Impact of Collective Violence on human health & well-being

1. Impact of Collective Violence on human health & well-being Course 3B03 - Session 2 16 January 2006 Vic Neufeld & Alex Mihailovic

2. Session Plan • Introductions and framework • [Exercise 1] • Uganda case study • [Exercise 2--small groups] • BREAK • Reports back from groups • Synthesis / summary • Your questions and ideas

3. A simple framework • WHAT (what types of health impacts) • WHO (who’s health is affected) • WHEN (when do these effects happen) • WHY (why do the effects happen, when they do?) And if we have time … • WHAT COULD WE DO?

4. Exercise 1 1. How would you measure the health effects of conflict (collective violence)? - list up to 3 types of measurement - pick ONE that you think is the most useful and important 2. Who is most affected? - identify ONE group whose health (in your view) is most affected.

5. WHAT effects: • DIRECT effects (of violence) • Mortality • Morbidity • Disability • INDIRECT effects • Mortality • Morbidity • Disability

6. WHAT effects (continued) • Health System effects • Other “systemic” effects - diversion of resources - exacerbating the “circle of violence” - environmental impacts

7. WHO is affected? • Countries in conflict - combatants - non-combatants (women, children) • Neighboring countries • Global community

8. WHEN do effects occur? • During the conflict • After the conflict

9. WHY do health effects happen, when they do? • “Root” causes of conflict--and ill-health - the role of poverty • Perpetuating causes of conflict--and ill-health - the “conflict trap”

14. Uganda: 20 years of neglected conflict • Since 1986, the Lord’s Resistance Army has kidnapped an estimated 30,000 children in Northern Uganda • Supported by the Sudanese government • Goals to create an “Acholi Nation” while terrorizing the Acholi population solely • 1.4 million people displaced locally (94% of the local population) • Core of only 200 adults…the remainder children

15. The Internally Displaced: The Forgotten Refugees • 24 million worldwide….dependent on own government for support/provisions • No where to turn for protection, unlawful restriction of movement by own forces • Crowded, poor sanitation, no education, no medical facilities, no income opportunities, sexual exploitation • Often very long term (decades)

17. The Challenges of the Internally Displaced: • Socio-economic challenges: • Food insecurity • Health threats • Alternative Income availability • Education Availability • Domestic Violence/Early marriage • Physical Challenges: • Sexual Violence • Risk of Abduction • Physical Attacks (UPDF security of camps?? EtOH use)

19. Youth the most susceptible…. • increased SES responsibility (orphans, able bodied…) • UPDF/LRA specifically target youth • Unrecognized as a vulnerable category with distinct needs by government and NGOs

20. Case Study: A Typical Family in Northern Uganda • Family of 6 currently living in Oktopi camp west of Gulu • 9 years living on the camp, all in one small hut • Father killed in ambush • Mother and 4 children aged 15, 13, 9 and 7 • Oldest daughter prostitute to UPDF for money • Two youngest commute nightly to Gulu due to unprotected area of camp • Mother has had large growth in abdomen for 9 years

21. Determinants of Family’s Health?? • War/Violence • Sanitation/Water • Food Scarcity • Sexual Exposure/HIV/AIDS/Early pregnancy • Risk of Abductions/Attack • Exposure to Roadways/Injury while commuting • Exposure to Malaria • Inability to Reach Medical Care for Incidental Ailments • Lack of Education….. Autonomy, preventative measures, self-protection • Mental Illness/Depression/Suicide/ PTSD • Alcoholism in children

23. Social Determinants of Health….. • Education • Food Security • Available Income • Sanitation/Water Availability • Personal Security/Autonomy • Family Planning/Sexual Health • Access to Medical Services

24. The unmeasured effects of war on health: “collateral damage” • Malnutrition • Sexual Exposure/Assault : STDs/HIV, back street abortions, pregnancy, stigma • Mental Illness/Depression/Suicide • Infectious Disease Spread: Cholera/Hepatitis/TB/malaria • Violence/Injury/Cross-fire • Alcohol and Drugs • Lack of Health Care Services

26. Exercise 2 Based on its new International Policy Statement, the Canadian government has announced that it will invest $10 million in Uganda over the next 5 years; the goal is to reduce the negative health effects of Uganda’s on-going civil conflict. You have been recruited to serve as a project assistant on a Canadian team, to design this 5-year program.

27. Exercise 2 (continued) • What ONE health effect (indicator, outcome) that you think could be improved over 5 years? • What is the key “intervention” that you would recommend in order to achieve the above outcome? • What do you think the main challenge (barrier, obstacle) might be in the project?

28. WHAT COULD WE DO? • As individuals? • As a university? • As a country?

29. Success Stories: From Ideas to Change INDIVIDUALS WHO COULD…..

30. Our goals, or “BIG IDEAS”, can be simplified to three major objectives: First, exposing the effects of a 20 year-long war on the children of Northern Uganda by telling their stories in a relevant way. Secondly, empowering the individual viewer towards action (volunteering, donations, the bracelet campaign, political pressure, etc.).  Finally, providing aid to the “invisible children” on the ground, in Uganda.

32. GULUWALK DAY DOLLARS TO MAKE AN IMPACT IN NORTHERN UGANDA On October 22, 2005 over 15,000 people in 38 cities worldwide took the first step towards telling the story of the children of northern Uganda. GuluWalk Day attracted people of all nationality, color, race and religion in a global show of support for the innocent victims of the world’s most ignored humanitarian emergency. Through pledges, donations, events, and the dedication of so many volunteers, the 2005 GuluWalk Day raised close to $40,000. MONEY TO GO TOWARDS….AMREF Canada, CPAR, Oxfam International, Quaker Peace UK, War Child Canada, World Vision Canada, World Vision USA GuluWalk was initiated by Adrian Bradbury and Kieran Hayward when they embarked on a 31-day ‘night commute’ in support of the children of northern Uganda. Every evening in July of 2005, Bradbury and Hayward walked 12.5 km into downtown Toronto to sleep in front of city hall. After about fours hours sleep they made the trek home at sunrise, all while continuing to work full-time and attempting to maintain their usual daily routine.

33. About Act for Stolen Children in Northern Uganda • to act as a catalyst for change by providing a platform for collaboration among media, policy and research advocates, and civil society, to facilitate increased awareness of and to increase capacity to respond to the humanitarian crisis in northern Uganda. • AWARENESS THROUGH MEDIA INITIATIVES • RESOLUATIONS THROUGH POLICY INITIATIVES AIMED AT ENDING THE CONFLICT • CRITICAL MASS ENGAGEMENT THROUGH GRASSROOTS MOBILIZATION (I.E. GULUWALK)

34. BEADS FOR LIFE…. 350 now women feeding and educating their families

35. INJURY CONTROL CENTER-UGANDA • GULU PEACE BUILDING INITIATIVE: • MILTION MUTTO MSc • Project started as Master’s thesis now funded by WHO and CNIS • Curriculum now in over 50 primary schools in Gulu teaching kids about tolerance, non-violent conflict resolution and peace building skills in the community

36. Project started by Kawesa and Chameleon and Friends. This is a registered non-profit making Hope Initiative for the people in Gulu. • Local Ugandan Celebrities using their podium and public figures to pressure the government to take ownership for Gulu By Julie Erusa I hope you all remember the 3 Hours Awa

37. The Butterfly Peace Garden opened its gates on September 11, 1996, and since then it has been bringing together artists, peace-workers, ritual healers and counselors with children from Batticaloa's various ethnic and religious groups - Tamil, Muslim, Hindu, Christian - in an oasis of peace amid the devastation of a civil war that has raged for two decades. The children of the Butterfly Peace Garden are a remarkable tribe of magicians who provide living testimony of the power of play as a tool in the lost art of making peace. BUTTERFLY PEACE GARDEN: SRI LANKA

38. War Child International is a network of independent organizations, working across the world to help children affected by war. • War Child was founded upon a fundamental goal: to advance the cause of peace through investing hope in the lives of children caught up in the horrors of war. They provide both psychosocial aid as well as vocational training. Both organizations have made peace-building an integral part of their projects.

39. AREAS TO AFFECT CHANGE… • ADVOCACY: be a voice for those who don’t have one, make governments accountable • POLICY: The Ugandan National Youth Policy and the National Displacement Policy on IDPs both exist but big gap between policy and reality • FUNDING: NGOs without provisions…increase aid so people have an option • CAPACITY BUILDING: increase grassroots collaboration for sustainable, self-assessed solutions • BE CREATIVE: think of ways to help