposively sampled studies from the fields of gender and health, and sexual abuse against men and LGBT people for theory building and testing. We identified 26 evaluations of interventions for survivors of CRSV. Nine studies included male survivors, twelve studies focussed exclusively on female survivors and one study targeted children and adolescents. No intervention evaluation focussed on LGBT survivors of CRSV. The interventions that included male survivors did not describe specific components for this population. Results of intervention evaluations that included male survivors were not disaggregated by gender, and some studies did not report the gender composition. Although some mental health and psychosocial consequences of sexual violence against men and boys may be similar among male and female survivors, the way each process trauma, display symptoms, seek help, adhere to treatment and improve their mental health differ by gender. Initiatives targeting male and LGBT survivors of CRSV need to be designed to actively address specific gender differences in access, adherence and response to MHPSS interventions. Models of care that are gender-sensitive and integrated to local resources are promising avenues to promote the health of male and LGBT survivors of CRSV.

Keywords: conflict-related sexual violence, men, boys, and LGBT survivors, medical interventions, mental health and psychosocial support interventions, systematic realist review, realist synthesis

Topics: Armed Conflict, Conflict, Gender, Men, Boys, Health, Mental Health, Trauma, LGBTQ, Sexual Violence, SV against men

Year: 2020

Child Safeguarding in a Peacekeeping Context: Lessons from Liberia

Citation:

Blakemore, Sarah, Rosa Freedman, and Nicolas Lemay-Hébert. 2019. "Child Safeguarding in a Peacekeeping Context: Lessons from Liberia." Development in Practice 29 (6): 735-47.

Authors: Sarah Blakemore, Rosa Freedman, Nicolas Lemay-Hébert

Abstract:

This article reviews how peacekeeping officials safeguard children from sexual exploitation and abuse (SEA) in Liberia, more than 15 years after the landmark reports published on this issue. Based on original fieldwork conducted in Liberia and in New York, the article introduces an innovative framework to assess whether or not organisations effectively safeguard children from SEA. It reviews three interrelated issues: reinforcing the institutional environment in the country, strengthening prevention of and accountability for child SEA by UN actors. The article concludes with specific policy recommendations for actors involved in peacekeeping activities.

Keywords: aid, accountability, aid effectiveness, civil society, NGOs, Gender and Diversity, youth, Rights, Sub-Saharan Africa

Topics: Age, Youth, Civil Society, Gender, Girls, Boys, NGOs, Peacekeeping, Sexual Violence, Sexual Exploitation and Abuse Regions: Africa, Central Africa, East Africa, Southern Africa, West Africa, Americas, North America Countries: Liberia, United States of America

Year: 2019

Languages of Castration – Male Genital Mutilation in Conflict and Its Embedded Messages

Citation:

Myrttinen, Henri. 2018. "Languages of Castration – Male Genital Mutilation in Conflict and Its Embedded Messages." In Sexual Violence Against Men in Global Politics, edited by Marysia Zalewski, Paula Drumond, Elisabeth Prugl, and Maria Stern. London: Routledge.

Author: Henri Myrttinen

Abstract:

This chapter explores the various forms of violence directed against male sexual/reproductive organs in different settings of violent conflict and some of the meanings attached to these acts in these contexts by the various people partaking in the act directly either as victims/survivors, perpetrator, and witnesses or indirectly as audiences. The tendency to not discuss acts of violence against male genital mutilation and its real-life repercussions even where there is evidence of these acts has the potential to render whole categories of victims/survivors invisible. Another key problem with interpreting the ‘languages of castration’ is a lack of research on perpetrator motivations as well as on victims’ and community members’ understandings of the violence and its meanings. The chapter focuses on a review of secondary materials, in addition to which some background interviews were conducted with academic researchers and NGO practitioners working on sexual violence against men and boys (SVAMB) as well as informal discussions with investigators working for international agencies.

Topics: Conflict, Gender, Men, Boys, Health, Reproductive Health, International Organizations, Male Victims, NGOs, Sexual Violence, SV against men

Year: 2018

International Encyclopedia of Men and Masculinities

Citation:

Flood, Michael, Judith Kegan Gardiner, Bob Pease, and Keith Pringle, eds. 2007. International Encyclopedia of Men and Masculinities. London: Routledge.

Authors: Michael Flood, Judith Kegan Gardiner, Bob Pease, Keith Pringle

Annotation:

Summary:
The International Encyclopedia of Men and Masculinities offers a comprehensive guide to the current state of scholarship about men, masculinities, and gender around the world. The Encyclopedia's coverage is comprehensive across three dimensions: areas of personal and social life, academic disciplines, and cultural and historical contexts and formations.
 
The Encyclopedia:
  • examines every area of men's personal and social lives as shaped by gender
  • covers masculinity politics, the men's groups and movements that have tried to change men's roles
  • presents entries on working with particular groups of boys or men, from male patients to men in prison
  • incorporates cross-disciplinary perspectives on and examinations of men, gender and gender relations
  • gives comprehensive coverage of diverse cultural and historical formations of masculinity and the bodies of scholarship that have documented them.
 
The Encyclopedia of Men and Masculinities is composed of over 350 free-standing entries written from their individual perspectives by eminent scholars in their fields. Entries are organized alphabetically for general ease of access but also listed thematically at the front of the encyclopedia, for the convenience of readers with specific areas of interest. (Summary from CRC Press)

Topics: Gender, Men, Boys, Masculinity/ies

Year: 2007

Natural and Man-Made Disasters: The Vulnerability of Women-Headed Households and Children Without Families

Citation:

Sapir, Debarati Guha. 1993. "Natural and Man-Made Disasters: The Vulnerability of Women-Headed Households and Children Without Families." World Health Statistics Quarterly 46 (4): 227-33.

Author: Debarati Guha Sapir

Abstract:

Since 1980, over 2 million people have died as an immediate result of natural and man-made disasters and by 1992, the refugee population registered nearly 16 million people. This article reviews the human impact of disasters as a composite of two elements: the catastrophic event itself and the vulnerability of people. It also examines the specific case of women and children in the current world emergency context. It identifies four broad policy areas that affect women and children in disaster situations and discusses them with examples and field evidence. The first policy area addresses humanitarian assistance and armed conflicts, and armed conflict and international humanitarian law, the use of food as instrument of war, mines and civilian disability, and rape and sexual violence are discussed within this context. The second problem discussed is the issue of unaccompanied and abandoned children in terms of its magnitude and implications for relief response. Thirdly, the article examines the differential risks in emergencies for mortality and morbidity, specifically for women and children. Finally, it addresses certain policies and approaches to disaster rehabilitation which effectively mirror and reinforce inherent inequities in the affected society. The article notes that: (i) the largest proportion of disaster victims today arise from civil strife and food crises and that the majority of those killed, wounded and permanently disabled are women and children; and (ii) the ability of any country to respond effectively to disasters depends on the strength of its health and social infrastructure, and its overall developmental status. It concludes by identifying seven areas where concrete measures could be taken to improve the current situation.

Topics: Age, Youth, Armed Conflict, Displacement & Migration, Refugees, Environment, Environmental Disasters, Gender, Women, Girls, Boys, International Law, International Humanitarian Law IHL, Humanitarian Assistance, Post-Conflict, Sexual Violence, Rape, SV against women

Year: 1993

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