Category Archives: Human Rights

Media Wars: #Ferguson, American Hypocrisy and a Hint of Spring

This was originally posted on my professional blog.

America has experienced an ugly spotlight reversal with the eruption of popular discontent into violence in its own backyard. Just a few weeks ago, international media was buzzing with reports of ISIS steamrolling the Iraqi military and Russian-supported separatists in Ukraine shooting down passenger airlines. Now, the US squirms uncomfortably under international scrutiny of Ferguson, Missouri, where the shooting of a young black man by a white police officer has once again raised the specter of racism and police brutality.

Obviously, the incident itself is complicated. Eyewitnesses – who have given conflicting testimonies – are the only window into what happened, since there was no dashboard camera. The initial description of Michael Brown, the victim of the shooting, as a “gentle giant” about to start college clashed with video footage of him stealing a box of cigarillos from a convenience store. Commentators have drawn parallels with the case of Trayvon Martin, whose mother has now reached out to Brown’s mother. Peaceful protests have given way to violence and looting, reporters have been arrested, and witnesses have complained of excessive use of force by the police.

Social media, which played a major role in bringing media attention to Ferguson in the first place, has played host to the battleground of ideological responses to the incident. The primary complaint from conservatives is that the uprising in Ferguson, and the underlying racial tensions it has exposed, don’t deserve our consideration because some of the protesters have been looting and vandalizing stores…

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…including a few gems that actually blame the community for the excessive force used against it.

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Meanwhile, people used the Twitter hastag #IfTheyGunnedMeDown to spar over which photos of Brown were used by traditional media (wearing a cap and gown vs. striking a “thug” pose) and post their own side-by-side pictures. Still others are expressing frustration at the fact that the vandalism and looting has been used as a straw man to distract from ongoing widespread racial profiling and policy brutality against blacks, including one refreshingly blunt protester at a rally in DC:

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What has been the most interesting to me is the global shock and horror at the incident and resulting fallout. The international community sees what many Americans are apparently missing: that the protests and unrest in Ferguson are the manifestation of a minority group sick of being oppressed and ignored. The UN High Commissioner for Human Rights drew parallels to South African apartheid, while several countries have been using the situation to take shots at America’s own human rights record when we so often criticize other countries. One might expect Iran and Russia troll the US over civil unrest, but as one friend of mine pointed out on Facebook, “When Egypt calls you out for human rights abuses, YOU’RE DOING IT WRONG.”

American police brutality, and the unwillingness of many police departments to be held accountable for their actions, have also been focal points. What happened to Michael Brown will unfortunately always be shrouded in mystery, since the Ferguson police department apparently prioritizes riot gear and tear gas over cameras for officers or police cruisers. They also seemed to have forgotten the meaning of “free press,” as they arrested and harassed several reporters who were trying to cover the protests. Interestingly, Obama was quick to condemn the bullying of journalists “here in the United States of America,” despite his own administration’s secrecy and aggression toward the press, including prosecuting a journalist who refused to identify the source of an intelligence leak.

Indeed, many observers have been quick to point out America’s hypocrisy at fingering human rights abuses outside our own borders when we have threads of discontent, similar to those found in the Arab Spring and other global protest movements, woven throughout our own society. A lovely little piece of satire from Vox portrays how American media might describe the events in Ferguson if they happened in another country.

When everything is said and done, America doesn’t look so much like a shining beacon of democracy and human rights – we just kinda look like everybody else.

Mass Shootings and Important Conversations

Elliot Rodger, a disturbed rich young man went on a shooting spree in Isla Vista, a wealthy district in Santa Barbara, California. Thanks to the joys of social media, both his written and videotaped “manifestos” were able to go viral. The reasons he listed for his killing tour included his parents’ divorce, lack of luck with the ladies, and being short.

I get the divorce and the sexual frustration, but being short? That one was new.

Predictably, this has set off all manner of commentary in the public sphere. First and foremost, of course, comes the discourse on gun control. Gun control advocates have pointed out that all of the guns that Rodger used were legally obtained. The Brady Campaign Against Gun Violence has spoken out on the need to tighten controls on obtaining firearms, and one of the victim’s fathers blamed “craven, irresponsible politicians and the NRA” for his son’s death. To be fair, three of the six people who died were actually stabbed to death, but Rodger had plenty more ready in his car that he could have used.

The feminist response to the “manifesto” (can we even call it that? should we?) has been swift and furious, pointing out the misogynism woven through it and drawing attention to his links to the usually peculiar, occasionally violence-embracing “Men’s Rights Movement” (which, by the way, is what exactly?)

But it also denies reality to pretend that Rodger’s sense of masculine entitlement and views about women didn’t matter or somehow existed in a vacuum. The horror of Rodger’s alleged crimes is unique, but the distorted way he understood himself as a man and the violence with which he discussed women — the bleak and dehumanizing way he judged them — is not. Just as we examine our culture of guns once again in the wake of yet another mass shooting, we must also examine our culture of misogyny and toxic masculinity, which devalues both women’s and men’s lives and worth, and inflicts real and daily harm.

Outspoken feminist writers have pointed out that this is not the first time a shooter has claimed similar motives, and Laurie Penny, in her usual no-holds-barred style, has dubbed the attack as the latest example of misogynistic extremism.

Last, and perhaps least, is the quiet conversation about mental health that seems to only experience half-hearted revivals when these tragedies strike. Mental health advocates speak up to point out that mental illness and seeking treatment for it are stigmatized in our culture, so social awkwardness and becomes anger without productive outlets which then warps into repressed rage. The media usually turns its head for a bit, shrugs, and then moves on to montages of grieving members of the community and talking heads interviewing NRA spokespeople on CNN. Unfortunately, this shooting has pitted feminists and mental health advocates against one another – as if Elliot Rodger the misogynist and Elliot Rodger the mentally unbalanced were mutually exclusive.

As both a feminist and a public health advocate, that makes me sad.

However, I think these are all important conversations to have. I much prefer them being featured on prime-time television in shows like Law and Order: SVU and Scandal than to have them forcibly thrust into the spotlight in the wake of a tragedy, but they need our attention nonetheless – and not at the expense of one another. While I’m not quite with the NRA on (lack of) gun control, I do think it’s something of a straw man in this case – California is one of the strictest states when it comes to gun ownership, and preventing mass killings goes beyond cutting off access to handguns (which, for better or worse, cannot be kept from citizens per the Supreme Court) – but conversations about gun violence segue into discussions about poverty and equity, which badly need to be confronted. We need to scrutinize sexism and gender violence as much as society’s assumption that a man’s worth is based on his sexual prowess – all of which hurt men as much as they hurt women, but in completely different ways. And we need to stop sweeping mental health advocacy under the rug, so that people don’t avoid treatment for mental illness for fear of being unable to get jobs in places like the military or the federal government.

Rather than fighting each other for the spotlight, let’s share it together.

Announcement: American-Iranian Academic Exchange

Section members and other interested professionals! Please see the following announcement from Taraneh Salke, who is leading an effort to organize a public health exchange to Iran. This exchange, while modeled after APHA’s sponsored delegation to Cuba, is not directly affiliated with APHA. If you are interested in learning more, please contact her at taranehsalke@yahoo.com.

If you would like to publicize commentary on the exchange described below, you may do so in the Comments section here, or contact me directly at jmkeralis [at] gmail [dot] com.


Dear colleagues,

My name is Taraneh Salke, an APHA member. I am writing to invite the APHA community to join an academic exchange trip to Iran tentatively scheduled for October of 2014. The American Iranian Academic Exchange is the first of its kind in nearly four decades, presenting a historic opportunity for public health professionals to bridge the distance of culture and politics, taking advantage of new openings created by high level dialogue between the American and Iranian governments. The exchange aims to support global academic cooperation through scientific exchange with our Iranian colleagues. This exchange is open to all professionals from all health and medical fields.

The visit will help us gain an understanding of the Iranian medical care structure, its integration with public health systems. The country’s successful family planning and reproductive health programs have led to maternal mortality rates at levels comparable with the United States, a total fertility rate of 1.6, and rates of contraceptive use that are among the best in the world. Iran’s public health establishment has also pursued a rigorous immunization campaign, reaching 99% coverage rates for most indicators tracked by UNICEF.

To learn more about Iran’s health care system, we will visit hospitals, clinics and medical universities. Also on our itinerary are visits to the Pasteur Institute of Iran and a generic pharmaceutical manufacturing plant in Isfahan.

In joining this project, we also join in the prospect of fostering collaborative research and the sharing of ideas, culture and values between American and Iranian health communities. There is a strong desire among Iranian professionals of all fields and many government officials to improve relations with the United States. During our travels, we will also be exposed to Iran’s rich culture–including Persian culinary arts, a storied architecture and the country’s famous rug crafts–which had the Huffington Post calling Iran a top tourist destination for 2014.

This trip is led by myself, Taraneh Salke, and my team. Since 1999, I have been working to promote women’s health and rights in the Middle East, founding the nonprofit organization Family Health Alliance (FHA) in 2005 to carry out my vision. In my position as FHA’s Executive Director, I have designed and implemented over 30 capacity building programs in Afghanistan, training hundreds of local health providers on strategies to reduce maternal and infant mortality. I have also studied Iran’s health care system extensively, coordinating two previous projects with Iranian medical universities and public hospitals.

More information on me and the work of Family Health Alliance is available at the following links:

http://www.taranehsalke.com/

http://www.familyhealthalliance.org/

The American/Iranian Academic Exchange is modeled after an APHA-sponsored delegation to Cuba that I had the good fortune to be a part of. The APHA community has helped build bridges between the scientific communities around the world, and this is an opportunity to continue in that tradition.

In November 2013, I traveled to Iran meeting with university officials and medical professionals who have eagerly agreed to participate in and host the academic exchange. There is a great deal of excitement over this trip among members of the Iranian scientific community. I have been asked to convey their desire to establish connections with their counterparts in the American public health community. They are hopeful that interactions during the exchange will serve as a springboard for collaborative research and joint publications, as well as leading to American academics teaching in Iran, and vice versa.

They have also invited exchange participants to present before our Iranian colleagues at a major medical university in Tehran, an opportunity available to those joining us in the October. The deadline for submitting abstracts is in June.

I am approaching APHA members’ to explore your interest in participating in this historic trip. The deadline for submitting visa processing documents is April 30th. This will reserve applicants a spot to be considered for the exchange trip. The deadline for making a final decision and submitting a security deposit is in June. We have requested for an extension on the visa application, please let me know if you require additional time for the visa application.

Please, if you have any other questions, feel free to contact me.

Sincerely,
Taraneh Salke
Executive Director, Family Health Alliance
taranehsalke@yahoo.com

Too far to go still: India’s struggle against gang-rape continues

This was cross-posted to my professional blog.

In the worst news you’ll read today, yet another gang-rape – of another tourist, and the second one this week – has surfaced in India.

An 18-year-old German was allegedly raped on Friday after falling asleep on a train heading to Chennai in southeastern India, where she was going to do volunteer work with a charity.

“The young lady took several days to muster courage to report to the police,” Inspector General of Police Seema Agarwal told NDTV. “Though it’s too late for medical examination, we have handled the case in a very sensitive manner.”

The attack brings the toll of publicized rapes on foreigners in the country to two in just a week, after a 51-year-old Danish woman was allegedly gang-raped in New Delhi on Tuesday.

En route to do charity work – they say no good deed goes unpunished, but damn.

Rape in general, and gang-rape in particular, has been the subject of a lot of scrutiny, and (thankfully) a whole lot of national soul-searching in India since the report of a brutal gang-rape on a bus in New Delhi made international headlines in 2012. Naturally, the stories involving tourists tend to garner more attention that those of locals, but there have been plenty of those to go around. Take the case of the German tourist raped by her yoga instructor in December. Or the British woman who jumped from her hotel window to escape a rape by the hotel manager. Or the Swiss woman who was brutalized by five tribesmen while her husband was tied to a tree. All of these news article mention, and often link to, stories of multiple other women who went through similar ordeals. You could spend all day following the links and questioning the humanity of humanity, or seriously wondering if Antoine Dodson had it right after all.

In response to the 2012 Delhi case and subsequent uproar, the Indian government worked very quickly to strengthen existing rape laws and increase punishments for perpetrators. However, while cases involving foreigners are seen through, too many cases reported by Indian women are just dropped, or completely ignored. Meanwhile, no one can really explain why this keeps happening.

A few obvious things spring to mind. Feminists in the west wage a never-ending battle against rape culture and victim-blaming, but the terms take on a whole new light in Indian culture, which is dominated by men and dictated by strict social rules. In the Delhi case, the defendants’ lawyer offered this gem to the press:

“Until today I have not seen a single incident or example of rape with a respected lady,” Sharma said in an interview at a cafe outside the Supreme Court in India’s capital. “Even an underworld don would not like to touch a girl with respect.”

Sharma said the man and woman should not have been traveling back late in the evening and making their journey on public transport. He also it was the man’s responsibility to protect the woman and that he had failed in his duty.

“The man has broken the faith of the woman,” Sharma said. “If a man fails to protect the woman, or she has a single doubt about his failure to protect her, the woman will never go with that man.”

A spiritual guru and a politician offered a different perspectives:

A spiritual guru, Asharam, sparked an outcry earlier this week when he said the New Delhi victim was equally responsible and should have “chanted God’s name and fallen at the feet of the attackers” to stop the assault.

Mohan Bhagwat, the head of the pro-Hindu Rashtriya Swayamsevak Sangh that underpins the country’s main opposition political party, said rapes only occur in Indian cities, not in its villages, because women there adopt western lifestyles.

Pearls of wisdom, to be sure.

One factoid that has been indicated is the stark gender imbalance, propagated by sex-selective abortions and female infanticide. Another issue is the widespread prevalence of abject poverty; the perpetrators are bored, desensitized, and have nothing to lose. An October article in the New York Times examined the issue in depth through coverage of a case in Mumbai:

One problem is that perpetrators may not view their actions as a grave crime, but something closer to mischief. A survey of more than 10,000 men carried out in six Asian countries — India not among them — and published in The Lancet Global Health journal in September came up with startling data. It found that, when the word “rape” was not used as part of a questionnaire, more than one in 10 men in the region admitted to forcing sex on a woman who was not their partner.

Asked why, 73 percent said the reason was “entitlement.” Fifty-nine percent said their motivation was “entertainment seeking,” agreeing with the statements “I wanted to have fun” or “I was bored.” Flavia Agnes, a Mumbai women’s rights lawyer who has been working on rape cases since the 1970s, said the findings rang true to her experience.

“It’s just frivolous; they just do it casually,” she said. “There is so much abject poverty. They just want to have a little fun on the side. That’s it. See, they have nothing to lose.”

Child marriage (finally) seen as a health issue (in addition to one of human rights)

This was cross-posted to my new professional blog.

As someone who takes particular interest in the intersection of health and human rights, I am glad to see this issue gaining the attention at the crossroads it deserves. Child marriage, which has been covered in recent years by such high-profile publications as National Geographic, has long been decried a human rights violation of young girls around the world. It garnered special attention with the story of Nujood Ali, an extraordinary young Yemeni girl who, after being married off at age ten to a man three times her age, escaped to a courthouse and demanded a divorce. She published her memoirs in 2009, which put the Middle East in the spotlight for the problem, but child marriage happens all around the world – and, in the case of Haiti, much closer to home than we Americans usually tend to think. Now, as my colleague Tom Murphy has pointed out on Humanosphere, child marriage is beginning to receive the attention it needs from the global health side as well.

Long considered an issue of human rights, the conversation about child marriage is shifting to that of health and education. Girls married too young are denied the educational opportunities of their peers and are put at greater health risks, such as HIV and teen pregnancy.

What may seem like a distant problem, child marriage is found in every part of the world. Ending the global practice will unleash opportunity for millions of women and girls.

(Side note: I promise that Humanosphere is not the only global health blog I follow, but I find it to be one of the most informative and well-rounded, so I link back to it a lot. Perhaps I need to lengthen my blogroll.)

At a glance, it’s easy enough to see both the health and the human rights problems with child marriages. First and foremost, the girls are married against their will, or without full knowledge of what it happening to them. Many of the girls are raped and abused; a few high-profile cases have featured girls who died of internal bleeding or fistula after their “husbands” finished with them. Teenage pregnancy, being cut off from education, perpetuating poverty cycles. The list goes on and on.

Unfortunately, it is just as easy to see that the solutions are not so simple; as the National Geographic feature points out, we cannot just “rescue” the girls by carrying them off into the sunset, as Nick Kristoff occasionally does. The reasons for these traditions are culturally ingrained and have to be addressed at the community level.

Efforts to reduce this number are mindful of the varied forces pushing a teenager to marry and begin childbearing, thus killing her chances at more education and decent wages. Coercion doesn’t always come in the form of domineering parents. Sometimes girls bail out on their childhoods because it’s expected of them or because their communities have nothing else to offer. What seems to work best, when marriage-delaying programs do take hold, is local incentive rather than castigation: direct inducements to keep girls in school, along with schools they can realistically attend. India trains village health workers called sathins, who monitor the well-being of area families; their duties include reminding villagers that child marriage is not only a crime but also a profound harm to their daughters.

“Two handcuffs” and no respite for garment workers

This was cross-posted to my own professional blog.

International outrage was sparked last with news of a massive factory collapse in Dhaka, Bangladesh, and the aid blogosphere spent months breaking down the

Photo credit: AP

Photo credit: AP

disaster and examining the fallout from it. Now, it seems that (though perhaps less of) our attention has been drawn again to the plight of garment workers – this time in Cambodia, where a large-scale protest was recently put down by force by the prime minister’s “private military.”

Why exactly the prime minister has a “private military” is a whole other issue that should be raising alarm, but perhaps beyond the scope of this particular discussion.

On Christmas Eve, a group of garment workers took to the streets of Phnom Penh to protest the Labour Ministry’s raise of the country’s minimum wage by a paltry fifteen cents.

In the days leading up to the protest, the Labour Ministry had approved an increase in the minimum wage for garment workers, from 80 to 95 dollars a month. But trade unions and workers protested, saying it was not enough to live on, and demanded a monthly minimum wage of 160 dollars.

Chrek Sophea, interim coordinator of the Workers’ Information Centre (WIC), which helps factory workers organise, told IPS workers cannot survive on the government’s proposed wage, and that it is in violation of Cambodia’s labour laws.

According to a 1997 law, “The minimum wage must ensure every worker of a decent standard of living compatible with human dignity.”

The military stepped in the night of Jan. 2, brutally beating and arresting labour leaders and protesting monks. Pictures of the bloodied trade unionists were widely shared on social media, which seems to be the point when the protests veered out of control.

By the early hours of Friday Jan. 3, young men allegedly armed with Molotov cocktails and machetes had replaced the women protesters. Hun Sen’s private military stormed the scene with live ammunition, shooting over 30 people, killing five and seriously injuring the rest.

Activists interviewed for the above-quoted article argue that the country’s current minimum way isn’t enough to scrape by an even sub-standard living without going into debt. “‘The minimum is for eight hours, so most work 10 hours to get a higher income to have just enough to sleep in a shared room. Most workers are in debt, borrowing about 50 dollars each month, and can only pay 10 dollars interest on the loan each month.’ Workers struggle to send money home to their families in the countryside.” Adding insult to injury is the fact that most laborers have to sign short-term contracts, which allows their employers to replace them easily if they get sick or have to take time off for the birth of a child. The result is “two handcuffs” – a low wage and no job security.

International media coverage is peppered with stories and commentary about the protest and its violent suppression, but the ongoing problems in Bangladesh’s garment industry are a handy reminder of how quickly we forget (no pun intended) our outrage. Even after Walmart cut off its business dealings with the guilty company and Congress tried (and failed) to do something about it, practically no is paying attention to the fact that garment factories catch fire every week. South Korea’s subtle encouragement of the crackdown in Cambodia is also a painful reminder that too often corporate interests – rather than a decent wage and safe working conditions – too often dictate our approach to the workers who stitch the clothes on our backs.

The Identity of a Protest

Most people are pretty surprised when they discover that I am Brazilian. You can look at my headshot on the “Bloggers” page if you want some idea as to why. Interestingly, most Americans and Europeans that I have met have accepted it with relatively little hesitation: when I explain that my mother is Brazilian, and that I am fluent in Portuguese and have a Brazilian passport, they nod in interest, and the conversation moves forward easily. With most Brazilians, however, the conversation goes quite differently; if you weren’t born in Brazil, there is a fair amount of skepticism in response to my claimed dual heritage. To a certain extent, I understand the reservation. But how do you classify a person with dual citizenship, fluent in both languages, who was born in one country but primarily raised by a mother from the other?

Such thoughts quickly bubbled to the surface as I was monitoring coverage of the protests in Brazil. What started as unrest over the botched construction of various World Cup stadiums and a nine-cent price hike of bus fares in São Paulo has erupted into a series of nationwide demonstrations so massive that they have turned the world’s collective head. The unrest caught the government by surprise (or, perhaps more accurately, with its pants down), and cancelling the fare hike and promising reform has done nothing to calm the national mood. A speech given by President Dilma Roussef last Friday has been dismissed by most as rhetoric.

The wave of protests began as opposition to transportation fare hikes, then became a laundry list of causes including anger at high taxes, poor services and high World Cup spending, before coalescing around the issue of rampant government corruption. They have become the largest public demonstrations that Latin America’s biggest nation has seen in two decades.

Brazil’s news media, which had blasted Rousseff in recent days for her lack of response to the protests, seemed largely unimpressed with her careful speech but noted the difficult situation facing a government trying to understand a mass movement with no central leaders and a flood of demands. …At the protests’ height an estimated million anti-government demonstrators took to the streets nationwide on Thursday night with grievances ranging from public services to the billions of dollars spent preparing for international sports events.

The fact that the protests seem to focus on government corruption came as no surprise to me. Corruption and government ineptitude is widely acknowledged and accepted among Brazilians to the point where it is almost a perpetual joke. They laugh at the poverty, the horrible traffic, and the virtual guarantee that pretty much everyone gets held up at gunpoint at least once in their life. My mother, who immigrated to America before the end of the military dictatorship, has never felt compelled to obtain U.S. citizenship to vote because, in her view, “all politicians are crooks.” My Facebook feed is peppered with memes disparaging government fraud and graft and decrying the state of the education system (several of my aunts and cousins are teachers). One night on Skype, my uncle made my mother and I laugh until we cried with the story of the multi-million dollar port that was built in a harbor too shallow for the ships it was designed to receive.

The last time I visited my family in Recife, we gathered around the computer so my cousins could show me the video montage made out of an interview with a woman who has become known on YouTube as “The Stutterer of Ilheus.” While I freely admit that it is tasteless to laugh at someone with a speech impediment, she became a minor social media sensation in equal part because of how vehemently she spoke out against the sorry state that her town was in due to neglect from local officials. Despite her stutter, she eagerly gave several interviews after her initial one.

The questions that remain for Brazil are much like the ones that followed Occupy Wall Street, or the Arab Spring. How long will they last? Some say they might persist, but similar predictions were made about the Wall Street Protests. What really triggered them? As political scientist Takoma Park at Dart-Throwing Chimp points out, it could be anything or everything:

We can’t learn a whole lot about the causes of mass protest by simply cataloging the conditions and things participants tell us about their motivations in cases where they occur. That information is useful, but not so much on its own.

To make real headway on causal analysis, we have to engage in contrasts. To learn about the origins of mass protest, for example, we need to compare cases where uprisings occur with ones where they don’t. Yes, income inequality is high in Brazil, but the same can be said for many of its regional neighbors. If inequality foments uprisings, why aren’t we seeing waves of mass protest in Honduras or Bolivia or Colombia or Paraguay? Meanwhile, inequality was comparatively low in many countries touched by the “Arab awakening.” According to World Bank data, income inequality is lower in Tunisia, Egypt, and Syria than in virtually every country in Latin America.

My mother told me this morning that there was a big protest in Houston held by Brazilian expats who wanted to stand in solidarity with the demonstrations in the country. It made me wonder: what gives someone a stake in these types of demonstrations. Is this, like the media analysts are claiming, a worldwide middle-class uprising? Do Brazilians living abroad truly understand what their countrymen are crying out against back home? What about those of us with citizenship and (some) culture, but no experience living there? Should I protest, or even blog about it?

There are a lot of analysts drawing parallels between Brazil and Turkey, and now it would seem that they have inspired similar demonstrations in Bulgaria. But when it comes down to it, I think each country’s movement – much like every individual’s sense of identity – belongs to, and must be defined, by them. As long as the voices are heard, maybe the demands are secondary.

My cousin Penelope sent e-mails to the family with two videos about the Brazilian protests. The first one is a short film about one of the marches held in Recife, my family’s hometown.

The second is an interview with a man commenting on vandalism and violence in some of the demonstrations. It’s in Portuguese, but the main point he makes in the video is that while he doesn’t advocate violent protests, he doesn’t think the government has any right to decry demonstrators for it. He says vandalism is when “politicians steal public money, when my son dies in a hospital because there are no doctors or medicines because of the rampant corruption.”

Violence against Women: An Important Global Health Priority

This is a guest post by Sarah M. Simpson.

Violence against women is a major health problem around the world and continues to be an important cause of morbidity and mortality among women.  Women suffer violent deaths either directly or indirectly, and this violence is also can important cause of morbidities such as mental, physical, sexual and reproductive health outcomes and is also linked to important risk factors for poor health, such as alcohol and drug use, smoking and unsafe sex.  The problem is so widespread that it has its own Millennium Development Goal 3 which seeks to “promote gender equality and empower women” along with Millennium Development Goal 5 which seeks to “improve maternal health”. However, in the light of several publicized acts of violence against women, this important issue is once again at the forefront of everyday discussion. Some key facts about violence against women from a United Nations factsheet:

  • A WHO multi-country study found that between 15–71% of women aged 15- 49 years reported physical and/or sexual violence by an intimate partner at some point in their lives.
  • These forms of violence can result in physical, mental, sexual, reproductive health and other health problems, and may increase vulnerability to HIV.
  • Risk factors for being a perpetrator also include low education, past exposure to child maltreatment or witnessing violence in the family, harmful use of alcohol, attitudes accepting of violence and gender inequality.
  • Risk factors for being a victim of intimate partner and sexual violence include low education, witnessing violence between parents, exposure to abuse during childhood and attitudes accepting violence and gender inequality.

In the wake of the world-wide Valentine’s Day  One Billion Rising events calling people everywhere to unite and bring an end to violence against women, The Guardian’s “Global Development podcast” has recently released a podcast proceeding  the United Nations Fifty-seventh session of the Commission on the Status of Women.

podcast

In this podcast, deputy editor of Guardian global development Liz Ford speaks with Irene Khan, head of the International Development Law Organization; Korto Williams, country director of ActionAid Liberia; Andrew Long from the U.K. Foreign Office’s prevention of sexual violence in conflict initiative; and Lakshmi Puri, deputy executive director of U.N. Women, about current global efforts to stop violence against women.

Against the backdrop of these movements to unite people world-wide, all eyes will be on policymakers at this upcoming session of the UN Commission on the Status of Women to produce and deliver results abroad and even in the United States.  Recently, two UN experts addressed the US State House of Representatives to approve the Violence Against Women Act (VAWA) which lapsed in 2011. Overall, the impact of violence against women needs to continue to be researched and explored from a public health perspective.

Rave Review of “Rights-Based Approaches to Public Health,” by our own Dr. Elvira Beracochea

Congratulations, Dr. Beracochea! A glowing review of her new book, Rights-Based Approaches to Public Health, was recently published in PsycCritiques, a collection of reviews from the American Psychological Association. I have posted the review below. This is a wonderful accomplishment for Dr. Beracochea and her fellow editors and authors of this book. The IH section is fortunate to have you!


Public Health and Human Rights: Realigning Approaches to Improve Global Health Problems

Reviewed by
Will Ross

At a time of heart-crushing stories of human deprivation due to regional conflict, forces of nature, or uncaring and at times immoral state policies, the world’s attention turns to the public health community for problem assessment and effective deployment of resources and programs to stabilize critical conditions on the ground. With great timing, the editors of Rights-Based Approaches to Public Health offer a targeted and innovative strategy to
combat global health problems. Balanced, comprehensive, and steeped in the historical traditions of human rights, the book persuasively moves the reader from abstract conceptions of inalienable human rights to evidence-based, pragmatic solutions that highlight the systematic integration of human rights principles in human development work.

For the audience of public health students, seasoned and novice public health
professionals, health care practitioners, and policy experts, the editors provide an overview of a rights-based approach that is elegant in simplicity and highly executable in design, referencing the UN’s (2000) General Comment 14 on the Right to the Highest Attainable Standard of Physical and Mental Health: “Every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life of dignity” (para. 1).

The editors and authors present a framework for a rights-based approach that is
normatively based on international human rights standards and that cannot be easily dismissed as political in nature or hegemonic. Most important, the editors charge some of the world’s most respected public health practitioners and human rights advocates to craft sensible methods of operationalizing the basic human rights principles outlined in the UN’s (2003) Human Rights-Based Approach: Statement of Common Understanding, which posits that human rights are universal, inalienable, interdependent, and interrelated. In essence,
they have created a veritable “how-to” guide that, when implemented, can in sustainable fashion uplift the human condition worldwide.

Universality of Rights-Based Approaches: Uniting Us All?

As detailed by the editors, a cardinal feature of a rights-based approach is its timelessness and universality, increasing its appeal to professionals who labor to keep the plight of marginalized communities on the global radar screen. By using the universal language of rights-based approaches, public health professionals may be better positioned to leverage greater social and political capital and enhanced resource allocation for their cause. Striking examples of rights-based approaches in diverse settings are outlined in the book, from demands for water rights in Haiti to conflict-affected settings such as the Gaza Strip and advocacy of children’s rights in Kosovo.

If the dramatic contemporary examples outlined in the book are not sufficient, the authors could easily extend the discussion further and call attention to the severe drought and attendant famine in Somalia, where the UN’s Food Security and Nutrition Analysis Unit (2011) found that nearly 250,000 people continue to face imminent starvation, or the Democratic Republic of the Congo, where U.S. researchers note that more than 400,000 women are raped each year (Peterman, Palermo, & Bredenkamp, 2011). In all instances a rights-based approach can reverse the erosion of socioeconomic stability that fosters such
injustices while holding the state accountable for protecting and fulfilling the rights of individuals in affected communities.

Inherent in a rights-based approach claim that individuals have the right to the highest attainable standard of health is the realization that health professionals cannot disentangle physical health from the myriad social and economic factors that influence health. If a rights-based approach empowers rights holders in asserting that human rights are universal and inalienable, then it is the incumbent responsibility of the duty bearer—entities sanctioned to protect society—to ensure the fulfillment of those rights. This conceptual framework is in contradistinction to traditional needs-based approaches, whose altruistic intent and actions may be perceived as both patronizing and lacking in accountability, and thus not amenable to legal redress in the event of adverse outcomes.

Marrying Rights-Based Approaches to Health Care Reform

A critical chapter for U.S. readers (Chapter 4) is “A Rights-Based Approach to Health Care Reform.” In the United States, profligate health care spending has not translated into improved health outcomes when compared with those of other developed countries. A fundamental, if not fatal, flaw in the U.S. health care delivery system is the disconnect between the high-quality acute, specialty care available to some who have the ability to pay in a system rooted in free enterprise and the haphazard primary and preventive care that is unevenly distributed across locales. Although unintended, this result is not unexpected in a country that has failed to embrace a full definition of health.

The divide on the proper role of government in health care in the United States was presaged in the response to the World Health Organization’s (1946) definition of health, promulgated in the 1948 UN convention:

a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity. . . . Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures. (p. 2)

This provision was rebuffed on the grounds that it was outwardly socialistic in intent and lacked legal standing, on the basis of the interpretation that health care was not among the enumerated rights in the U.S. Constitution.

The perennial argument surrounding the government’s role in health care has since devolved into rants about market-based reforms as opposed to moral-based claims of health care as a right for every citizen. Such a false dichotomy only promotes greater social division; consensus will be gained when every country affirms the connection between health and human rights. A rights-based approach to health, which has been relatively absent from the contemporary discourse on health reform, could effectively realign staunch political forces around the unassailable conceptual framework of health as a public good rather than a commodity.

The rights-based approach permits a more nuanced view of the roots of health
inequities; consequently, more systematic steps can be taken to ameliorate inequities since a framework exists that addresses the social determinants of health. Rights-Based Approaches to Public Health outlines several international treaties, such as the 1977 International Covenant on Economic, Social, and Cultural Rights, which would reduce stillbirth rates and infant mortality by paving the way for special protection for mothers in the childbirth period. Although the United States signed the treaty, it did not ratify it and so failed to allocate the requisite resources to enforce the treaty.

Hopefully there will be greater U.S. embrace of the UN’s Millennium Development Goals—explicit milestones for the realization of global human development that offer an opportunity to reduce health inequities by spurring economic development. The United States, in its effort to reduce health inequities as outlined in the Centers for Disease Control and Prevention’s (2011) “Health Disparities and Inequalities Report,” will find willing partners in realizing two seminal Millennium Development Goals: reducing child mortality
and improving maternal health.

Limitations of Rights-Based Approaches

The authors and editors of Rights-Based Approaches to Public Health rightfully
acknowledge that the still-nascent field of rights-based public health has limitations that have constrained its widespread adoption. Rights-based approaches rest on the belief that individual empowerment and restored human dignity can be ensured through programmatic efforts that address the social determinants of health. Social determinants of health, as espoused by the World Health Organization’s Commission on Social Determinants of Health (2008, p. 2 of Executive Summary), are “the conditions in which people are born, grow, live, work and age . . . . In their turn, poor and unequal living conditions are the consequence of poor social policies and programmes, unfair economic arrangements, and bad politics.”

Criticism abounds that such an approach is too costly, time intensive, and inherently difficult to measure since it involves restructuring the social fabric of disadvantaged communities and raises the potential for conflicts due to encroachment on national sovereignty. There is correspondingly a lack of solid evidence supporting the effectiveness of rights-based approaches. Finally, a rights-based approach in public health can come across as canonical, even prescriptive in its assertion that individual rights warrant the same protection as societal ones (Berman, 2008).

The book concludes, in powerful tones, that rights-based approaches provide public health professionals the framework and the infrastructure to address the needs of vulnerable populations and society at large. Public health students, academicians, and both medical and public health practitioners should feel empowered to act with this transformative approach that asserts the dignity of humankind.

References
Berman, G. (2008). Undertaking a human rights-based approach: Lessons for policy, planning, and programming. Bangkok, Thailand: UNESCO Asia and Pacific Regional Bureau for Education.

Centers for Disease Control and Prevention. (2011, January 14). CDC health disparities and inequalities report—United States, 2011. MMWR: Morbidity and Mortality Weekly Report, 60(Suppl).

Peterman, A., Palermo, T., & Bredenkamp, C. (2011). Estimates and determinants of sexual violence against women in the Democratic Republic of Congo. American Journal of Public Health, 101, 1060–1067. doi:10.2105/AJPH.2010.300070

United Nations. (2000). The right to the highest attainable standard of health. Retrieved from http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En

United Nations. (2003). Human rights-based approach: Statement of common
understanding. Retrieved from http://www.unicef.org/sowc04/files/AnnexB.pdf

United Nations Food Security and Nutrition Analysis Unit. (2011, November 18). Famine continues: Observed improvements contingent on continued response. Retrieved from http://www.fsnau.org/in-focus/famine-continues-observed-improvements-contingentcontinued-response

World Health Organization. (1946). Constitution of the World Health Organization. Geneva, Switzerland: Author.

World Health Organization Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva, Switzerland: World Health Organization.

“Driving out Trash”: Five years brings only more evictions for Harare’s slum-dwellers

Flickr, Sokwanele - Zimbabwe

The Shona word murambatsvina means “to drive out trash.” This was the word used to describe the Zimbabwean government’s campaign to forcibly clear out the slum areas around the country, under the pretense of combating illegal housing and reducing the spread of infectious disease. Zimbabwe’s current president has described the “urban renewal campaign” as “a vigorous clean-up campaign to restore sanity.” UNHCR has estimated that the forced evictions have directly affected at least 700,000 people, and that approximately 2.4 million more could have been indirectly affected in some way. The campaign was condemned by the UN and was called a crime against humanity.

Five years later, the evicted slum-dwellers still remain homeless. The few houses that were built as part of the re-housing scheme were given to government employees. Obvious human rights abuses aside (like torching people’s houses and belongings) aside, the campaign had serious health consequences for the evicted populations. HIV patients were cut off from clinics and antiretroviral medications. Thousands of IDPs are still living under emergency plastic sheeting with no medical services or clean water, no schools, no sanitation, and no source of income. Amnesty International has reported a shockingly high neonatal mortality rate among babies born to evicted mothers: in five months, there were 21 newborn deaths in Hopley, a settlement 10 km south of Harare. Most of the babies died within 48 hours of birth. The women have said that they were fully aware of the importance of maternal healthcare, and they all wanted to give birth in a hospital or with a trained birth attendant, but many could not afford the $50 required to register for antenatal care. The nearest maternity clinic is 8 km away. Some thought their babies had died because of minimal access to healthcare, while others suspected they had died of cold because they live in plastic shacks.

Amnesty International and other human rights groups have called for an investigation of the newborn deaths, but there seems to be little hope of a serious inquiry. Meanwhile, there are growing concerns of another eviction campaign: residents are again being forced to leave their homes because they cannot afford a(n arbitrarily-imposed) $140 “lease renewal fee.” Zimbabwe’s government of course denies this, but it a bit difficult to argue when the evidence consists of shacks on fire. Several MEPs have called for the Zimbabwean diplomat to the EU to be sent home in response to the evictions – but will it be enough?

This was also posted on Jessica’s Refugee Research Network blog.

One Step Forward, Two Steps Back: Court Decision in China Upholds HIV Employment Discrimination

China always seems to find its way into human rights headlines these days. Now that the sound and fury of Liu Xiaobo’s Nobel Peace Prize has died down, the People’s Republic is in the news again: this time for a landmark court decision in which a man lost a discrimination case for being denied a teaching job based on his HIV status. Wu Xiao (an alias that means “Little Wu”), a 22-year-old college grad, passed a series of written tests and an interview for the position, so he should have been perfectly qualified for the post. However, when his mandatory blood test revealed his HIV status, the local education bureau in Anqing rejected his application. The court ruled that the criteria for hiring civil servants (which disqualifies HIV-positive individuals from being hired) overrules a 2006 law that prohibits discrimination against persons with HIV and their families. The verdict is highly discouraging to Chinese AIDS advocates.

Discrimination against persons with HIV is nothing new. The history of the disease is littered with horror stories of stigma, persecution, and invasion of privacy, and discrimination continues all over the world in various forms, including cultural norms and, in some cases, even laws. In Chile, HIV-positive women are frequently pressured to get sterilized, and some are even sterilized without consent. Twenty-two countries, including Russia, Egypt, and South Korea, will deport foreign nationals based solely on HIV status, and other countries (such as Malaysia and Syria) will not allow students with HIV to apply for study. Gugu Dlamini, a SouthAfrican woman, was beaten to death after speaking openly about her HIV status at an AIDS awareness gathering on World AIDS Day in 1998.

China is certainly no stranger to HIV/AIDS discrimination. From the government’s frantic cover-up of the “Bloodhead Scandal” (in which 30,000-50,000 people were infected through blood transfusion programs in the 90s) to present-day violations of patient privacy laws, Chinese HIV patients face harsh stigma from healthcare providers, government officials, and their friends and neighbors. On the surface, the country has been somewhat proactive in mitigating this: it passed its first laws regarding HIV patient privacy in 1988, and it is illegal to disclose personal information of HIV-positive individuals. Chinese President Hu Jintao and Prime Minister Wen Jiabao make visible appearances with people with AIDS every year on World AIDS Day, and ARVs are available to AIDS patients for free. However, privacy laws are routinely violated, and people with HIV are ostracized from their families and communities. The government routinely harasses and often imprisons AIDS activists (Hu Jia, for example, was held under house in 2006 and has been in jail since 2008). Fear, ignorance and the threat of discrimination discourage individuals from getting tested and deter many who already know their status from seeking treatment. Chinese AIDS patients are encouraged by their providers to use fake names and IDs when seeking treatment and picking up medicines.

Wu’s lawyers plan to appeal the decision, but advocates are frustrated. “The entire H.I.V. community had high hopes, but now the door appears to be shutting for people who want to use the courts to fight against discrimination,” said Yu Fangqiang, whose organization represented Wu in his case. Others, however, urge patience, and point out that the fact that the case was even heard demonstrates progress. Either way, it is crucial to end the institutionalization of discrimination against HIV. Cultural norms will not change until the official government position changes, and, along with it, its laws. People will not seek treatment until they are no longer afraid to come out of hiding.

Rohingya Refugees: Where do you go when everyone just wants you to go away?

Rebel groups in the Congo.  Religious radicals in Iraq.  Mercenaries in Darfur.  Starvation in North Korea.  Natural disasters in Haiti and Chile.  Every region in the world has something to run from, and the people running from them are dispersed far and wide.  Refugees, while pitied, are often treated with a mild neglect, or sometimes with disdain or outright hostility.  Still, many of them find the means to survive in less dangerous conditions.  Some try to make a life for themselves by emigrating, while others do their best to scrape a life together in refugee camps dotting the borders of their more peaceful neighbors.  The public health and medical challenges in refugee camps are many and daunting: unsanitary conditions, no running water, little to no food security, scant medical care. 

A Rohingya woman collects rain water.

From "Rohingya in Bangladesh: Unrecognized, Unprotected, and Unassisted," a slideshow by MSF

The Rohingya are suffering from these conditions perhaps more acutely than most.  They are an ethnic Muslim group from Myanmar, but they are not recognized as one of the country’s 135 “national races” by the military junta.  About 750,000 currently live in Myanmar, where they are oppressed by the military and not allowed to own property, vote, travel, or marry; one million have fled persecution and emigrated to other parts of the world.1  There are refugees in each of the country’s five neighbors – China, India, Laos, Thailand, and Bangladesh – with the largest refugee camps in Bangladesh.2  While 28,000 in the official Kutupalong camp have recognized refugee status in Bangladesh,3  another 220,000 are illegal immigrants with no official status and no assistance.3,4  Many live in a makeshift camp just down the road from Kutupalong with no water, power, schools, or medicine.1  When Médecins sans Frontières (Doctors without Borders) made its initial assessment of the camp in March of 2009, they found that 90% of the more than 20,000 residents were severely food-insecure; malnutrition and mortality rates were past emergency thresholds; and people had little access to safe drinking water, sanitation, or medical care.3,5  MSF immediately began offering basic health care and treating malnourished children and has now established a primary health care program for the refugees.  MSF and Action contre la Faim (Action against Hunger) are the only international NGOs working at the makeshift camp.5The treatment the Rohingya face in Bangladesh and elsewhere isn’t much better than in Myanmar.  The Bangladeshi government has been accused of blocking food aid, conducting arbitrary arrests, beating and harassing the unrecognized refugees.3,4  Reports have come in of the Thai military conducting “pushbacks” – rounding up Rohingya, putting them on a boat, and pushing them out to sea.1  But the truth is that no one wants them.  Bangladeshi officials, denying allegations of abuse, insist that “[w]e are the victims. The Burmese people have been kicked out of their country and we gave them shelter.”4 

More information on the Rohingya and refugee health
Rohingya in Bangladesh: Unrecognized, Unprotected, and Unassisted (MSF slideshow)
The United Nations High Commissioner for Refugees
Forced Migration Review – published three times a year in English, Arabic, Spanish, and French by the Refugee Studies Centre of the Department of International Development, University of Oxford. 

Spotlight on Maryam Bibi, an extraordinary woman, on International Women’s Day

The twittersphere is abuzz today with tweets from people, government agencies, and NGOs celebrating International Women’s Day.  The call to continue working to improve health and human rights for women across the globe is loud, clear, and multi-voiced.  And although much still remains to be done for women in developed and developing countries alike, the voices of high-profile women and the tireless work of individuals and organizations committed to bettering the lives of women are making great strides.

But while governments and large aid machines attract most of the attention given to work in women’s health, it is often the work of individuals that is the most moving.  Amid all of the “#internationalwomensday” tweets over the course of the day, the one that caught my eye was the Acumen Fund calling attention to Maryam Bibi, an extraordinary woman who has worked for women’s health and education in Waziristan since 1993.

Maryam Bibi, a Pakistani woman, wearing a white shawl and holding a book.

Image courtesy of the Times Online.

Ms. Bibi set up Khwendo Kor (a phrase in Pashto meanings “Sisters’ Home”), an agency in Peshawar that works with women in Pakistan’s Northwest Frontier Province to improve their education, health, and economic well-being.  The organization began in one village with four staff members; now it works in more than 300 cities and has over 340 staffers.1,2,3  Khwendo Kor focuses primarily on social organization, community-based education for women, microcredit, primary health care, and advocacy, and it collaborates with men and local leaders to accomplish its goals.1  It has trained 180 young women as village-based teachers and established 170 community schools, and over 200 women have been given opportunities to begin small businesses through microcredit.2,3  Through her schools, approximately 6,500 girls have been educated, and 3,500 are currently enrolled.3  She has received multiple awards for her work, including the Fatima Jinah Medal (2003) for outstanding women in the social sector and the Star of Excellence National Civil Award (2001) in Pakistan, the UN’s Recognition of Services award (2000), and the ILO’s Human Rights Award (2001).1,2,3

Despite international honor and recognition for her work, Ms. Bibi still faces considerable opposition and danger close to home.  While she enjoys walking to work, she says that “the office vehicle often collects me.”4  Radical religious organizations slander Khwendo Kor through mosques and local media.  Children’s learning centers established by the organization have been blown up.  Their vehicles have been stolen, staffers have been shot at, and fatwas have been issued against them.  Ms. Bibi can no longer stay late in her office because of death threats.  Still, she is not deterred.  “Some people say that I am an elderly lady and that I should be ashamed of myself doing this work: that I should be sat at home and saying my prayers. But as an elderly woman I would like other elderly women to join me because this work is a matter of our children and our future generations and we have to do something to bring about change.” 2

February 6: International No Tolerance Day to Female Genital Mutilation

February 6 has been designated by the UN as “International Day against Female Genital Mutilation,” a day to raise awareness about the dangers and health consequences of this traditional practice in sub-Saharan Africa and the Middle East.1 Female genital mutilation (FGM) refers to the partial or total removal of the external female genitalia for cultural, religious, or other non-therapeutic reasons.2 It has no health benefits and frequently causes both immediate and long-term problems for women and girls: in addition to severe bleeding, infection, and problems urinating, it can cause infertility and complications with childbirth.1,3 An estimated 130 million women alive today are currently living with the consequences of FGM.

Image courtesy of afrol News

Prevalence of FGM in AfricaFGM is entrenched in the cultural and religious beliefs in many communities.4 In many parts of West Africa, this cutting is presented as a religious obligation to Muslim women.5 It is internationally recognized as a violation of the human rights of girls and women: it is nearly always performed on minors,2 and it is sometimes used to facilitate sexual relations with child brides.5 Additionally, FGM is just one component of cultures in which women have no voice in decisions that affect their everyday health and well-being. For example, Amnesty International recently called attention to the high rate of maternal deaths in Burkina Faso, which it ascribes to gender discrimination: many women are unable to access sexual and reproductive health services due to discriminatory attitudes and illegal demands for payments by corrupt medical staff.  Burkinabe women have little to no say in when they can seek medical care or the timing and spacing of their pregnancies, and they are still being subjected to early marriages and FGM.6

There has been recent progress by governments, human rights groups, and NGOs in persuading communities to abandon the practice.  In Mauritania, 34 imams and Muslim scholars recently signed a fatwa, or religious ruling, against the practice.7,8 Authorities in Niger recently took steps to enforce a ban enacted in 2003 by administering fines and jail sentences to 45 mothers who allowed their daughters to be cut.7  Tostan, an NGO that works primarily in Sénégal, has worked with thousands of villages that have made the decision to abandon FGM: the group educates villagers and then allows them to make their own conclusions.  Because the practice is often tied to marriage opportunities, intramarrying groups must make a collective decision to abandon the practice in order for efforts to be effective.4 Since 1997, 4,580 communities working with Tostan have declared their decision to end the practice.

The UN and other international health and human rights groups have campaigned aggressively to end FGM, and more countries are passing laws against the practice.  Recent indications that communities in West Africa are moving away from it are encouraging.  However, two million girls are still at risk every year.2 As the international community observes this day of awareness, we should be attuned to the need for culturally sensitive approaches to end FGM in order to protect the rights of women and girls.

The “Angel of Bukavu”: A light in the heart of darkness

Blog contributor: Jessica M. Keralis

To most, the Rwandan genocide that began in 1994 is a page in the history books, and the resulting instability in the Kivu region of eastern DRC is old news.  But for Dr. Denis Mukwege, a surgeon who specializes in the repair of vaginal fistulas, the atrocities of Congo’s “second war” are a harsh, every-day reality.  Vagina fistula, a condition in which the tissue wall between the vagina and the bladder and/or colon is torn, is a common result of the systematic rape to which the women of this region of the Congo are subjected.

During Rwanda’s civil war and genocide in 1994, thousands of refugees and armed militant groups fled to the eastern region of the Congo, generating a climate of political instability and local anarchy.  A “second war” began in 1998, in which Rwanda and Uganda organized and fostered armed bands to terrorize the local people and maintain the insecurity to justify militarization that enables them to plunder the resource-rich region.  This conflict has been the deadliest since World War II, and more people have died than in Iraq, Afghanistan, and Darfur combined.  Intermingled with the high death toll is the widespread calculated rape of women of all ages.  It is used to physically and psychologically terrorize: the women are raped or gang-raped in broad daylight and in plain view of their families and neighbors.  As a result, social networks are destroyed and family ties are fragmented.    The widespread sexual violence has taken its toll on public health both physically and socially. Sexually assaulted victims outnumber wounded soldiers 4 or 5 to one and civilians with gunshot wounds 2 or 3 to one.  Medical sources estimate that between 19 and 30 percent of the victims test positive for HIV.  Half of them have syphilis.  The women are virtually destroyed, often abandoned by their husbands, and their children are traumatized.  Those that survive become outcasts.

In the midst of such atrocities, Dr. Mukwege has been called the “angel of Bukavu.”  He typically performs ten surgeries per day, often working 14 hours or more.  To the women he heals, he is more than just their doctor: he is their brother, their counselor, their confidant.  He has been featured by CNN, the New York Times, and Glamour magazine, and has been given numerous awards, including the Olof Palme Prize and the UN Human Rights prize.  But while Mukwege is grateful for the attention drawn to the conflict and money for the hospital, what is truly needed, he says, is a political response to the violence.  “Visitors come from the international community.  They eat sandwiches and cry, but they do not come back with help. Even President Kabila has never put his foot here. His wife was here. She wept, but she has done nothing.”

Interview with Cécile Mulolo Kamwanya, psychologist at Panzi hospital: