Soon after visiting war-torn Myanmar, I had a chance to closely interact with the refugee population of Nakivale, Uganda. The Nakivale refugee settlement, which covers an area of 185sq km, is in the southwestern part of the land locked East African country, and hosts refugees from all the conflict-ridden neighbouring countries.
The purpose of my visit was to assess the progress made in the IPPF-SPRINT (International Planned Parenthood Federation's humanitarian assistance programme) intervention to provide key sexual and reproductive health (SRH) services and to hear from the refugees at ground zero. As soon as I walked into the health camps and clinics, I was struck by how essential these interventions remain for the refugee population.
A chat with the health workers opened a can of worms. Most of the refugees who have escaped conflict situations and civil wars in Rwanda, the Democratic Republic of Congo, South Sudan, Burundi and Ethiopia have barely heard about HIV or family planning. Tackling the ever growing problem of HIV/AIDS in refugee settlements gets worse with prevalent religious and cultural beliefs. Dr Joy, who is a senior health worker, says, "In order to tackle HIV and to promote family planning, we need the buy-in of religious leaders, as most of the displaced population here are averse to it. In fact, they are so ignorant about HIV that we need to counsel them to make them realise the dangers of the infection. We tell them and their partners about the lifestyle changes that they need to adopt and also prepare them with knowledge to tackle any pregnancies during the infection period so that we can avoid mother-to-child transmission."
"Violence against women is a commonly practiced method of subjugation during civil unrest and the refugees have heart-breaking stories to share."
The more I probed and talked to refugees, the scarier their stories became. Recent population-based surveys demonstrate that sexual and gender-based violence (SGBV) is common in the East and Southern Africa region and cuts across nationality, ethnicity, and socioeconomic status. SGBV affects a large proportion of women across the region.
In many cases the perpetrator is known to the survivor, and intimate partners (such as husbands and boyfriends) are frequently identified as the criminals in question. Other data indicate that girls in the region frequently experience coerced sexual initiation which is often viewed as a normal part of relationships.
Sexual violence is a public health problem and women and girls who suffer it are more likely to be infected with HIV, other sexually transmitted infections (STIs), and experience other reproductive health problems.
Jenna (name changed) is a 39-year-old Burundian refugee who had crossed over to Uganda two months ago following civil unrest in Burundi. Tears roll down her eyes, as she starts talking about her escape from Burundi. She was 36 weeks pregnant when she was brutally gangraped by goons at her village. After violating her, they killed her husband. As soon as she regained consciousness, she picked up her 9-year-old son and ran for her life. After a gruelling trek of three days she managed to reach Nakivale. She was soon attended to by health workers at the IPPF-SPRINT clinic, but unfortunately her unborn child could not be saved. Jenna breaks down as she talks about her 36-week pregnancy. She has been checked for HIV and STIs and also screened for cervical cancer. Although she is healing physically, mentally she is far from recovered. Dr Joy, who has been treating her said, "We are counselling her, but the loss of her husband and the rape still give her nightmares. Her son, however, has started going to school," adding that she hopes Jenna too will be able to resume a normal life soon.
Violence against women is a commonly practiced method of subjugation during civil unrest and the refugees have heart-breaking stories to share. But among the tales of despair, hopelessness and darkness, I got a chance to meet 20-year-old Anunciata. This newly married woman not only got an IUD implanted, but has also involved her husband in the decision, which is rare in this settlement owing to the patriarchal setting in the community. "I have seen my mothers, sisters suffer. The IUD will help me to decide when I am prepared to welcome a child," she smiles.
SGBV is a curse, and most African refugee households have some bone-chilling experiences to share. With no land to go back to (as most fear execution in the most brutal forms on returning), these refugees have created a community of their own, welcoming new members into their fold with open arms.