Health

The Democratic Republic of the Congo (‘DRC’) has been called “the rape capital of the world” while Colombia was known in the late 1990s as “the murder capital of the world”. What do these capitals of crime have in common? Both countries have been plagued by conflict-related violence, including sexual violence. This chapter will serve as a comparative study to explore how such different cases – situated at difference points on the spectrum in terms of prevalence and attention received – are still described using the same narrative language.

This study seeks to offer a practical examination of resilience in complex urban landscapes for the academic community and humanitarian actors at the local and international levels. Distrito de Aguablanca (Cali, Colombia), a complex settlement area with some 600,000 residents, functions as a case study in human security and resilience that can inform public policy and community level decision making in especially difficult humanitarian environments, with sociopolitical volatility, large populations of internally displaced persons, and high crime and violence rates.

The Syrian refugee crisis represents one of the greatest humanitarian challenges the international community has faced over the recent years, prompting record-high levels of international aid. In view of the complexity of the political and social environment in which these challenges arise and the historical scale of the population affected, innovative and creative programmatic responses are essential to address the short and middle-term needs of refugees and reducing instability in the Middle East region.

This report presents the results of a mixed-methods study conducted in Abidjan, Côte d’Ivoire, to assess the population’s perceptions, knowledge, and attitudes about security and justice. The study included a survey of 1,000 randomly selected adult residents, to provide results that are representative of the population of the city of Abidjan. The specific objectives of this study were to:

1. Assess the overall exposure to violence among the population in Abidjan.
2. Document attitudes and opinions about transitional justice mechanisms.
3. Examine how the population gathers information about the International Criminal Court (ICC), what factors influence Ivorians’ knowledge of the Court, and what correlation exists between information sources and perceptions.

Detailed results provided in the report outline the challenges of rebuilding peace and achieving justice after a decade of conflict, and just two years after a dramatic post-election crisis. The report reveals a population that has little or no trust in its government and in each other, concerned with its economic well-being, and somewhat divided about holding accountable the perpetrators of serious crimes during the postelection violence.

Two dominant narratives have characterized the conflict in eastern Democratic Republic of the Congo (DRC): (1) the horrific abuse of women through sexual violence and (2) the use of “conflict minerals” to fuel the fighting. These two advocacy narratives intersect uniquely in artisanal and small-scale mining (ASM) towns and can lead to flawed understandings of the true dynamics of women's experiences in these contexts. Mining areas are important centers of economic activity for women, but also pose distinct risks. A simplistic portrayal of women's victimization in mining towns suppress discussion of their participation in non-conflict political and social processes. Yet, these processes are among the most important to ensure that women secure opportunities for long-term, substantive engagement in mining activities. This paper draws on systematically collected qualitative data from two territories in South Kivu, Walungu and Kalehe, to examine how women negotiate these complex social and economic mining landscapes in eastern Democratic Republic of Congo. Their accounts compel a re-examination of development efforts to remove women from the mines altogether, and to look more closely at the measures available to help them realize their legal rights to work safely and fairly in these contexts.

Two dominant narratives have characterized the conflict in eastern Democratic Republic of the Congo (DRC): (1) the horrific abuse of women through sexual violence and (2) the use of “conflict minerals” to fuel the fighting. These two advocacy narratives intersect uniquely in artisanal and small-scale mining (ASM) towns and can lead to flawed understandings of the true dynamics of women's experiences in these contexts. Mining areas are important centers of economic activity for women, but also pose distinct risks. A simplistic portrayal of women's victimization in mining towns suppress discussion of their participation in non-conflict political and social processes. Yet, these processes are among the most important to ensure that women secure opportunities for long-term, substantive engagement in mining activities. This paper draws on systematically collected qualitative data from two territories in South Kivu, Walungu and Kalehe, to examine how women negotiate these complex social and economic mining landscapes in eastern Democratic Republic of Congo. Their accounts compel a re-examination of development efforts to remove women from the mines altogether, and to look more closely at the measures available to help them realize their legal rights to work safely and fairly in these contexts.

The decades-long conflict in eastern Democratic Republic of the Congo (DRC) has resulted in major changes to local economies, strained social networks and insecurity. This environment forces many to pursue unconventional and, at times, socially stigmatised avenues for income. This paper explores the ways in which individuals in eastern DRC engage in, and are affected by, the commoditisation of sex within the context of decades of violent conflict.

This report documents the experiences and attitudes of former underage combatants in eastern Democratic Republic of the Congo (DRC) who went through the reintegration process, the families and communities who received them and the organizations that funded and implemented reintegration programming. Despite increasing attention to the scope and importance of child soldiering globally, there is still limited systematic research on the successes and challenges of reintegration programming for former underage combatants. This project, a collaboration between the Harvard Humanitarian Initiative and Eastern Congo Initiative, used DRC as a case study to examine the community experiences and attitudes around Disarmament, Demobilization and Reintegration (DDR) programming to generate lessons learned for improving future programming for former underage combatants and at-risk youth.

This study highlights the voices of individuals currently affected by the Lord’s Resistance Army to detail the extensive and systematic devastation felt specifically by formerly abducted children and their communities in northeastern Democratic Republic of the Congo. Respondents stressed that the international community must assist with providing essential services through long-term engagement, including life-saving health services; improving water and sanitation access; and providing psychosocial and educational interventions to formerly abducted children and adults. While these communities are facing emergency-level challenges now, the need for solutions that will last into the future.

The scale and cadence of crises that demand international humanitarian response is increasing. The cumulative frequency and severity of climate change on large populations, rapid and unsustainable urbanization, decreasing biodiversity, and the impending realities of resource scarcities and the armed conflicts they might catalyze are only some of the challenges that loom ahead. It is ironic that while human civilization today possesses the most advanced technologies, global prosperity, and abundance, we face the greatest absolute number of people lacking access to clean water, food, shelter, and basic healthcare.

Treatment of non-communicable diseases such as cancer in refugees is neglected in low-income and middle-income countries, but is of increasing importance because the number of refugees is growing. The UNHCR, through exceptional care committees (ECCs), has developed standard operating procedures to address expensive medical treatment for refugees in host countries, to decide on eligibility and amount of payment. We present data from funding applications for cancer treatments for refugees in Jordan between 2010 and 2012, and in Syria between 2009 and 2011. Cancer in refugees causes a substantial burden on the health systems of the host countries. Recommendations to improve prevention and treatment include improvement of health systems through standard operating procedures and innovative financing schemes, balance of primary and emergency care with expensive referral care, development of electronic cancer registries, and securement of sustainable funding sources. Analysis of cancer care in low-income refugee settings, particularly in sub-Saharan Africa, is needed to inform future responses.

Communities in South Sudan have endured decades of conflict. Protracted conflict exacerbated reproductive health disparities and gender inequities. This study, conducted prior to the country’s 2011 independence, aimed to assess attitudes toward gender inequitable norms related to sexual relationships and reproductive health and the effects of sex, age, and education on these attitudes.

This project rigorously evaluated programming that addresses stigma against survivors. In this program evaluation, the Harvard Humanitarian Initiative’s Women in War program worked with the Congolese NGO, Centre d’Assistance Medico-Psychosociale (CAMPS) to assess which parts of their programming are most effective and how to continue to improve services related to reducing stigma. 

Since 1988, more than 2.5 billion children have been immunized against polio through programs in more than 200 countries involving some 20 million volunteers and an international investment of over US$8 billion. By 2006, polio cases around the world had decreased by over 99% and remained endemic in only four countries – Afghanistan, India, Nigeria and Pakistan – with a handful of other countries reporting sporadic cases. In 2008, the World Health Assembly called for the formulation of a concerted global strategy to eradicate polio from these remaining countries and create a polio-free world. This led to the Global Polio Eradication Initiative (GPEI) Strategic Plan 2010 – 2012, an aggressive action- and time-specific initiative to end polio transmission in the remaining areas where this persisted.

Studies report that between 6 per cent and 29 per cent of survivors of sexual violence in eastern Democratic Republic of the Congo (DRC) are rejected by their families and communities. This research project was designed to provide insights into survivors' experiences of stigmatisation and rejection. Surveys were conducted with 310 women as they sought psychosocial services in eastern DRC. In total, 44.3 per cent of women reported suffering rejection after sexual violence. The majority of women felt that their status in the household (58.0 per cent) and community (54.9 per cent) diminished after rape. The odds of rejection were greater among women reporting ongoing displacement, pregnancy owing to sexual violence, worsening family relations, and diminished community status. This work highlights the extremely high levels of loss associated with the war in eastern DRC, particularly among survivors of sexual violence. The rejection of a survivor of rape has concrete and devastating psychosocial consequences.