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Greater need, fewer resources: ensuring adequate health care for women during armed conflict

03-03-2009 Interview

In areas ravaged by conflict, women’s specific health needs are often neglected and ignored. But women are particularly at risk when the bombs are falling. On the occasion of International Women's Day, Nadine Puechguirbal, the ICRC's women and war adviser, explains the challenges that women face in war and why they need better access to health care.

What are the most serious health problems confronting women during an armed conflict?  

This is problematic for several reasons. First, pregnant and nursing women often face life-threatening medical emergencies and require immediate medical assistance right where they are. Second, women may be less able to move around during a conflict. This may be on account of the threat of violence, but it may also result from cultural restrictions that prohibit women from travelling without a male relative. That restriction becomes even more onerous when the men of the family are not available because they are fighting, have fled the area, or are dead or injured. The loss of the primary breadwinner also means that women often find themselves with little or no money. As a result, war may place women who have long relied on local health practitioners in a situation where adequate health care is inaccessible, and where they would be unable to pay for it even if they could reach it.

Conflict also increases a woman’s risk of becoming a victim of sexual violence, especially if she is alone, very young, or the head of her household and therefore obliged to take up tasks that would usually be taken care of by a man in the family. Rape can have very serious consequences for woman’s psychological and physical health, and these may include sexually transmitted diseases or reproductive health problems. In such cases, it is extremely important that the victim of sexual violence receive medical attention as soon as possible to treat her injuries and to prevent sexually transmitted infections, including HIV. Once she has received treatment for her physical symptoms, she will need psychosocial services to help her deal with her psychological trauma and to mediate between her, her family, and the community, in order to prevent her being stigmatized or rejected.

What specific reproductive health needs do women have during armed conflict?  

Women require uninterrupted access to a functioning health-care system, in large part because of the risk of death, illness, and disability associated with pregnancy and childbirth, particularly in a poor country. Armed conflict can disrupt already fragile health-care systems and can create intolerable circumstances for pregnant women and nursing mothers. They need full and immediate access to antenatal and postnatal care, together with medical assistance during childbirth. In addition to safe motherhood, women's reproductive health needs include protection from sexual violence and the prevention and treatment of sexually transmitted infections.
Every year, more than half a million women die as a result of pregnancy or childbirth complications, including about 70,000 girls and young women aged 15 to 19. Incidentally, among the ten countries with the highest lifetime risk of maternal death, most are at war today or are in a post-conflict situation, such as Afghanistan, Sierra Leone, Chad, Angola, Liberia, Somalia and the Democratic Republic of the Congo.
Conflict can further weaken a woman’s reproductive health by limiting the availability of proper nutrition for pregnant and nursing women and by disrupting national immunization campaigns.

What effect does displacement have on these health problems?  

Displacement can make it even harder for women to get quality health care. For example, even if women normally have access to good health-care services, they may be forced to flee, depriving the m of access to contraception and hence leading to a higher incidence of pregnancy and a greater need for reproductive health services. Displacement can also deprive women of their support systems and make it harder for them to share knowledge about childcare and basic health and hygiene. That can affect the health of the entire family. Separation from their social network can also cause women a great deal of stress and anxiety.
 What specific health problems do women encounter in detention?  
Women in detention have specific medical needs, which differ from those of men. They may be more vulnerable to health problems because of their reproductive systems – menstruation heightens the risk of anaemia and mineral deficiencies, for example. Women deprived of their freedom also require regular medical check-ups, medicines, and treatment, including gynaecological, obstetric, antenatal and postnatal care. This can become a problem if non-medical staff control access to treatment, or a shortage of resources limits the availability of quality medical care. Both mothers and infants are vulnerable in the days and weeks after birth. This is a critical time, during which post-natal visits, proper hygiene, and counselling about the danger signs of maternal and newborn health may mean the difference between life and death.

See also: Health in prison: looking after women in a man’s world  


What is the ICRC doing about women's health in armed conflicts?  

The ICRC trains local nurses, doctors, hospital staff, female community health workers and traditional birth attendants/midwives, so they can treat female patients effectively, identify victims of sexual violence and refer them to appropriate medical services. This is the case in Liberia, for example.

The ICRC also trains community volunteers to counsel victims of rape. For example, the ICRC supports the Maisons d'Écoute in the Democratic Republic of the Congo. These centres provide a safe place for victims of rape to talk about their experiences and receive the support they need in order to re-integrate into their communities.

Where women have no appropriate health services because of armed conflict, the ICRC approaches the authorities with a view to finding a solution. The ICRC also supports the building and repair of medical facilities, such as hospitals, health centres and physical rehabilitation centres, taking the specific needs of women and children into account. Furthermore, the ICRC supports emergency surgical, obstetric, and paediatric care, which can include providing equipment, medical supplies and training.


See also : Press release

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