IRIN headlines - Tues 3/4/2008

4 - GLOBAL: Africa worst affected by shortage of health workers

KAMPALA, 4 March (IRIN) - Poor working conditions and inadequate pay have driven away health professionals from developing countries, thereby undermining medical services, a conference to address the global shortage has noted.

"For too long we have watched this crisis unfold in front of our eyes - this is unacceptable," Francis Omaswa, head of the Global Health Workforce Alliance, told the first Global Forum on Human Resources for Health that opened in the Ugandan capital, Kampala, on 3 March.

The deficit, the conference heard, had reached four million doctors, nurses, midwives and other healthcare professionals. Of these, one million are needed in Africa alone.

Some 57 countries, especially in Africa and Asia, are particularly affected and unable to effectively provide access to essential health services, prevention and information campaigns, drug distribution and other life-saving interventions such as immunisation, maternity care and treatment of several diseases.

"The world is looking to us and encouraging us to be ambitious in our goals, open to innovation, and determined to implement solutions," Omaswa told the conference. "We want political will of the highest level [to] translate into concrete action."

Uganda's health minister, Stephen Malinga, said his country had lost more than 500 doctors and thousands of nurses, of whom 200 were working in South Africa.

"Our neighbours have also taken them ... they are paid in dollars in Sudan and others with indispensable expertise have gone to Rwanda," he said.

Those who opt to stay in Uganda, Malinga explained, were earning so little they could often not afford to pay the rent. Uganda thus had one doctor for 100,000 patients.

The Global Health Workforce Alliance said one in four doctors trained in Africa was working in western industrialised countries.

"They seek better employment and quality of life. Income is an important motivation for migration [as well as] better working conditions, career opportunities and more job satisfaction," Sigrun Mogedal, one of the conference organisers, said.

"Sub-Saharan Africa faces the greatest challenge and proportionately, is the most heavily affected region of the world. One million health workers are needed to bridge the gap in this region," the alliance noted. "While it has 11 percent of the world population and 24 percent of the global burden of disease, it has only 3 percent of the world's health workers."

The conference aims to produce a 10-year global action plan to deal with the problem, which would require US$3.3 billion per year to train 1.8 million health workers in Africa for the next eight years. Another $27 billion would be required to pay them to stay.

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5 - KENYA: Sexual violence continues in IDP camps

NAKURU, 4 March (IRIN) - Residents in a camp for displaced persons in Nakuru, in Rift Valley Province, western Kenya, were deeply shocked when a gang of men attacked and sexually assaulted five boys, but the health officials dealing with sexual violence during the recent political upheaval have had to become immune.

"Since the violence started we are seeing similar numbers of cases to what we would normally see over the same timespan, but there is one major difference: 90 percent of the cases we are seeing since the political crisis began are gang rapes," said Lucy Kiama, head of the Gender Violence Recovery Centre at the Nairobi Women's Hospital. "The gangs range from groups of two men to as many as eleven."

An estimated 300 women have been treated for rape since the year began, many of them women and girls who had travelled from Rift Valley Province to the capital, Nairobi, often a journey of hundreds of kilometres that could take many hours by bus.

The women usually arrive too late for post-exposure prophylaxis, which can prevent HIV infection following exposure, but receive post-trauma counselling and treatment for other injuries. For a few weeks, roadblocks on the highways linking Nairobi to the Rift Valley also prevented many from travelling to hospitals for treatment.

Kiama said she could not rule out the possibility that these gang rapes were planned and ethnically motivated, but said they were also likely crimes of opportunity carried out by men taking advantage of the lack of proper security.

According to Jeanne Ward, an international consultant on gender-based violence (GBV), the spike in gang rape in a situation as violent as Kenya was at the beginning of the year was not unusual. "Most violence is carried out in gangs during times when there is a breakdown of law and order, so gang rape is merely a replication of the other kinds of violence using the same methods," she said.

"There are always pre-disposing factors with the kind of sexual violence we're seeing in the camps, such as a lack of respect for human rights, a sense among perpetrators that it is okay to do it," Ward said.

"However, there are also exacerbating factors in play, such as alcohol abuse, close camp quarters, men whose traditional roles have suddenly changed, limited security - these also create an environment where rape can become common. The basic fact is that they know they are able to carry these crimes out with impunity," she added.

"Legal redress may be available in urban centres like Nairobi, Mombasa [Kenya's port city] or Nakuru, but in the rural areas there is no way women have access to legal services."

Another common thread in many IDP camps is the sexual coercion and exploitation of girls and women by people in positions of responsibility or power.

An interagency assessment of GBV reported that in the early stages of camp development at the Nakuru showgrounds (an agricultural exhibition facility), community members reportedly took girls from the camp to serve as domestic help, likely increasing their risk of sexual exploitation.

The same report said women had stated that men in the community around the camp set up on the showgrounds at Eldoret, another town in Rift Valley Province, were inducing girls to leave the camp with the promise that they would "eat something sweet".

"In some cases, team leaders responsible for handing out food have been making girls give them sex in exchange for the food they are actually entitled to," Kiama said. "So even when the sex is consensual, it is often survival sex - the girls and women don't feel they have a choice."

Psychological first aid not sufficient

She noted that many women appeared to be in a state of shock. "The kind of trauma we are seeing is different; not only are these women raped, but many have lost loved ones, land and property, and suddenly find themselves in the strange surroundings of an IDP [internally displaced persons] camp.

"What we are giving them is a kind of psychological first aid, but handling these cases will necessitate long-term care, but as many of the IDPs are still moving from place to place, this will prove difficult," Kiama said. "One woman came here so traumatised she did not speak for several days - she needed speech therapy; others are suicidal, and others want revenge."

Besides the physical health risks of these crimes, such as HIV and unwanted pregnancies, the long-term psychological health of women who had been attacked was also at risk. "There is still so much IDP movement, and we have no way of tracing these women to provide them with the longer-term counselling they will need," she added. "These are going to be the long-term consequences of this violence."

Improving protection

The continued rape and sexual exploitation has highlighted the need for better protection of women and girls in the camps. In response, several organisations, under the umbrella of the United Nations Protection Cluster, have come together to ensure that new camps are constructed with separate toilets for men and women, sufficient lighting and more organised sleeping quarters.

Kenya's Red Cross Society has been running seminars on GBV. "We were taught about the Inter-Agency Standing Committee [a mechanism for coordinating humanitarian assistance by key UN and non-UN partners] guidelines [on gender-based violence in emergencies]," said John Mbugua, coordinator of health service at the Nakuru IDP camps, whose team also attended.

"After the seminars we formed groups where we could start spreading the message and see how we could protect people." The guidelines outline preventive and curative measures for dealing with GBV in IDP camps, including providing activities for bored young people such as sports, and income-generating projects to keep older men and women busy and able to support their families.

Other initiatives include sensitising camp residents to the inhumanity and risks of sexual violence, strengthening the legal system, and ensuring that the police and other staff handling sexual assault cases were properly trained.

********Now that President Mwai Kibaki and his erstwhile rival, Raila Odinga, have signed a peace agreement, it is hoped that the IDP camps will be disbanded and Kenya's 600,000 displaced people will return to their homes.

However, camp officials in Nakuru said so far few people had left the camp and many would remain until the government could guarantee their safety or provide them with alternative homes.

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