Conflict-affected Areas Research Articles

Engaging men to transform inequitable gender attitudes and prevent intimate partner violence: a cluster randomised controlled trial in North and South Kivu, Democratic Republic of Congo

IntroductionThe study objective was to understand the effectiveness of Engaging Men through Accountable Practice (EMAP), a group-based discussion series which sought to transform gender relations in communities, on intimate partner...

‘A Rough Trade’? Towards a More Sustainable Minerals Supply Chain

Target 16.6 of the 2015 Sustainable Development Goals (sdgs) seeks to create ‘effective, accountable and transparent institutions at all levels’ for the purpose of achieving sustainable development. Nevertheless, the inherent vagueness of the notions of transparency and accountability poses difficulties for achieving the target. This is why this article examines how these notions have been conceptualized in international legal discourse and applied in practice. It does so within the context of the trade in natural resources that finance armed conflict, which is considered detrimental to the development opportunities of developing countries. The article examines how two of the most important initiatives in this field, namely the Kimberley Process for the Certification of Rough Diamonds and the oecd Due Diligence Guidance for Responsible Supply Chains of Minerals from Conflict-affected and High-risk Areas, operationalize transparency and accountability. It posits that both initiatives fall short of establishing full accountability. However, notwithstanding their flaws and limitations, they make a valuable contribution to achieving target 16.6.

Insecurity, Dispossession, Depletion: Women\u2019s Experiences of Post-War Development in Myanmar

This article explores the gendered dynamics of Myanmar’s post-war economic reforms through an analysis of women’s experiences of development in Kayah (Karenni) state. In Myanmar, ceasefires and a reduction of armed violence combined with state-driven economic liberalization reforms are conditioned by, but also contribute to remake, gendered relations of power, privilege and marginalization. While new land legislation and development projects have contributed to loss of land and livelihoods among rural populations in general, our study demonstrates that women living in conflict-affected border areas are disproportionally affected. Drawing on interviews and participant observation, we show how this is directly related to an overarching gendered political economy defined by legacies of conflict, discrimination and uneven processes of development, which positions women as particularly vulnerable to new forms of insecurity, dispossession and depletion generated by post-war economic transformations. We argue that the political and economic legacies of war in the state has produced a gendered division of labor that positions women as responsible for unpaid and underpaid informal and social reproductive labor, weakens women’s access to land, and results in physical, material, and emotional depletion. Through this focus, our study adds to research on development and economic restructuring in post-war contexts in general, and to emergent scholarship on Myanmar’s economic reforms in particular.

PRELIMINARY INSIGHTS ON THE ACEHNESE DAILY STRESSORS IN CONFLICT AFFECTED AREA

The 2005 peace memorandum was a significant event for the development of Aceh province, following 30 years living in the adversity of political conflict and violence. Persistent stress in post-conflict communities may occur due to daily life hardships related to economic and political instability, such as access to education, employment, and others. These stresses are referred to as daily stressors. The purpose of this study is to explore the daily stressors among the Acehnese 13 years following the peace memorandum. The study was conducted in the city center of North Aceh, one of the regencies that were highly affected by political conflict and violence. We recruited 20 participants with convenience sampling that were consisted of village headmen and local villagers from one of the villages in North Aceh, Alue Anoe Timu. The study employed qualitative design by collecting data with focus group discussion and data were analyzed with thematic analysis. The results are discussed and may provide meaningful knowledge to the development of conflict-affected areas in Aceh.

\u201cThe midwife helped me ... otherwise I could have died\u201d: women\u2019s experience of professional midwifery services in rural Afghanistan - a qualitative study in the provinces Kunar and Laghman

BackgroundAfghanistan has one of the world’s highest maternal mortality ratios, with more than 60% of women having no access to a skilled birth attendant in some areas. The main challenges for childbearing Afghan women are access to skilled birth attendance, emergency obstetric care and reliable contraception. The NGO-based project Advancing Maternal and Newborn Health in Afghanistan has supported education of midwives since 2002, in accordance with the national plan for midwifery education.The aim of this study is to explore women’s experiences of professional midwifery care in four villages in Afghanistan covered by the project, so as to reveal challenges and improve services in rural and conflict-affected areas of the country.MethodsAn exploratory case-study approach was adopted. Fourteen in-depth interviews and four focus-group discussions were conducted. A total of 39 women participated – 25 who had given birth during the last six months, 11 mothers-in-law and three community midwives in the provinces of Kunar and Laghman. Data generated by the interviews and observations was analysed using thematic content analysis.FindingsMany of the women greatly valued the trained midwives’ life-saving experience, skills and care, and the latter were important reasons for choosing to give birth in a clinic. Women further appreciated midwives’ promotion of immediate skin-to-skin contact and breastfeeding. However, some women experienced rudeness, discrimination and negligence on the part of the midwives. Moreover, relatives’ disapproval, shame and problems with transport and security were important obstacles to women giving birth in the clinics.ConclusionsLocal recruitment and professional education of midwives as promoted by Afghan authorities and applied in the project seem successful in promoting utilisation and satisfaction with maternal and neonatal health services in rural Afghanistan. Nevertheless, the quality of the services is still lacking, with some women complaining of disrespectful care. There seems to be a need to focus more on communication issues during the education of midwives. An increased focus on in-service training and factors promoting quality care and respectful communication is necessary and should be prioritised.

Diagnosing Posttraumatic Stress Disorder in Refugees

Global crises has amounted to the forced international displacement of 25.4 million refugees. Refugees from conflict-affected areas are especially vulnerable to posttraumatic stress disorder (PTSD) compared to the general population due to their past and present hardships and history of trauma. PTSD is characterized by a constellation of symptoms identified by the Diagnostic and Statistical Manual of Mental Disorders (DSM). DSM-5 departed from DSM-IV by reclassifying PTSD as a trauma- and stressor-related disorder and introducing a fourth symptom cluster—negative alterations in mood/cognition—to the previous three-symptom cluster model. In severely traumatized refugees, this new cluster exhibited relatively high sensitivity, specificity, positive predictive power, and negative predictive power—in concordance with the range of symptoms exhibited by this population—and allowed for the applicability of the DSM-5 criteria. However, the Western sample basis of the DSM-5 might make it inferior to alternative models as a diagnostic tool for PTSD in refugees and as a springboard for treatment. In addition (and possibly due) to PTSD, refugees are at high risk for mental health distress and suffer from poor health outcomes. Optimizing diagnostic criteria and overcoming barriers to diagnosis and access to care would benefit patients and facilitate treatment.

Do we need to go further to train healthcare providers in the targeted regions for malaria elimination in Myanmar? A mixed-methods study

BackgroundThe National Malaria Control Programme (NMCP) in Myanmar trained health staff at the township level starting in mid-2016 in order to achieve the Plasmodium falciparum malaria elimination target by 2020. This study aimed to evaluate the knowledge and perception of Basic Health Staff (BHS) and Vector-borne Diseases Control (VBDC) teams exposed to a short training course on malaria elimination in six targeted townships which included two conflict-affected townships between 2016 and 2017.MethodsThis was a cross-sectional mixed-methods study using quantitative and qualitative data extracted from one survey database conducted between October 2018 and March 2019. Modified Poisson regression analysis was performed to ascertain the determinants of low knowledge scores after the training programme.ResultsAltogether, 544 trained frontline health workers involved in malaria elimination at the time of the survey were recruited and 56% (302/544) were stationed at sub-Rural Health Centers. More than half of the respondents had correct knowledge of malaria case categories although relapse and recrudescent cases (39% and 37% respectively) were less well known. Over two-thirds of respondents could mention those eligible for malaria testing. Less than 30% knew the foci classification. The overall knowledge scores ranged from 10 to 31. The significant predictors of low level of knowledge [the cut-off point was set at the median value of 21 (IQR 12–30)] in multivariate analysis were the younger age group (18–29 years) and health staff who had attended malaria elimination training in 2017, [(APR = 1.6, 95% CI 1.2–2.2)]; and (APR = 1.5, 95%CI 1.2–1.8)]. Qualitative data from 10 key informants identified perceived challenges in conflict-affected areas as well as in areas of high population mobility with further implications for case surveillance. In addition, the low level of education of community members was noted as one of the barriers that hampered public readiness in the elimination scenario.ConclusionA significant impact on knowledge improvement after the training programme was not visible especially for correct notification of malaria cases and treatment according to National Malaria Elimination Guidelines. Regular monitoring and continuing guidance by the higher level management is critical to support the field staff.

Investigating the intersections between counter-terrorism and NGOs in Nigeria: development practice in conflict-affected areas

ABSTRACT This article examines the factors that influence the Nigerian government’s constraints of NGOs in counter-terrorism context, analysing whether NGO type, nature, areas of operation and size were determinant factors. Drawing from mixed-methods design, it argues that NGOs’ political advocacy, reporting of human rights abuses and monitoring the use of security funds were key factors that attract government restrictions. Women, youth, children, and faith-based NGOs experienced more government constraints than human rights NGOs. Advocacy and international NGOs also suffered more restrictions. The findings contribute to generalisable knowledge by demonstrating the link between counter-terrorism and NGOs in Nigeria.

The paradox of illicit economies: survival, resilience, and the limits of development and drug policy orthodoxy

ABSTRACT The illicit drug crops opium and coca are conventionally regarded as sources of instability, an ‘evil’ that breeds fragility and violence. Fragile states are supposed to be most vulnerable to their production and consequent harms. Yet by looking into the local contexts of the world’s leading opium and coca producers – Afghanistan, Myanmar, Colombia and Bolivia – these illicit crops are found to also be sources of stability, even drivers of economic growth. They enable marginalized communities and territories abandoned by the state to be reinserted into national and global markets. Within so-called ‘fragile’ and conflict-affected areas are displaced and dispossessed households adopting innovative and unorthodox strategies for coping and survival in changing and insecure environments. This paper maps out an approach, useful for examining the resilience that has emerged amidst violence and uncertainty in illicit-crop-producing territories, and which can hopefully tackle the continuing disconnect between drugs and development policy.

Peace Education and the Promotion of Peace-building Initiatives through Health Care Programs in Conflict-Affected Areas in Mindanao

For several years now, there has been a growing global consciousness on the close connection between health and peace. This study aimed to describe peace education and determine the promotion of peace-building initiatives through healthcare programs in conflict-affected areas in Mindanao. The study utilized the descriptive research design and correlation method using survey, interview, and Focus Group Discussion, to 250 survey respondents, eight informants, and 16 FGD participants from conflict-affected areas of Maguindanao and North Cotabato. Data were analyzed and interpreted using mean and multiple regression methods. The study found out that the delivery of the health care programs, the performance of the roles and responsibilities of the healthcare providers, and the use of peace mechanisms were moderately extensive. That peace education has significantly contributed to the promotion of peace-building initiatives in conflict-affected areas. However, the health care programs and health to peace mechanisms strongly influence peace education. The study concludes that health care programs have been delivered well, although there is still a need for improvement in terms of the performance of the roles and responsibilities of the health care providers. The use of peace mechanisms still needs to be intensified.

Don’t forget the Geneva Conventions: achieving responsible business conduct in conflict-affected areas through adherence to international humanitarian law

ABSTRACT This article examines the question of how a business operating in a conflict-affected area can uphold human rights. It contends that a crucial yet often overlooked element is a business’s commitment to embedding the fundamental standards of international humanitarian law (IHL) (as distinct from international human rights law) into its policies and practices. The United Nations Guiding Principles on Business and Human Rights state that companies doing business in conflict-affected areas should respect IHL—the law of armed conflict. However, businesses are often unfamiliar with IHL and its relevance to their operations; it both provides legal protections and represents potential risks and liabilities. Similarly, the scholarly discourse around business and human rights (BHR) tends to overlook the relevance of IHL. The absence of IHL from the scope of the draft BHR treaty currently being negotiated at the United Nations is indicative of this. While some businesses operate with greater conflict sensitivity than others, in most cases they do not use an IHL lens to do so. The article outlines the significance of IHL for business and provides an affirmative case for greater integration of IHL into the BHR project, including its governance instruments and practical tools, to help realise the goal of responsible business conduct in conflict-affected areas.

Solidarity in the face of global fragility

Maisha, in the fifth article in this issue (pp. 45-51), reflects on the therapeutic care of child survivors of sexual violence in conflict-affected areas and draws specifically on the cultural context of the eastern region of the Democratic Republic of Congo. Findings indicate that programmes facilitated a safe emotional space for men to talk about their problems, to become more reflective about their relationships with their wives and children, which resulted in improved patterns of interaction and communication, and increased openness and greater tolerance by men of changing gender roles in families as a result of displacement. The first by Almoshmosh, Jefee-Bahloul, Abdallah and Barkil-Oteo (pp. 66-70) reports on the Syrian Tele-Mental Health Network, a form of telemedicine that provides mental health assessment and treatment at a distance.

The Peace Baby Boom: Evidence From Colombia’s Peace Agreement With the FARC

Violent environments are known to affect household fertility choices, demand for health services and health outcomes of newborns. Using administrative data with a difference-in- differences, we study how the end of the 50 years old Colombian conflict with FARC modified such decisions and outcomes in traditionally affected areas of the country. Results indicate that generalized reductions in total fertility rate were slowed down for municipalities traditionally affected by conflict as a result of the permanent ceasefire declared by the FARC insurgency. Total fertility rate observed a relative increase of 2.6% in the formerly conflict-affected areas, in all age groups. However, no impact was found for demand of health care services, neonatal and infant mortality rates, or birth outcomes such as the incidence of low weight at birth or the percentage of preterm births. Our evidence shows that municipalities with mines victims and expelled population by forced displacement before the ceasefire have significantly higher total fertility rate in the four years following the ceasefire. We argue that the mechanism behind this result is the optimism to raise the children in a better environment due to the reduction in victimization in areas that experience FARC violence.

GeneXpert and Community Health Workers Supported Patient Tracing for Tuberculosis Diagnosis in Conflict-Affected Border Areas in India.

Médecins Sans Frontières (MSF) has been providing diagnosis and treatment for patients with tuberculosis (TB) via mobile clinics in conflict-affected border areas of Chhattisgarh, India since 2009. The study objectives were to determine the proportion of patients diagnosed with TB and those who were lost-to-follow-up (LTFU) prior to treatment initiation among patients with presumptive TB between April 2015 and August 2018. The study also compared bacteriological confirmation and pretreatment LTFU during two time periods: a) April 2015–August 2016 and b) April 2017–August 2018 (before and after the introduction of GeneXpert as a first diagnostic test). Community health workers (CHW) supported patient tracing. This study was a retrospective analysis of routine program data. Among 1042 patients with presumptive TB, 376 (36%) were diagnosed with TB. Of presumptive TB patients, the pretreatment LTFU was 7%. Upon comparing the two time-periods, bacteriological confirmation increased from 20% to 33%, while pretreatment LTFU decreased from 11% to 4%. TB diagnosis with GeneXpert as the first diagnostic test and CHW-supported patient tracing in a mobile-clinic model of care shows feasibility for replication in similar conflict-affected, hard to reach areas.

Mobile outreach health services for mothers and children in conflict-affected and remote areas: a population-based study from Afghanistan

ObjectiveTo assess whether sustained, scheduled mobile health team (MHT) services increase antenatal care (ANC), postnatal care (PNC) and childhood immunisation in conflict-affected and remote regions of Afghanistan.DesignCross-sectional, population-based study from...

\u2018Even though I Am Blind, I Am Still Human!\u2019: the Neglect of Adolescents with Disabilities\u2019 Human Rights in Conflict-Affected Contexts

Drawing on qualitative research undertaken with adolescents with disabilities from refugee and host communities in Jordan and the State of Palestine, this article critically interrogates the framing of child neglect, which to date has situated the state as a protector rather than a perpetrator, the narrow understanding of adolescent needs and the responsibility of international actors for ensuring that the full range of human rights of adolescents with disabilities is supported. We frame our findings on adolescent neglect through a multidimensional capabilities lens and argue that although both adolescence as a distinct lifecycle stage and the rights of persons with disabilities have moved up the development agenda, adolescents with disabilities remain largely invisible, and especially so in conflict-affected contexts. Our findings highlight that adolescents with disabilities have limited access to schooling, skills building for economic empowerment and healthcare, due to accessibility challenges, cost and highly limited specialist provisioning. Moreover, adolescents with disabilities also have very little access to psychosocial support or opportunities to develop the independence which is a hallmark of adolescence and critical for successful transitions into early adulthood. Rather than working to meet those needs, the government and UN agencies tasked with provisioning in conflict-affected areas continue to miss opportunities to link young people with disabilities to existent services and tend to rely on NGOs to deliver small-scale, time-bound programming rather than assuming responsibility for appropriate programming at scale.

Prevention From Afar: Gendering Resilience and Sustaining Hope in Post-UNMIL Liberia

ABSTRACTThis article argues that resilience programmes in conflict-affected areas of limited statehood could be understood as much as an effort to equip vulnerable populations with tools to mitigate the effects of poverty, discrimination, lack of opportunities and manage gender inequalities than as an opportunity for the international community to prolong their interventions, consolidate local partnerships and sustain hope. We demonstrate our argument through an examination of the implementation in post-UNMIL Liberia of the ‘Spotlight Initiative’, a new multi-year multi-million programme of the European Union (EU) and the United Nations (UN) focused on the complete elimination of harmful practices and violence against women.

Mental Health and Wellbeing of South Sudanese-Australians

The majority of South Sudanese-Australians arrived in Australia, and other host countries outside Africa, after spending a greater part of their lives in refugee camps or conflict-affected areas. In addition, refugees are often not able to return to their home countries because the causes of their departure (wars, insecurity, hunger) continue to apply in their country of origin. The purpose of this paper is to examine some of the mental health and wellbeing issues some South Sudanese-Australians experience as a result of settlement difficulties and their earlier experience of conflict. The study looks at experiences of resettlement and settlement difficulties, and, more importantly, mental health and wellbeing issues in the wake of the aforesaid challenges. The data was collected from a qualitative method which comprised a series of semi-structured, one-on-one interviews with a total of 20 South Sudanese-Australians living in Melbourne. There were 11 males and nine females, with ages ranging from 18 to 64 years, who volunteered to participate in this study. Findings indicated that, as with many other people from refugee backgrounds, South Sudanese-Australians face a range of settlement-related challenges, and a host of post-resettlement adaptation experiences such as limited change of gender roles, language proficiency, unemployment, host society unacceptance or intolerance, constrained recreational opportunities, lack of community connectedness and overall mental health and general wellbeing issues. Experiencing conflict can be traumatic and refuge in neighbouring countries that are socio-culturally different can be challenging. In conclusion, these issues can not only be troublesome on a day-to-day basis, but also adversely affect the long-term mental health and wellbeing of refugees.

Civilian science: the potential of participatory environmental monitoring in areas affected by armed conflicts

Legal and policy initiatives to address the environmental dimensions of armed conflicts and their impact on people, ecosystems and sustainable development are highly dependent on the availability of environmental data from conflict-affected areas. Socio-political and security conditions in these areas often impede data collection, while traditional models of post-conflict environmental assessments are limited in scope. In response, an increasing range of actors is utilising remote sensing and open source data collection to identify and estimate health and ecological risks during and after conflicts. This paper considers the role of participatory citizen science methodologies in complementing both remote monitoring and post-conflict assessments. It examines existing models and mechanisms for environmental data collection and utilisation in conflict contexts, and the extent to which the core values and principles of citizen science are transferable. We find that ‘civilian science’ is feasible and could be well-suited to conflict conditions. In addition to addressing gaps in data collection, it may also empower communities affected by environmental degradation, enhance their environmental human rights, supplement the often limited monitoring capacity of governmental agencies and facilitate cooperation and peacebuilding. The paper concludes by proposing methodological approaches for three common forms of environmental degradation associated with armed conflicts.

Epidemiological findings and policy implications from the nationwide schistosomiasis and intestinal helminthiasis survey in Sudan

BackgroundThe World Health Assembly endorsed the WHO Neglected Tropical Disease (NTD) Roadmap in 2013, in which NTDs were suggested as tracers of equity in the assessment of progress towards the Sustainable Development Goals. Nationwide surveys were undertaken in all 18 states of Sudan to identify the geographical distribution and to estimate the prevalence and intensity of schistosomiasis and other intestinal helminthiases from December 2016 to March 2017.MethodsWe used two-stage random sampling. Each district was subdivided into one to three different ecological zones (EZs) based on proximity to water bodies. Probability-proportional-to-size sampling was used to select schools from each EZ. We estimated schistosomiasis and intestinal helminthiasis prevalence by the centrifugation method and Kato-Katz smears. Multi-level mixed-effect models were used to investigate the relationship between the prevalence of infections and risk factors, including improved water or latrine status at the household or school level. We estimated the cost-effectiveness of a one-time mass drug administration (MDA) intervention with 75% coverage at the district and EZ levels.ResultsA total of 105,167 students from 1772 schools were surveyed. The overall egg-positive rates were: Schistosoma haematobium, 5.2%; S. mansoni, 0.06%; and intestinal helminths, 5.47%. Severe endemic areas were concentrated in East and South Darfur States. Children living in a house or attending schools with an improved latrine were less likely to be infected with schistosomiasis than those without a latrine (adjusted odds ratio, aOR: 0.45, 95% confidence interval, CI: 0.41–0.51 and aOR: 0.75, 95% CI: 0.70–0.81 at the household or the school levels, respectively). Open defecation was strongly associated with schistosomiasis (aOR: 1.50, 95% CI: 1.35–1.66). In community-wide mass treatment at the district level with an 8% threshold for schistosomiasis, 2.2 million people would not benefit from MDA interventions with 75% coverage despite high endemicity, whilst 1.7 million people would receive the MDA intervention unnecessarily. EZ-level MDA was estimated to be more cost-effective than district-level administration under all circumstances.ConclusionsOur findings provide updated prevalence figures to guide preventive chemotherapy programmes for schistosomiasis and intestinal helminthiasis in Sudan. Schistosomiasis was found to be common among the inhabitants of fragile and conflict-affected areas. In addition, we found that MDA interventions would be more cost-effective at the sub-district level than at the district level, and there was a strong association between schistosomiasis prevalence and latrine status, at both the household and school levels. This study will help the Sudanese government and its neighbouring countries develop adequate control and elimination strategies.