Humanitariman Weekly Roundup

Source: http://worldculturecelebrationfestival.com/2016/11/03/can-expect-festival/ Formatted for use on Humanitariman.com

Source: http://worldculturecelebrationfestival.com/2016/11/03/can-expect-festival/ Formatted for use on Humanitariman.com

Humanitariman's Weekly Roundup is a weekly segment dedicated to bringing you news from around the world. Each week we will highlight current events and interesting updates so that you can stay informed about what is happening around you. 

Myanmar Denies U.N. Allegations of Ethnic Cleansing

This week, top military officials in Myanmar denied U.N. accusations of ethnic cleansing and crimes against humanity. The Burmese media and local human rights groups have reported incidences of killings, rape, torture, unwarranted arrests, and the burning of people and homes all targeted at Rohingya Muslims, a minority ethnic group in the Rhakine State in Northwestern Myanmar. The atrocities waged by the Burmese government appear to be in response to attacks in October on three police outposts on the Myamar-Bangladesh border that reportedly left nine police officers dead. The Burmese government has been adamant that Rohingya militia groups were behind the attacks, however, these claims remain unverified. The United Nations and various human rights groups have been calling on the Burmese government to allow a special investigation into these abuses. On Thursday, the Rapporteur to the Human Rights Council called for a Commission of Inquiry, which is the United Nations strongest investigative tool. The call would allow an investigation into the treatment and abuses against the Rohingya in 2010, 2012, and most recently October of 2016. The U.N. has estimated over 70,000 Rohingya have fled to Bangladesh since October. The Burmese government has cracked down on media access to the region, making investigations into these atrocities difficult.

The Lost Generation of Yemen

Houthi rebels and pro-government forces loyal to President Hadi continue to fight in Yemen in a conflict that does not seem to be ending anytime soon. Over 10,000 people have died in the bloody civil conflict and three million people have been displaced from their homes. International involvement from the United States and Saudi Arabia has exacerbated the casualties. Saudi Arabia began airstrikes in March of 2015 after Houthi rebels forced the Saudi-backed President to flee the country. Saudi Arabia has been criticized for their airstrikes in Yemen, which have targeted schools, hospitals, weddings, funerals, and prisons. The U.N. has estimated that over half of the death toll in Yemen is due to Saudi intervention and Saudi coalition forces, who are supported by the U.S and European governments. The death, destruction, and degradation of institutions has become so bad that the United Nations has warned that those young people that survive will constitute a “lost generation,” having grown up in the absence of a proper education. The U.N. currently estimates that 86% of the Yemeni population is in need of humanitarian assistance.

On Thursday, the United States carried out over 20 airstrikes, continuing the military strategy seen under the Obama Administration and adding to the death total.

DROUGHT IN KENYA

In mid February, Kenya’s government declared that the current drought in their country is now a national emergency. The number of people now food insecure due to the ongoing issue is upwards of 2.7 million. As one can imagine, due to the dry climate crop production has decreased dramatically. The same goes for water accessibility. Many, especially in the more rural and isolated regions of the countryside now have to travel more than three times further to retrieve water.

The government has pledged $70 million to drought relief efforts, however according to a study led by the Institute for Environmental Studies at Vrije University in Amsterdam, the Kenyan government’s current National Water Master Plan is unsustainable. This plan includes diverting water from the Tana River (Kenya’s largest river) to provide drinking water for those in desperate need and to irrigate crops that are in dire condition. The plan also includes construction of a 165 square kilometer damn which will take at least six years to complete. Where these moves will put Kenya in the long term is yet to be seen, and in even if the rains return on time in April, damage from the drought could last generations.

Forget the Formula: Breastfeeding Saves Lives

Casey Mohrien

Chernihivska, Ukraine

Increasing prevalence of exclusive breastfeeding for the first month to 95%, the first 6 months to 90%, and continued but non-exclusive breastfeeding for one year to 90%, would save 823,000 lives of children under 5 and 20,000 lives of women.

The benefits of breastfeeding for mother, child, and society as a whole

The benefits of breastfeeding for mother, child, and society as a whole

There may not be a more natural process than that of the human reproductive cycle. The transformation from a mass of cells to a fully formed infant is nothing short of remarkable. However, the reproductive cycle does not end at the birth of a child. The notion that breastfeeding is inherently linked to the natural reproductive cycle in women has largely been ignored by the medical community, and society as a whole. While conception and embryonic development has dominated society’s conversation around reproduction and reproductive rights, breastfeeding has been disregarded. And yet research has shown that scaling up breastfeeding practices to near universal levels could save close to a million lives each year. A series commissioned by The Lancet, estimates that increasing prevalence of exclusive breastfeeding for the first month to 95%, the first 6 months to 90%, and continued but non-exclusive breastfeeding for one year to 90%, would save 823,000 lives of children under 5 and 20,000 lives of women.

Breastfeeding may be one of the only positive health behaviors more prevalent in poorer populations than in wealthier ones. In fact, research has shown that for every doubling of GDP per capita a country experiences, the prevalence of breastfeeding at 12 months drops by 10 percent. Between country comparisons show low-income countries (LICs) have a higher prevalence of breastfeeding both exclusively (exclusive until 6 months) and up to 12 months (partial breastfeeding until 12 months). From a global perspective, the prevalence of exclusive breastfeeding for the first 6 months has been steadily increasing since the 1990’s, from 24.9% in 1993 to 35.7% in 2013. As stated above, these percentages are higher in low-income countries and decrease into higher income countries. However, even in low and middle-income countries (LMICs), breastfeeding rates are far below recommendations. In LMIC’s alone it is estimated that over 101 million babies are not being breastfed according to World Health Organization recommendations. This includes 36.3 million infants less than 6 months of age not being exclusively breastfed and 64.8 million infants 6-23 months of age not receiving any breast milk at all. 

Sub-Saharan Africa has the highest prevalence of breast-feeding at 12 months. In general, low income countries and lower-middle income countries had much higher rates of breastfeeding than high-income countries. Having ever breastfed was common throughout the world with only three countries having a prevalence less than 80% (United States, Spain, and France). However, continued breastfeeding at 12 months was below 20% in high-income countries. And while breastfeeding in general was common throughout LMICs, early initiation rates and exclusive breastfeeding rates were sub-par.

World Breastfeeding week 2016 Logo Source: www.worldbreastfeedingweek.org

World Breastfeeding week 2016 Logo Source: www.worldbreastfeedingweek.org

Breastfeeding has enormous impacts for both child and mother. Studies in LMICs showed that exclusively breastfed infants have just 12% of the risk of death compared to their non-breastfed counterparts. Another group of studies found that both female and male infants younger than 6 months who were not breastfed at all had 4.1 times and 3.5 times higher mortality rates, respectively, than those infants who received any breast milk within the first six months. For infants 6 – 23 months, research in LMICs has estimated that breastfeeding in any capacity is associated with a 50% reduction of deaths. Studies done in high income countries have also shown significant decreases in mortality, with ever breastfeeding being associated with a 36% reduction in sudden infant death syndrome (SIDS) and a 58% reduction in necrotizing enterocolitis (a disease that results in intestinal tissue death and often death of the infant).

Analyses from hundreds of different studies all show overwhelming evidence that breastfeeding offers extremely strong protection against a myriad of different diseases. A meta-analysis of sixty-six different studies found a 50% decrease in episodes of diarrhea and a 33% decrease in the incidence of respiratory infections thereby preventing 72% of hospital admissions from diarrhea and 57% from respiratory infections. A combination of forty-nine different studies found an inverse association between breastfeeding and malocclusions (under-bites, overbites, and other abnormalities in jaw alignment) with breastfeeding offering a decrease in the occurrence of malocclusions by 68%. Analyses of an additional 113 studies found longer periods of breastfeeding correlated with a 26% reduction in overweight or obesity and three high quality studies showed a possible reduction (statistically insignificant) of 24% in the incidence of type 2 diabetes in children. Longer breastfeeding was associated with a 19% reduction in childhood leukemia as well as consistently correlated with increases in IQ in children and adolescents. Studies conducted in high-income countries showed a possible association between breastfeeding and education attained with breastfed infants attaining higher levels of schooling than their non-breastfed counterparts. However in LMICs similar researched returned mixed results.

Mother Breastfeeding her baby. Source: www.medela.com

Mother Breastfeeding her baby. Source: www.medela.com

Breastfeeding does not only provide protection to nursing infants but also to their mothers. Women who breastfed had a 7% reduction in breast cancer risk per every 12 months of breastfeeding and longer periods of breastfeeding were also associated with an 18% reduction in ovarian cancer. Breastfeeding was also associated with longer periods of lactational amenorrhea (period of infertility post-pregnancy due to lactation) and increased birth spacing. In countries where exclusive and continued breastfeeding is more prevalent, breastfeeding is attributed to a decrease of 50% in total births, often allowing women to fully recover post-partum before another pregnancy is possible. Longer periods of breastfeeding show a possible protection against type 2 diabetes in women, however more research needs to be done on this association.

Currently there remains societal, cultural, institutional, and industry barriers to breastfeeding. Perceptions of breastfeeding in many societies are still archaic and evidence of its benefits not widely known. Communities around the world need to raise awareness about the benefits of breastfeeding and fight negative societal attitudes towards it. Society still sees breastfeeding in public as taboo with many studies indicating negative perceptions of public breastfeeding. Employers have also reported a high degree of employee discomfort at the sight of breastfeeding in the workplace. Policy-makers and businesses alike need to be more accommodating to breastfeeding women. Instituting policies and norms that increase maternity and paternity leave, provide places and time for women to breastfeed or pump during the work-day, provide on-site child-care, and abolish restrictions on breastfeeding in public spaces would all aid in increasing the prevalence of breastfeeding. Society should see breastfeeding as the natural process it is, and should support breastfeeding women. The antiquated idea that breastfeeding success is solely the responsibility of the mother must be distinguished, and the community must acknowledge its role in supporting and protecting the rights of breastfeeding mothers. Counseling family members and partners can have a dramatic effect on breastfeeding prevalence. Studies have shown that women have more positive outcomes and breastfeed for longer periods of time when their partners or family members are supportive and take an active role in the breastfeeding process, Breastfeeding needs to be looked at as a natural and powerful health intervention for women and children, and society as a whole. Hospitals and healthcare professionals need to increase their awareness of the impact of breastfeeding and counsel patients about not only the benefits but the possible obstacles that may arise when beginning breastfeeding. Hospitals need to adopt institutional policies that place an emphasis on early initiation of breastfeeding and direct counseling for new mothers after the birth of their child. Stricter regulation on the formula industry is also needed. Global breast milk substitutes are a billion dollar industry with profits exceeding 44 billion dollars annually. Many of their campaigns and advertising negatively influences and undermines breastfeeding practices worldwide. Policy-makers need to restrict advertising of breastmilk substitutes and ramp up breastfeeding awareness campaigns.

Fives Circles of Support for breastfeeding women. Source: World Breastfeeding Week, http://worldbreastfeedingweek.org/

Fives Circles of Support for breastfeeding women. Source: World Breastfeeding Week, http://worldbreastfeedingweek.org/

Despite the fact that breastfeeding is associated with a decrease in child mortality and morbidity, maternal morbidity, child and adolescent intelligence, and an annual GDP savings of over 300 billion dollars, only 1 in 5 infants is still breastfed at 12 months of age. Scaling up exclusive breastfeeding for the first 6 months, and partial breastfeeding for the first 12 months can save 823,000 child lives and 20,000 lives of women from breast cancer. Breastfeeding is a powerful and easily scalable public health and development intervention with enormous benefits. The research cannot be ignored any longer.

 

Want to learn more about breastfeeding and the organizations that advocate for it? Check out these links below

La Leche League International

World Alliance for Breastfeeding Action

Lactation Matters

 

South Sudan: A Nation in Peril

By Matt Goldweber

New York, New York, USA

The world’s newest nation has been facing collapse ever since its inception in 2011. South Sudan, which itself is the product of a turmoil filled past with now neighbor to the north, Sudan, is now at war. Not at war with its historic foe, but with itself.

A young South Sudanese refugee cooks food at a camp in northern Uganda Photo: UNHCR

A young South Sudanese refugee cooks food at a camp in northern Uganda Photo: UNHCR

Background

Instability has deep roots in the region. As was the case in most colonized African countries before it, when Sudan was under British and Egyptian rule early in the late 19th/early 20th century, the map that defined the nation was seemingly created out of thin air by its then rulers. This was done without taking into account, and perhaps without having any knowledge of the fact that this area was heavily tribal long before it’s conquering.

Beginning in the mid 1950’s, following the declaration of Sudan as an independent nation, the southern states became increasingly unhappy with their lack of autonomy. The South was soon given a certain level of independence by rulers in the northern capital city of Khartoum. However, this gift of independence did not last long, and by the mid 1980’s, further instability soon led to fighting. From there, over 20 years of tribal warfare throughout the Sudan would lead to over 1.5 million deaths, and millions more who would become displaced. This violence primarily took place between the Muslim led Government, along with pro government militias, and the Christian/traditionally religious south.

Independence Declared

In 2011, a glimmer of hope. With the backing of the United States and other Western nations, as well as approval from the United Nations, South Sudan became the world’s 193rd recognized country. However, simply declaring independence did not erase years of ethnic and political tension. The two ethnic groups that make up a majority of the South Sudan population are the Dinka and the Nuer. Both are pastoral groups and speak languages that are somewhat similar.

Jikany Nuer White Army fighters in Upper Nile State, South Sudan Photo: Newsweek

Jikany Nuer White Army fighters in Upper Nile State, South Sudan Photo: Newsweek

Despite their similarities, inter-ethnic fighting has plagued these two groups. When Juba (the capital city of what is now South Sudan) was established as the capital city, and borders were set, ethnic lines began to form and violence ensued between the Dinka and Nuer. Like with Darfur 10-15 years ago, this civil war has pitted groups of people against one another as a result of historic implications. The inter-ethnic fighting hasn’t stopped at Dinka vs. Nuer, as there are more than 60 ethnic groups in the nation, many of whom have been at odds with another over past decades. In addition to ethnic feuding, an ongoing dispute between pro-government forces supportive of President Salva Kiir Mayardit, and rebel forces loyal of then Vice President Riek Machar has contributed greatly to displacement and violence; eventually leading to an assassination attempt on Machar, which forced him to leave the country in mid-2015.

Effects on the Innocent

The humanitarian implications of this conflict are vast. According to the United Nations, there are roughly six million people in South Sudan that are either in the midst of being or are at risk of becoming food insecure. An increasing number of South Sudanese will continue to face difficulty in meeting daily food needs in the coming months despite harvests, the UN’s Food and Agriculture Organization has warned. The start of harvests in South Sudan are traditionally associated with a reduction in food insecurity due to more food stocks and lower food prices in the markets, hopefully bringing much needed relief. However, an estimated 675,000 people are currently in emergency need, meaning that they face large gaps in their ability to meet basic food requirements. These populations, particularly children, face a significantly elevated risk of malnutrition and mortality. This widespread need for food has caused drastic levels of displacement.

Displaced people walk next to a razor wire fence at the United Nations base in the capital Juba, South Sudan Photo: AP

Displaced people walk next to a razor wire fence at the United Nations base in the capital Juba, South Sudan Photo: AP

As stated by development organization World Vision, almost 500,000 people have fled South Sudan since its fifth birthday in July 2016 due to food insecurity, rising conflict, and lawlessness. Daily violence and unease has made it very difficult for humanitarian missions and aid to reach those most in need over past months. According to the United States Agency for International Development (USAID),

“Confronting deteriorating economic conditions, populations are less able to cope with shocks and increasingly rely on the humanitarian community for basic food and non-food assistance. However, insecurity, bureaucratic harassment of relief organizations, logistical challenges, and Government of the Republic of South Sudan-imposed restrictions constrain humanitarian activities across the country, hindering the delivery of critical assistance to populations in need” (https://www.usaid.gov/crisis/south-sudan)

 

99% of the now South Sudanese population supported their move to independence in 2011. Today, these same innocent people, who yearned to break free from violence and find stability, are being slaughtered so that chaos can continue. Massacres of hundreds at a time have taken place over the past few years, and there is not a single systematic solution that has been successful in countering or preventing these catastrophes.

 It is safe to say that South Sudan is on a crash course to become Africa’s next failed experiment in practicing democracy, unless influential global powers soon step up and ensure that compromise is found within the new nation’s battling factions.

Trump's War on Refugees

By Casey Mohrien: 

Chernihivska, Ukraine

At a time when we should be organizing a global refugee resettlement program, the United States is turning its back on the most vulnerable people in the world.

Two Syrian boys walk together to their tent at a camp for displaced Syrians. Syria is among the 7 countries whose people, refugees included have been banned from entering the United States (Syrians face an indefinite ban unlike the 6 other nations). Syria, December, 2012. Freedom House

Two Syrian boys walk together to their tent at a camp for displaced Syrians. Syria is among the 7 countries whose people, refugees included have been banned from entering the United States (Syrians face an indefinite ban unlike the 6 other nations). Syria, December, 2012. Freedom House

 

Last Friday, the newly elected President of the United States, Donald Trump, signed an executive order severely restricting immigration from seven different countries, all of which have a Muslim majority. The decision to close the United States off from a myriad of middle-eastern and African countries has garnered enormous media attention and backlash from human rights activists and world leaders. Protests have erupted around the United States in response to what many people are calling (borrowing from rhetoric used by Trump himself on the campaign trail and by wording in the executive order that prioritizes refugees of minority religions) a “Muslim ban.” However, the Trump administration doesn’t seem to be broadly targeting Muslim majority nations as much they seem to be targeting conflict-ridden nations with large-scale displacement (refugee/IDP) crises. A breakdown of the 7 countries included in the executive order, shows that 6 of the 7 nations are currently in the midst of internal conflict that has cumulatively displaced millions of people. According to the United Nations High Commission on Refugees 3 of the 7 countries included are in the top ten countries of origin for refugees (Syria, Somalia, and Sudan) with Syria atop the list as the single biggest origin country. According to the Department of Homeland Security, the United States admitted 96,874 refugees in 2016 with 43,259 refugees coming from the 7 nations on the ban. That is nearly 50 percent of the total refugees granted admission into the US in 2016. Syrian refugees, who have been banned from entering the US indefinitely, accounted for roughly 16% of the total refugees welcomed into the US last year. A temporary ban on refugees from the 7 countries that produced half of the resettled refugee population in the US, and specifically an indefinite ban on Syrian refugees, is the Trump administration’s way of turning its back on the international agreement to protect the most vulnerable population in the world. Under George W. Bush and Barack Obama the US played a large role in creating crises in Iraq, Syria, Yemen, and many other countries. Considering that, and it’s meager response to accepting refugees post-9/11, now is not the time for the United States to shut it’s borders to the very countries it contributed in destabilizing.

For its size and wealth, the United States does not house many refugees. Only 1% of refugees are actually resettled in a third country. Those that are referred for resettlement are the most vulnerable people in the world, unable to go back home and unable to survive where they currently are. Many refugees slated for resettlement are women and children, with women and children comprising 75% of refugee admissions to the US in 2016. The fact that the US doesn’t deal with 99% of the world’s refugees is due, in large part, to its geographical distance from conflict areas. Most refugees seek asylum in bordering countries in Sub-Saharan Africa and the Middle East. As of the end of 2015, Sub-Saharan Africa housed the most refugees at 4.4 million. Turkey has welcomed the most refugees of any country with 2.5 million refugees currently residing there. In Lebanon 1 in every 5 people living there is a refugee. Trump’s decision to wage war on refugees has already left many in limbo. According to the UN, 26,000 Somalian and Sudanese refugees were in the process of resettlement in the US, around 15,000 of them coming from the Dadaab refugee complex in Kenya, the largest refugee complex in the world. Around 137 refugees in Kenya, who thought they would be boarding flights for resettlement soon, have now been left in uncertainty. Imagine, for a second, spending years or even decades trying to escape a life in a refugee camp and on the eve of your departure being told you can no longer enter that country. The United States is an important refugee resettlement country and the US should be expanding its intake of refugees not halting it in any way. Donald Trump, whether intentionally or not, has waged a war against the most vulnerable people in the world. This is an attack at the very core of what it means to be a human being. It must be halted.

The sun looming above a part of the Dadaab Refugee Complex in Kenya, the largest Refugee camp in the world. 26,000 refugees were slated to be resettled in the United States before the Trump Administration's executive order. Photo taken from http://africa.tvcnews.tv/

The sun looming above a part of the Dadaab Refugee Complex in Kenya, the largest Refugee camp in the world. 26,000 refugees were slated to be resettled in the United States before the Trump Administration's executive order. Photo taken from http://africa.tvcnews.tv/

 

Not only is turning away refugees during the largest refugee crisis since World War 2 amoral, but evidence has shown that it is not an effective tool in the fight against terrorism. According to the Cato Institute, a historically conservative think tank, not a single refugee has ever been implicated in a fatal terrorist attack on US soil since the Refugee act of 1980. In fact your odds of being killed by a Refugee in a terrorist act on US soil are almost non-existent. Refugees undergo the most thorough security screenings of anyone admitted into the US. In general, your annual odds of being killed by a terrorist attack committed by any foreign born person on US soil is around 1 in 3.6 million. To put that in comparison you are far more likely to be struck by lightning this year (1 in 1.04 million) or die in a car crash this year (1 in 8,938) and you are 256 times more likely to be killed by homicide in the US then you are to be killed by a foreign born person in a terrorist act on US soil. Politicians have used refugees and immigrants as scapegoats, playing up fears over terrorism to push through racist and xenophobic policies like the executive order President Trump signed over a week ago. A ban on immigration from these countries only gives ISIS and other terrorist organizations more recruiting material as they try to bring more people into their extreme ideology. People often forget that fighting terrorism is much different than wars fought between countries. Terrorism is an ideology and ideologies aren’t defeated through military intervention. The Trump administration’s executive order on ISIS plays into the picture terrorist’s paint of the United States as the anti-Muslim enemy.

Despite the popular notion that American’s vetting process for refugees is inadequate or outdated, America’s screening system is actually an overly stringent and long bureaucratic process involving both national and international agencies. In fact, America has the longest and toughest refugee resettlement process of any nation in the world. To even be classified as a refugee, you must first register and interview with the UNHCR. Upon receiving refugee status from UNHCR, you must then be referred to the United States as a possible candidate for refugee resettlement. Most people with refugee status will not be referred for resettlement, as less than 1% of Refugees are resettled in a third country. Upon referral to the US, the United Nations sends the background information to the one the State Department-funded Resettlement Support Centers (RSC). The RSC conducts an in-depth interview while cross-referencing biographical information and sending appropriate information to various US agencies for background checks. US agencies including the Department of Homeland Security, the National Counterterrorism Center, the Department of State, the Department of Defense, as well as the Central Intelligence Agency all run background and security checks on the applicant. Syrian Refugees must undergo an additional enhanced screening. The results of the security screening are transmitted back to the Department of Homeland Security where they review them and schedule extensive in-country interviews with specially trained DHS officers. If any new information arises, security screenings are redone, and if information doesn’t match up with previous information given, the applicant is put on hold until the discrepancies are adjudicated. Biometric data is collected, in the form of fingerprints, during the interview and ran against the FBI biometric database, the DHS biometric database which includes a government watch-list and previous immigration encounters, and the US Department of Defense database containing fingerprints from all over the world. If the applicant passes all biometric screenings, they must then undergo a medical examination and complete a cultural orientation class before a resettlement agency in the US determines their resettlement location. Because the process takes so long the applicant must go through an additional multi-agency background check before leaving for the US as well. The entire process takes on average 18-24 months with many refugees awaiting resettlement for years or even decades in refugee camps with limited resources.

A breakdown of the long and thorough Refugee resettlement process in the United States

A breakdown of the long and thorough Refugee resettlement process in the United States

A non-specific and blunt ban on immigration into the United States from any country goes against the core values the United States has stated it has as a nation. But there is something more inherently evil about closing your borders to refugees. Refugees are the most vulnerable people in the world. Fleeing conflict and persecution, they are forced to leave their home in search for a safer place. Under international law every country has agreed to aid in the protection of refugees. At a time when we should be organizing a global refugee resettlement program, the United States is turning its back on the most vulnerable. With this latest immigration ban, the United States has failed to uphold its duty as a country, but more importantly its duty as a collection of morally-rooted human beings. 

When Home is a Battlefield: The Urbanization of the Iraq War and its Effect on Innocent Civilians

As Syria descends deeper and deeper into urban warfare, a look back at the Iraq war and the repercussions of the conflict on the only innocent people involved, Iraqi civilians.

Written November 2014 and updated December 2016

War has far-reaching implications in the health of a society. The impact of war and conflict go beyond the direct calculations by which it is often measured.  Mortality due to violence, the toll through which wars are often reported, only partially displays the bearing war has on people individually, and society as a whole. Often times the consequences of war are not considered initially, only looked at retrospectively, and then very often ignored. 

In 2003, as part of the War on Terror, a United States led coalition of troops invaded Iraq in order to overthrow the Ba’athist regime in power.  Although Saddam Hussein surrendered quickly, insurgent groups and militias sprang up, and the U.S found itself in the midst of a war for the next 8 years, the repercussions and remnants of which still affect Iraq today. The implications and negative effects of the Iraq War on the health of the Iraqi population has led to the continued suffering of innocent Iraqi civilians.  Whether through direct causes such as violence related mortality or morbidity, or through the indirect destruction of public infrastructure and forced migration of millions of people, the Iraq war has had, and will continue to have, a negative impact on the health and well-being of the only innocent party involved, the Iraqi civilians.

During the Iraq war, warfare became increasingly more urbanized, blurring the lines between enemy combatants and innocent civilians. Rapid destabilization led to a wide-spread augmentation of violence that still persists today, a disproportionate majority of which affects civilians. As Iraqi’s saw their homes transformed into urban battlefields, hundreds of thousands of innocent people lost their lives directly from violence and terrorism. The Iraq Body Count estimates that anywhere from 168, 658 to 187,863 noncombatant civilians have died from causes directly related to war since 2003 and continuing to this day. Furthermore, it is estimated that the conflict is attributable, either directly or indirectly, to 405,000 excess deaths (95% CI 48,000-751,000) from 2003-2011, 40 percent of which are associated with the collapse of public infrastructure and systems. Compared to pre-war levels (2001-2003) the crude mortality rate in Iraq increased by 50% to 4.55 per 1000 person-years from 2003-2011. Data concerning war-related morbidity and injury has not been adequately collected, although one study calculated the injury rate in 2009 to be roughly 60 per 1000 person-years, the majority of which was due to incidental and unintentional explosions.

While a vast proportion of mortality and morbidity was due to widespread violence, a significant amount was also associated with the breakdown of infrastructure indirectly as a result of war. The breakdown of general infrastructure, particularly the health infrastructure, has had a profoundly negative impact on the health of the Iraqi population.  Before the Iran-Iraq war in 1980, the Iraqi health system was widely considered one of the best in the region. Over two decades of war and economic sanctions led to a weak, dilapidated system, when the U.S led coalition invaded in 2003.  The destabilization and subsequent increase in violence led to the further breakdown of an already fragile health infrastructure. Many health professionals fled the violence, relocating to neighboring countries. By 2006, three years into the war, an estimated 20, 000 out of Iraq’s 34,000 physicians had either fled the country or had been killed. Furthermore, by late 2007, only an estimated 22% of pre-war Iraqi physicians remained in Baghdad. This departure not only limited the availability of adequate treatment to the Iraqi population, but also significantly reduced the capacity to train new health professionals. During the initial coalition invasion, twelve percent of Iraqi hospitals were destroyed and many clinics and laboratories were looted for equipment and pharmaceuticals and damaged beyond usefulness.  Dewachi et al. blames the “militarization of healthcare,” the blurring of the line between healthcare and warfare, for the mass exodus of health professionals and the targeting of hospitals during conflict. In the aftermath of the collapse of the Hussein regime, various radical insurgencies erupted in an attempt to take control of government institutions.  Hospitals and physicians became targets for violence and takeover, from both militia groups and coalition forces. Hospitals and health clinics were understaffed, understocked, and overwhelmed with increased injuries and illness stemming from conflict. State run vaccine programs were discontinued and vector control and tuberculosis treatments disrupted, further compounding the strain on the health system. The poor state of the healthcare system meant that millions of Iraqi’s lacked adequate access to healthcare during the war, a problem that continues to persist today. Multi-drug Tuberculosis cases continue to rise, partially due to disruption of antibiotic treatment during the war, and pose a significant problem.  Hospitals no longer epitomize a place of safety and well-being in Iraq like they once did, and a growing mistrust of health professionals is occurring, a direct result of the war.  As Iraq looks towards rebuilding its once robust healthcare system, it must increase the availability of healthcare workers, build and renovate hospitals, and increase its medical technology and capacity, despite on-going violence and unrest.

The decline of public infrastructure played a large in role in the further exacerbation of the health system and the increase in the suffering of the Iraqi population. Although the overall percentage of the rural population with access to clean water increased (44%-56%) from 1990-2010, the overall urban population with access to clean water declined during the same time period (97%-91%), leaving more than 7.6 million people without access to clean water at any one time throughout the war. Urban areas were epicenters for the majority of violence, and significant damage to health –related public infrastructure occurred in these areas. Extensive damage to sewage and water treatment facilities, initially from the first Gulf-War and extensively worsened during the Iraq War, led to a decrease in access to clean water for urban populations, and the dumping of millions of tons of raw sewage into the Tigris and Euphrates rivers and tributaries. These factors helped foster an increase in infectious water-borne and diarrheal diseases throughout Iraq that exist still today. In 2011 and 2012, Iraq experienced two separate major cholera outbreaks and outbreaks of dysentery occur throughout the country..

The violence and terrorism associated with, and still stemming from, the Iraq War has led to the displacement of millions of Iraqi’s both externally and internally. Upwards to 746,400 refugees fled Iraq in 2012 and there were 1.1 million internally displaced Iraqis, the majority of which suffer from lack of necessities, ranging from inadequate access to healthcare to food insecurity. Over two million (2.2) Iraqi’s fled the country, and 2.7 million were internally displaced through the first four and a half years of the war.  Although internally displaced peoples and refugees living in camps are usually provided with basic health services, the World Food Programme found that only 27% of internally displaced people were living in camps in 2008. The public health systems in neighboring countries like Jordan and Lebanon, have struggled to incorporate the health needs of refugees coming across the border from Iraq and now more recently Syria, many of which cannot afford to cover the costs of their medical treatment. In fact the ministry of Health in Jordan has asked and advocated repeatedly for foreign aid in order to fund the treatment of refugees from these two countries. Higher socio-economic Iraqis have begun to travel to and from hospitals in neighboring Jordan and Turkey, for the sole purpose of attaining healthcare.  Dewachi et al. refers to the phenomenon of displaced people accessing healthcare outside of Iraq, as the “regionalization of healthcare,” a shift away from the containment of healthcare within borders to a more regional healthcare system in the Middle East. They reference the conflicts in Syria and Iraq as a factor involved in this shift.

Food insecurity remains a significant problem in Iraq, especially for internally displaced populations. Much of the Iraqi population receives food rations through the Public Distribution System (PDS), which continued to function throughout the war and continues to provide rations today. Despite PDS rations, malnutrion was exacerbated throughout the war, and with violence and poverty still endemic to Iraq, malnutrition continues to be a problem.  Malnutrition has subsequently led to adverse health effects, further increasing the need for adequate health services and a strong health system. Lack of access to health services and food insecurity, resulting from years of war and sanctions have led to decreases in maternal and child health, specifically newborn health.  Half of all under-five mortality is due to neonatal deaths and the low birth weight rate is estimated to be 15% in Iraq. In 2006, three years into the war and despite the delivery of food rations, 26% of children under five years of age were stunted due to inadequate nutritional intake. Providing access to nutritionally adequate foods and health services remains a concern and problem for the new Iraqi Government looking forward. 

The decision to invade Iraq in 2003 was one that has not been void of consequences. Millions of innocent Iraqi civilians have died and continue to die as a result of the direct violence and terrorism, and the indirect collapse of public infrastructure associated with and exacerbated by the Iraq war. Few people stop to consider the traumatic effects modern war has on the people living in the conflict area. And while mortality can tell part of the story, it is often the unintended, indirect effects of war that create lasting suffering in communities. In addition to the indirect consequences of war discussed above (collapse of health system and disruption of public health programs, collapse of sanitation and water infrastructure, forced migration, food security), there are also several other consequences not discussed in this article such as economic and mental health effects, all of which must be considered before entering conflict.  Along with others, the Iraq War represents a shift to more urbanized warfare, a trend that has the biggest impact on the most vulnerable and innocent group, noncombatant civilians. 

For the ease of the reader Humanitariman leaves out in-text citations. To access our citations for this article click here. To access the PDF version of this article with in-text citations click here. 

Keep on the lookout for the second part of our 7 part series on Global Displacement. 

Forced Displacement: A Global Overview

By Casey Mohrien: 

Chernihivska, Ukraine

What if the entire population of Thailand or the United Kingdom was forced to leave their homes or country due to violence, persecution, or conflict?

Refugees arrive at the small Greek Island of Lesbos after making the dangerous trip From Syria. Thousands of people have died trying to cross into Europe in search of a better life. 

Refugees arrive at the small Greek Island of Lesbos after making the dangerous trip From Syria. Thousands of people have died trying to cross into Europe in search of a better life. 

In the wake of the United Kingdom’s vote to exit the European Union, a result due in large part to xenophobic and anti-immigrant sentiment, and the rise of nationalist anti-immigration and anti-refugee sentiment across the globe, it has never been more important to examine the extent of the Refugees, IDPs, and Asylum-seekers globally. As of 2015, 65.3 million people have been forcibly displaced worldwide, an increase of over 5 million from 2014 statistics. To put that into perspective it is as if the entire population of Thailand or the United Kingdom was forced to leave their homes or country due to violence, persecution, conflict, or human rights violations. Of the 65.3 million, 40.8 million are classified as Internally Displaced Peoples (IDPs), meaning that they have not crossed an internationally recognized border. These people continue to reside in their native country, many without a home, or adequate access to food, water, education, or healthcare. Still 21.3 million are classified as refugees, currently living outside of their national borders and 3.3 million are asylum-seekers, meaning their status within their current host country is undetermined.

The 2015 figures are the highest recorded in the history of the United Nations High Commission on Refugees (UNHCR), a United Nations Organization that began collecting statistics on refugees in the 1950’s. This trend, however, is not new. In 2011, the UNCHR announced a record high of Forcibly Displaced People at 42.1 million, a number that has increased dramatically in the past 5 years. In 1996 the rate of Forcibly Displaced Peoples was around 5.5 per 1000 world population, a number which has almost doubled in the past 10 years to nearly 9 per 1000 world population. One in every one hundred and thirteen people is displaced from their home today due to violence or persecution. According to the UNHCR 24 people were displaced every minute of every day in 2015. That rate is down from 30 people per minute in 2014, however, it still remains a staggering number continuously adding to the number of globally displaced people. In 2015 12.4 Million people were newly displaced, 8.6 million classified as IDPs while 1.8 million people crossed international borders to seek refuge in neighboring countries. Two million more people applied for asylum, their status yet to be determined.

A young woman stands among the housing structures in the largest Refugee camp in the wold, the Dadaab Refugee Complex in Kenya. This May, Kenyan officials. have announced its closure amid concern of terrorist activity within the camp.

A young woman stands among the housing structures in the largest Refugee camp in the wold, the Dadaab Refugee Complex in Kenya. This May, Kenyan officials. have announced its closure amid concern of terrorist activity within the camp.

The number of forcibly displaced peoples continues to rise due to both new and ongoing conflicts around the world. Syria and Afghanistan, the most widely known and covered humanitarian conflicts and crises, contribute the highest amount of refugees and IDPs, followed closely by Somalia. According to the UNHCR these three countries account for 54% of all refugees worldwide, with Syria accounting for 4.9 million refugees worldwide. Of the 65.3 million forcibly displaced people, 11.7 million, or nearly 18 percent, are Syrian citizens. While the Syrian and Afghani conflicts have seen the most media attention and worldwide concern, other unresolved or newly ignited conflicts, like those seen in Burundi, Nigeria, Niger, Yemen, Libya, Ukraine, the Central African Republic, and Democratic Republic of Congo (DRC) as well as widespread violence in Columbia, El Salvador, Guatemala, and Honduras has contributed to the rapid increase in displaced persons. Of the total number of forcibly displaced people worldwide, the Congo (DRC), South Sudan, Sudan, Afghanistan, Yemen, Columbia, Nigeria, Iraq, and Somalia each accounted for over 2 million people.

Despite unprecedented coverage of the European Refugee Crisis, Sub-Sharan African Countries continue to host the most refugees globally at 4.4 million. Just 5 countries, DRC, CAR, South Sudan, Sudan, and Somalia accounted for over 80% of these 4.4 million refugees, as people continue to flee these conflict heavy countries. Currently Europe hosts slightly less than 4.4 million Refugees, the majority of which reside in Turkey who hosts the most refugees (in Europe and the world) as of 2015 at 2.5 million, followed by Germany at 316, 000 people, Russia at 314, 000 people, and France at 273,100 refugees. Three of the top five countries hosting the most refugees are in the Middle East (Excluding Turkey). As of 2015, 3.7 million refugees reside in Lebanon, Pakistan, and Iran. Lebanon itself now hosts 186 refugees per 1000 native persons or roughly 19% of its current in country population has refugee status. Despite misconception it is important to realize that 86% of refugees reside in “Developing Countries” and over half of them are under the age of 19 years old.

Iraqi refugee children in Syria

Iraqi refugee children in Syria

Almost twice as many people are internally displaced than have refugee status. Around 40.8 million people are estimated to be internally displaced. Over half of all new internally displaced people reside in Yemen, Iraq, or Syria. However, a significant number of new IDPs are also currently residing in Ukraine, the DRC, Afghanistan, and Sudan. In Yemen, 2.5 million people were displaced in 2015 alone. In Columbia, where the highest amount of IDPs reside, 6.9 million people remain internally displaced, while 6.6 million and 4.4 million reside in Syria and Iraq, respectively.

The sheer size of this problem calls for immediate and collective action. Displaced people often lack adequate access to food, water, healthcare, education, or legal protections. The cost of displacement is enormous. Displaced peoples face a substantial loss of livelihood, purpose, security, access to education and shared prosperity that not only affects people and communities in the interim but also continues to affect them for generations to come. Solutions will require cooperation and open-mindedness on the part of all countries and cultures. The world has to rise above nationalism and nativism and decide to put humanity first. To take in refugees should be a point of pride for countries and their citizens that they are willing lend a hand to others regardless of their nationality or race. As Ugandan Prime Minister Ruhakana Rugunda stated earlier this year “For the last 20 or 30 years, Uganda has been shouldering half a million refugees…Uganda is proud to do this and we would like to see all other countries play a role.” We all have a shared stake in the prosperity of others whether in our home country or abroad, whether as a country or as an individual. In these times of crisis we cannot afford to close ourselves of to others. We should all take pride and responsibility in helping our fellow man, it’s the only way we can solve the issues we face.

*All statistics were taken from the UNHCR 2015 Global Trends Report

HumanitariOP-Ed - Western Media Bias: Where's the Response?

Our thoughts and prayers go out to any and all people in this world who have lost a loved one to the multiple terrorist attacks that have occurred worldwide since we wrote about responding to the Paris attacks a couple months ago. Our hearts ache for this unnecessary loss of life and the tragedy that is one life taking another.

-The Humanitariman Team

Beach In Cote d'Ivoire where 16 people were gunned down by Al-Qaeda. Our deepest condolences to the friends and family of those who died.

Beach In Cote d'Ivoire where 16 people were gunned down by Al-Qaeda. Our deepest condolences to the friends and family of those who died.

The terrorist attacks that occurred in Belgium are a tragedy that cannot be truly expressed or summarized into words. No person, no community, no nation, and no civilization should ever have to witness or experience such inhumane and egregious acts of violence. We in the west have followed the tragedy and we continue to support Belgium during this somber time. The media has provided wall to wall coverage, delivering the horrific details and updating the public periodically. People from around the world took to Facebook and Twitter, sending messages of solidarity to our Belgium brothers and sisters. Prominent political figures, however misguided they were, made statements and offered solutions aimed at prevention of future attacks on European and American soil.  And this is undoubtedly how we should react. The world should stand together, unified, with Belgium now, like we did earlier with France. But our response, the media coverage, the public outrage, the thoughts and prayers, and the solidarity, should not be unique to European or US tragedy. When Al-Qaeda gunmen open fire in a crowded beachfront hotel in Grand Bassam killing 16 people, we should stand with our Ivorian brothers and sisters. When a bomb goes off in the crowded streets of Istanbul, killing 5 people and injuring more than 30 others, people should be outraged and somber. When a Taliban soldier sets off a suicide bomb in a court in Shabqadar, Pakistan killing 10 and wounding some thirty more, western media should cover it wall to wall. But that doesn't happen. The western world has grown accustomed to dismissing non-European and non- American terrorist acts as somehow less of a tragedy. The muted response to the tragedies in Turkey, Cote d’Ivoire, Pakistan, Indonesia, Cameroon, Nigeria, Libya, Iraq, Afghanistan, Syria, Egypt, Burkina Faso, and Somalia in 2016, shows just how ethnocentric the western media and public continue to be. No one is arguing that outrage and support is called for in the wake of the Belgium bombings, and that intelligent and realistic measures need to be put in place for preventing such attacks in the future. But this outrage, these discussions on curbing terrorism worldwide, need to occur not just after European or North American tragedy but after every tragedy. Every time a life is lost from a needless and horrifying act of terrorism, it should be acknowledged as a loss of a human being. The world should mourn such loss, whether in war–torn Syria or in stable France. Our thoughts are with the people of Belgium, especially with those who have lost someone close to them, but our thoughts are also with the people of Cote d’Ivoire, the people of Turkey, the people of Pakistan, of Indonesia, of Burkina Faso, and with the people of every other country who has been struck by unnecessary and egregious acts of terrorism recently. We stand with you. The world stands with you. Let’s shine a light on western media and public bias, so that we might stop talking about Donald Trump, and start talking about and acknowledging things that matter.

On the Verge of Global Eradication: How the World is Fighting the Guinea Worm….and Winning

By Casey Mohrien: 

Chernihivska, Ukraine

A disease that has plagued the world since biblical times may finally be eradicated in 2016. Read on to find out more about the Guinea Worm and how humanity is ridding the world of this debilitating disease.

Guinea Worm being extracted from an infected individual's foot

Guinea Worm being extracted from an infected individual's foot

Guinea worm disease, a debilitating and painful disease caused by the parasite Dracunculus medinensis, is mentioned in written texts as far back as 1586 B.C. Drancunculus medinensis, or more colloquially termed Guinea worm due to its formerly large presence in the Gulf of Guinea, is even referenced in the Old Testament of the Bible. Many biblical scholars believe the fiery serpents referred to by Moses may in fact have been a reference to the Guinea worm, further inferring that infection was a common occurrence in that time. Several Egyptian texts from the same era also refer to Guinea worm disease (although not called that), and medical texts from 9th century Egyptian physicians show a surprisingly accurate knowledge of the worm and its infection in humans. Despite this knowledge and presence of Guinea worm for centuries, it wasn’t until the 1990’s that the entirety of its life cycle was discovered. This increased understanding of the life cycle and transmission patterns of the Guinea Worm has allowed for great progress to be made in preventing human Guinea worm Infection. The once common and incapacitating disease is now on the brink of global eradication. Eradication of Guinea Worm infection would be the first and only disease to be eradicated since the world eradicated smallpox in 1979. Global eradication would not only prove that a parasite can be eradicated from the human population, but that public health programs are an effective way of preventing and eradicating disease.

Doctor pulls Guinea Worm from patient, the treatment still used today

Doctor pulls Guinea Worm from patient, the treatment still used today

            The life cycle of the Guinea worm involves what is known as an indirect host, meaning that the worm is dependent on a secondary organism for development. In order to develop, larvae released from the adult female worm have to be ingested by small crustaceans known as copepods (also referred to as cyclops) which are found in stagnant waters. When humans drink the contaminated water, the copepods are ingested and killed by the gastric juices within the stomach, releasing the larvae. The larvae then penetrate through the stomach and intestines, where they mature into adult worms. The male and female worms copulate and the males eventually die while the fertilized female worms migrate to the lowermost layer of skin anywhere from ten to fourteen months after initial infection.  The female worm causes a small painful blister, usually on the lower extremities (leg, ankle, or foot). Sufferers seeking relief from the pain submerge the afflicted body part into water. The female worm senses the water and punctures out of the blister laying thousands of tiny larvae. The larvae are subsequently ingested by copepods and the life cycle repeats itself

Life Cycle of the Guinea Worm

Life Cycle of the Guinea Worm

            It’s this migration and movement of the female worm to the skin that causes the majority of the symptoms and debilitation involved in the infection. The presence of the worm in the tissue results in an intense itchiness of the skin followed by possible fever, nausea, vomiting, diarrhea, dizziness, and rash, eventually culminating with a painful white blister most notably on the lower extremities. The treatment for Guinea worm infection, first mentioned in a 1550 B.C. Egyptian medical text has remained consistent for centuries.  There is no vaccine or anti-parasitic drug that is effective against Guinea worm infection.  Furthermore, unlike closely related filarial worms, no symbiotic relationship exists between the Guinea worm and Wolbachia bacteria, leaving no therapeutic avenue for treatment with Doxycycline or other antibiotics.  The parasite must be manually extracted using a stick, an extremely painful process that can take anywhere from a couple of weeks up to months to complete. The blister is usually submerged in water to coax the worm out of the body and a small incision is made whereupon the worm is carefully pulled out (to avoid rupture) and wrapped around a stick/gauze until there is no slack in the worm. The stick is then usually taped to the infected person until the next day where more of the worm is again pulled out. Submersion in water is a cost-effective way to alleviate the pain caused by the blister and the life cycle is actually dependent on this. The lesion left behind by the emersion of the worm is especially susceptible to secondary bacterial infections such as tetanus and in very few cases has led to fatal septicemia. While the mortality associated with Guinea worm infection is relatively low, the morbidity and loss of economic production can be devastatingly higher. Disability, most noticeably from infection of the joints resulting in “Locked Knees” can prevent people from tending to their daily lives and jobs. Emergence of the worm, particularly during the harvest season, can result in the loss of agricultural production and subsequent loss of livelihood for many infected people.

For centuries Guinea worm Infection was a common and wide-spread occurrence causing millions of cases worldwide. Before the funding and creation of the Guinea Worm Eradication Programs (GWEPs) in 1986, there were over 3.5 million estimated cases from twenty different endemic countries. Due to an increase focus and collaboration between the Carter Center, World Health Organization (WHO), the United Nations Children Fund (UNICEF), BASR Chemical, and the national governments of endemic countries, the number of cases of Guinea worm infection in 2014 was only 126 and the number of endemic countries fell to just four. That number has sense fallen even more, with only 22 cases of Guinea worm infection recorded in 2015. Five cases were recorded in South Sudan (22.7%), five recorded in Mali (22.7%), nine in Chad (40.9%), and three in Ethiopia (13.6%). Since 1986 there has been a 99.99% reduction in reported Guinea worm cases worldwide. This has been due to public health measures such as education, water treatment, use of alternative water sources, and water filtration. The Carter Center, an NGO based in Atlanta Georgia, has led the way in the fight against the Guinea worm. Their efforts have resulted in almost complete eradication of a parasitic disease that has plagued humanity for centuries. Let’s make 2016 a year where we work to understand this debilitating disease and rid the world of it! Check out our links below to the Carter Center’s webpage to learn more about their efforts.

http://www.cartercenter.org/health/guinea_worm/index.html

Fixing the system: Solutions for Problems in International Development

With over 150 Billion dollars spent on development aid each year, can we really afford to have a broken system? Here's how we can change it.

hands-908165_960_720.jpg

A couple days ago we published an article about the problems our system of international development faces today. As part of this two part series this article will focus on how we can fix and improve this current system.

Give the Power back to the Beneficiaries

It makes inherent sense that countries and local communities would know the issues that affect them far better than any donor organization or donor government. Giving aid with ties and stipulations as to how it can be spent only hinders the ability of a country or organization to truly focus on their most pressing needs. It also creates a system whereby organizations plan projects around issues and topics based on how they can obtain more resources instead of what needs to be accomplish. This leads to waste and inappropriate use of aid. This system should be completely reversed. Donors should have less power and say as to where resources are allocated. Governments and organizations should submit proposals to donor organizations based on their biggest needs, regardless of whether the projects address the donor’s top priorities.

Keep the focus on capacity building and sustainability

The purpose of development is to work your way out of a job. Projects that span the course of decades focusing on just one issue are counter-intuitive to the idea of development. Capacity building and sustainability should be the primary focus of any project. Organizations should work to hand over projects and developments to capable local government or non-government organizations. The point of development should not be to increase dependency on aid or dependency on other countries, but rather to build systems that will run effectively, long after outside resources have been withdrawn. While it may take decades to see real and lasting change, the idea should not be to create that change, but rather to create the local development agents that will see that change through.

Focus on underlying, systemic causes

The underlying causes of problems and issues are often neglected in development. Instead of focusing on the root causes of poverty, we tend to focus on the symptoms. And while combating the issues that arise from poverty is essential, there needs to be a continuous focus on determining and changing systemic structures that underlie poverty and income inequality.

Realize development loans don’t make any sense

Loans for the purpose of development don’t intrinsically make sense. Making resource poor countries pay back interest laden loans, diverts resources and economic gains back to the lending agency and away from the intended country. Development should not be a business. Lending financial support to resource poor countries should not result in an economic gain for anyone. While requiring repayment in certain circumstances is necessary (stolen or wasted resources), it should not be built into our development system. We need to phase out our inclusion of loans (especially those with interest) in development and move forward with a grant-based system of development. International development should be about the common and public good not about financial or political gains for lending agencies and countries.

Strengthen indicators needed and create an outcome-based system for resource distribution

Accountability is a crucial aspect of international development. Resources are often misallocated or wasted within both governmental and non-governmental organizations, yet organizations are not held accountable. International development donor agencies need to not only require strong indicators for measuring success but they need to hold organizations responsible when they don’t meet the goals of the project. The indicators required to assess whether or not goals and objectives were achieved must be decided upon beforehand. Indicators should be less about the process and more about measuring the efficacy of the process. For example a common indicator for many training projects is the amount of professionals trained. This is an indicator that the process is working (i.e. that nurses, teachers, or community workers are attending trainings) but says nothing about the effectiveness of the trainings or if what is being learned is actually applied in a practical situation. And while process indicators are extremely important, the international development community needs to put a larger emphasis on outcomes and assuring outcome displacement isn’t occurring or even worse, outcomes aren’t being achieved. If money or resources are wasted or stolen by governments or projects fail due to lack of follow-through or inept management, organizations or governments should be liable for them. This incentivizes organizations to better appropriate resources and ensure the success of their projects.

Increase Collaboration

International development is an all-encompassing and inter-connected field. Organizations both governmental and non-governmental, need to work together and communicate about current and overlapping projects. Education, health, human rights, infrastructure, and economics are all part of one dynamic system, yet projects are often proposed and carried out in a vacuum. Organizations tackling similar issues or in similar regions (regardless of the issue) need to collaborate in order to optimize resources, ensure success, and prevent wasteful spending.

 

The Problems with International Development

863px-UN_Human_Development_Report_2013.svg.png

It can often times be hard to criticize international development, specifically NGO’s, the majority of which are staffed with well intentioned people who truly want to make a difference in the lives of others. However, when so much money and emphasis is put into international development it is essential that we hold all of the players accountable and ask ourselves the appropriate questions. In a world where over one hundred billion dollars is disbursed each year for development projects around the world, is the money actually making the impact it is intended to make? How much of the money donated by us or our governments is actually seen by the people it’s intended to help?

It would be naïve to think that our current system of development functions at the level it should, or in some cases functions at all. While many problems plague our current system of international development, this article will focus on the major inefficiencies that need our attention now.

Donors have too much power

Under normal circumstances it makes sense that the people financing projects should be able to decide where and what their money is going to go towards. However, in the case of development this is actually counter- productive and leads to astronomical amounts of waste. Much of the aid given to countries come with ties or stipulations on how and what it can be used on. Because the donor agencies decide what projects will be funded and what issues they will target, sometimes only considering their own interests, countries often end up implementing projects that don’t address their biggest needs. These decisions often come at the expense of the local people. Money is all too often funneled into projects that don’t actually address local needs so that donor agencies or NGO’s have marketing materials. An organization can assert and market the fact that is has raised funds and built 10 schools in a country, but leave out the fact that those schools aren’t being used and weren’t needed. Even worse than that, often times the lack of focus on imminent weaknesses in infrastructure are the underlying causes of severe outbreaks or epidemics. The most recent example of this is the Ebola epidemic that continues to persist in Western Africa. Billions of dollars were mobilized in the initial response in an effort to combat an outbreak decimating an already weak overall health system. Had more funding been previously used to build and strengthen the overall health systems of those countries, the Ebola outbreak and epidemic may have very well never taken hold. In development, and especially in health-related development, we tend to focus on symptoms of a dysfunctional system instead of the system itself.

Waste is rampant

How much of the money we donate, give, or loan to countries or NGO’s actually reaches the people it is intended to help? A good amount of the funding an NGO receives gets bogged down in salaries or spent on unnecessary expenditures. And while salaries are important to attract talented individuals to the field of international development, frivolous expenditures on unnecessary infrastructure and extraneous items only retract from the overall impact you can have.

Accountability is often disregarded

Monitoring and evaluation is a critical aspect to development in order to ensure that the resources distributed by donors are being used appropriately. However, often times projects lack strong indicators of success and fail to address whether the project is actually effective. Along the same lines NGO’s and governments aren’t actively accountable for the money they are given. When projects fail, or money is simply wasted or stolen by corrupt governments, donor or aid agencies often cannot hold these entities accountable. They can stop lending or giving money to certain countries or NGO’s, but organizations that loan money in the form of development loans don’t always do that. Historically, the World Bank and the International Monetary Foundation have kept giving loans to countries regardless of the outcomes of their intended projects.

Loans are expected to be paid back

Accountability and transparency is key when it comes to development, but the current system of expecting resource poor countries to pay back loan debts is misinformed. This is even true for small loans used in micro-financing on an individual or group level. In the case of loans to governments, the gains and byproducts of these loans often take years if not decades to see, yet these countries are expected to make payments well before that. This often creates a system of dependency where countries are borrowing more money to solely pay the interest of previous loans and therefore not using those resources to address the needs of their people.  In the case of micro-financing loans to individuals or small groups, the same problems exist. It often takes a while to see the products of these loans, if they are seen at all. Requiring that these loans be paid back often times hurts the people they intend to help, by pushing them further into poverty.

ID Article worlds.jpg

There is a blatant lack of collaboration

Because of the high stakes game of grant-writing and funding projects, many of the biggest NGO’s fail to cooperate with each other. Often times NGO’s working on the same thing or in the same area have no clue what each other are doing or what resources each bring to the table. International Development is a an interconnected field. Projects and areas from seemingly different fields are interconnected, and therefore necessitate a certain level of collaboration. A healthy child does better in school and a well-educated child knows how to stay healthy. NGO’s working towards the same goal and those working in the same geographic area need a higher level of collaboration in order to ensure resources are optimized and long-term success is achieved.

 

If you’re like us here at Humanitariman and you want to donate to great NGO’s check out and Take action page where we have highlighted an NGO worth looking into! And always remember to check into any organization you donate to. Also stay tuned for the follow-up of this two part article where we discuss ways we can improve our current system of international development.

Our Response in the Wake of Tragedy

Bourj_el-Barajneh_entrance_-_Flickr_-_Al_Jazeera_English.jpg

We here at Humanitariman want to start this post off by expressing our deepest condolences to the families and friends of those killed in both the Paris and Beirut attacks last week. We cannot begin to imagine the pain and suffering you are enduring at this time. Humanitariman stands with both the countries of France and Lebanon in this moment of great sadness, and encourages people to rise together as one species to reject this unnecessary violence and promote peace and health worldwide. At this time more than ever we must begin to realize that despite religion, race, and ethnicity we truly still are one humanity.

 

Our Deepest Condolences,

 

-The Humanitariman Team

 

The heinous and deplorable attacks in both Paris and Beirut have shown us that ISIS continues to survive and that its egregious ideology continues to spread. It is apparent from such tragedies that something must be done to mitigate the global threat that ISIS and terrorism present to the world. However, recent actions by France, and on-going actions by the US, are terribly misguided, and will no doubt create more chaos and destruction than they intend to prevent. France has stepped up bombings in the past week and has waged an “all out war” against ISIS in the Middle East. US politicians have called for the deployment of troops, and while that is not a realistic option, the US seems primed to intensify their already large-scale air assault on ISIS. But what nobody seems to be questioning is whether or not this approach is even effective? Recent history of American Intervention in Iraq and Syria has shown that this approach and these tactics may actually do more harm than good. According to the DOD the US has carried out 6,353 airstrikes on ISIS targets in the past 15 months. That is approximately fourteen airstrikes per day, every day for fifteen straight months. To say that these airstrikes have been largely ineffective, might be an understatement. What governments and the people who elect them don’t understand is that airstrikes and armies are largely ineffective when dealing with ISIS and terrorism. This is because ISIS is more than a group of immoral and depraved people, it is an ideology. An ideology based in a false narrative of religion, a disturbing disregard for the sanctity of life, and a perverted hatred towards western civilization. But ideologies cannot be defeated by armies. They cannot be targeted by bombs, or occupied by foreign nations. When we attack and bomb ISIS strongholds, often killing innocent civilians in the process, it only pushes more people into their perverted ideology. 

Militaries can topple regimes but they cannot dismiss ideologies. They can destroy infrastructure and kill people, but they cannot stop the spread of extremism. If history has taught us anything it's that military intervention is not the answer to terrorism. Military Intervention and occupation, and specifically US military intervention and occupation, has arguably done much more harm than good.  A study out of the University of Chicago found that the underlying cause of 95% of terrorist attacks between 1990 and 2003 were due to foreign country occupation. US, French, and Russian occupation in Syria will only cause more death to innocent civilians and increase the amount of people who join this disgraceful and perverted ideology. The invasion of Iraq in 2003 was the catalyst for the rise of ISIS. Increasing military intervention now, will only fail to address a problem much bigger than ISIS, and lead to the death of a large number of innocent civilians and soldiers.

What we need do is work with Middle Eastern and Muslim countries and people to empower them to take back their religion. Empower them to fight for the very thing they hold sacred. We need to work with Sunni, Shia, and Kurdish peoples to seek compromise in Iraq and Syria, and to unite them in opposition to ISIS. Our main focus cannot, and should not, be based in military intervention but rather in local support and empowerment. We need to act as catalysts to train and support Muslims in their effort to liberate themselves from radical groups and authoritarian regimes. We need to stop persecuting, condemning, and generalizing all Muslims based on the actions of a small fraction of insane, immoral people. We need to welcome Syrian and Iraqi refugees into our country and realize that they are fleeing the same violence and terror we condemn on a daily basis. We need to work to increase opportunity and prosperity for Muslim youth and refugees in the US, Europe, and the Middle East. ISIS thrives off instability, lack of social mobility, and the xenophobia of the western world. These are not concrete structures that can be fixed through military intervention but rather abstract concepts that must be tackled at a political, economic, and systemic level worldwide. We need to attack ISIS, not at their military strongholds, but at their technological ones. We need to devote more resources to tracking and shutting down pro-ISIS recruiting and propaganda sites and social media accounts.

When US governors write letters to the president saying they will not accept refugees and when European countries close their borders to Islamic asylum-seekers, we send a message that we equate all Muslims to ISIS. When we prosecute Muslims; when we bomb or invade Syria and Iraq and kill innocent civilians, we become the enemy ISIS wants us to be. Our recent devolution into xenophobia and increased intolerance towards Muslims is just what ISIS seeks. We must rise above these recent trends. Our long-term strategy to defeat ISIS cannot be centered on the same military intervention that led to the creation of ISIS. We must decide to come together as a world and to empower Muslims worldwide to take back their beautiful religion from the hands of the depraved individuals who continue to twist it in an attempt to strengthen their own perverted ideology. We need to come together as a civilization to defeat the very group bent on destroying it.

The Need for Global Surgical Capacity Building

It is estimated that over 2 billion people, an overwhelming majority of which are from low and middle income countries, lack access to affordable surgical care. The poorest third of the world’s population undergo just 3.5% of surgeries each year. Surgical care remains a pivotal component of a robust healthcare system and an essential aspect of universal healthcare coverage. The moral and ethical imperative of scaling up surgical capacity is evident.  Surgical intervention is essential to the prevention, diagnosis, and treatment of a wide variety of diseases. It is estimated that that surgical care is required for as much as 30% of the global burden of disease (GBD). By 2025 it is estimated that two thirds of the GBD will be attributed to non-communicable diseases that require the use of surgical interventions to treat.  Lack of access to surgery for people in low and middle income countries means that many of the debilitating complications of disease will be left untreated causing immense suffering and premature death.

            In addition to a moral imperative, a strong economic imperative for scaling up global surgical capacity exists. While many leaders and experts in the field of global health consider surgery too expensive or complex, recent research has exposed this notion as incorrect. Cost effective analysis involving the calculation of cost-effective ratios (A CER is considered the amount of United States dollars per DALY averted) for surgical interventions can be used to prioritize surgical procedures and public health measures in resource poor countries as well as to compare the cost of surgical intervention with the economic loss attributable to surgically treatable diseases. Research on the economic feasibility of surgical capacity building has found that CERs of many surgical interventions were the same or even lower than CERs of other widely used public health measures.  For example the median CERs for both Caesarean sections and orthopedic surgery are far less than the median CER for HIV treatment. Furthermore analysis found that the cost per outcome for almost all surgical procedures was far less than the economic loss per capita (GDP per capita). Based on such findings, highly cost-effective and feasible interventions for surgery involving trauma, obstetrics, laparotomies and male circumcisions (tier 1 surgical procedures) should be scaled up in low and middle income countries.Capacity for these four areas of surgical intervention infer capacity for a wide variety of other surgeries.

                Scaling up of global surgery requires a corresponding scale up or improvement of corollary facets of the overall health system. For example scaling up cesarean sections requires the subsequent scale up of a primary health system to identify and refer high risk pregnancies. Surgical capacity is directly affected by the strength of the overall health system. By placing an emphasis on the scaling up surgical capacities another stronger emphasis will be put on the strengthening of the overall health system in general.

            We have an ethical imperative as humans to demand the right to both health and healthcare. This right to healthcare includes the right to affordable and reliant surgical care anywhere in the world. Millions of people continue to suffer for no other reason than the place they were born. Stand with Humanitariman and the Lancet Commission on Global Surgery in saying that now is the time to start taking action! Now is the time to begin to measure indicators so that surgical capacity in low and middle-income countries can be tracked and built!

http://www.thelancet.com/commissions/global-surgery

http://www.lancetglobalsurgery.org/

Without a Home in Their Homeland: The Somali Internally Displaced Persons Crisis

Matt Goldweber

Burlington, Vermont, USA

At the beginning of this year, there were some 38 million people around the globe who fall under the term Internally Displaced Person, or IDP. To put that number in perspective, it’s as if the entire population of California no longer had a home within the state, instead wandering, living in shelters or camps within the boundary of the state’s area.

How do these people become displaced? Many causes contribute to their homelessness; civil war, tribal strife, weak governance, effects of climate shift, and scarcity of resources are just a few. In the case of Somalia, at least one of these causes seems to relate to all of the nation’s 1.1 million IDPs.

Parliament IDP camp, Mogadishu, Somalia.

Parliament IDP camp, Mogadishu, Somalia.

Conflict has been brewing in Somalia for the last 30 years. In the early 90’s the military dictatorship of Siad Barre was overthrown by a coalition of pro-democratic militant groups. Without a proper plan in place between the coalition as to how the nation would be governed post-dictatorship, a “power vacuum” ensued. Each group was vying for control over the land for their own political gain.

As a result of violent conflict that soon stemmed from this chaos, and the natural effects of lacking government control overnight such as infrastructure failure, the civilians of Somalia began to suffer. The nation was now a disconnected power struggle, judicially run by courts acting on behalf of Sharia law.

In 2000, an official set of courts called the Islamic Courts Union (ICU) was established. Replacing the separated court system that arose from the Barre overthrow, this group established 11 autonomous courts throughout the country, each acting on behalf of Sharia law. The ICU had many militiamen fighting to keep the chaotic form of rule in place, and this drew constant military action and violence to Somalia from throughout the international community.

With the assistance of the United States, Ethiopian, Kenyan, and Eritrean military forces, the new Transitional Federal Government of Somalia eventually broke the ICU down in 2006, but this was not the end of the nation’s troubles. The organization and former militant wing of the ICU, Al-Shabaab, sprung from the ashes of the ICU, and continues to push the extremist perspective of Sharia rule throughout much of Somalia.

Members of the group Al-Shabaab outside of Mogadishu.

Members of the group Al-Shabaab outside of Mogadishu.

 

How exactly has the aforementioned history affected the nations most vulnerable? Well in 2004, the number of IDPs was at roughly 400,000. In the 11 years since, that number has tripled. Millions more are food and water insecure, and even millions more have been driven out of the country to nearby Kenya and Ethiopia.

In recent years, there has been a glimmer of hope for those suffering, but it remains just that. In 2012, the Federal Government of Somalia was officially established as Somalia’s recognized central government. This was a huge step in the right direction to stabilize the nation. However, the government has been unable to completely focus on the IDP population due to constant military conflict with Al-Shabaab.

In addition to violent clashes driving innocent Somalis from their homes, weather extremes such as drought and over-saturation by rain have plagued much of the countries farm system, causing massive displacement. From 2010-14, this erratic weather left nearly 3 million people in water and food insecure situations. Widespread famine was at its highest level in modern history, and the marginalized poor have been the one’s to suffer.

So what efforts have been put in place to combat the dire situation millions of Somalians are facing? Since the 1980’s, humanitarian efforts have been abundant in Somalia. Hundreds of organizations both domestic and international have been vying to ease the burden of the millions of distressed, but are met with difficult obstacles on their path to delivering aid.

With most of South and Central Somalia continually in a state of conflict between pro-government forces and Al-Shabaab, the delivery of aid to affected areas and populations has been greatly stymied. In late 2014, the Federal Government of Somalia, working in conjunction with the United Nations put together a policy framework which seeks to improve the living conditions of IDPs, as well as prevent new displacement. Time will tell how these policies affect the population once they are put into practice via government programs.

For now, the IDPs throughout Somalia are relying primarily on the hope that international and domestic aid via NGOs will reach their locations. Lack of access due to military conflict and social unrest has been a definite hindrance in this effort, but many organizations such as Relief International have been able to find a way to infiltrate even the most hostile of regions to provide material and social support to IDPs. By working with local aid organizations and counterparts, they have successfully reached this population that requires effective assistance.

As this situation is ongoing, there are continuously opportunities to help active IDPs and those at risk of entering the category improve their quality of life. Below are just a few organizations that we here at HumanitariMan recommend getting involved with.

 

Action Against Hunger-http://www.actionagainsthunger.org/

Concern Worldwide-https://www.concern.net/

Relief International-http://www.ri.org