Social determinants of health in countries in conflict - What is GIS ...

52 Social determinants of health in countries in conflict
Women’s centres provide female victims of sexual violence with resources, support
and referral. Women share their individual stories, recognizing that where rape is
used as a weapon of war the experience is a collective one. By providing a safe space
for women to build trust, share experiences and rest from the tasks of daily survival,
such centres provide a source of empowerment to women [118]. In response to sexual
violence, IDPs called for: increased prevention and response to sexual and gender-based
violence; community-based policing based on dialogue with IDPs; health facilities that
offer privacy to women, and are able to treat them for fistula; and birth attendants and
community leaders trained to deal with the health and emotional needs of survivors of
sexual violence [119,120].
Women in Darfur are in danger of being raped while collecting firewood, both for
their own use or to sell. Solutions attempted included firewood patrols and the use of
efficient stoves and/or alternative fuels. Firewood patrols could protect women outside
the camps, however, they have often been ineffective as a result of the difficulty of
communication between the women and the civilian police or troops assigned to protect
them. The use of fuel efficient stoves and/or alternative fuels would obviate the need for
women to go outside the camp to collect firewood [24].
7.3 Cooperation to improve health care and access to
care
Collaboration between the many actors responsible for health care in crisis is
essential. The WHO Regional Office for the Eastern Mediterranean has been working
in conflict-affected countries to ensure the continuation of basic health services, in
cooperation with other partners, and undertakes a major coordinating role in the health
sector. In a conflict setting it is essential to support the role of the ministries of health, and
to support their future role as a regulatory agency, as well as a provider of basic health
services. Often, ministries of health have been fatally weakened and, by default, much
care is provided by voluntary, non-profit organizations. Ministries of health have a vital
role to play in regulating and managing the activities of nongovernmental organizations,
rationalizing the provision over all geographic areas and ensuring equitable access.
In Afghanistan, the seriously under-resourced Ministry of Public Health embarked
on a programme to contract out a Basic Package of Health Services to nongovernmental
organizations, which were already providing most of the health care in the country.
Although these services, which may be provided through existing ministry facilities,
resulted in a positive improvement in access to basic health services, the short-term
contracts fostered a short-term “quick fix” view of the task. Such contracts need
to be carefully managed and monitored in the interests of long-term sustainability.
Strengthening the essential management and oversight functions of the Ministry will
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