Through the Eye of a Needle

My mate, a career bureacrat goes apoplectic. He slams his gin and tonic down on the marble tabletop. “WHAT! You mean the Red Cross gives these… these… junkies free needles so they can fill themselves full of heroin? Well that’s it. You’ve just lost my respect”.

It’s true. The Red Cross gives injecting drug users free needles so that they can continue their habit.

Safely.

I spent much of yesterday in small town called Slutsk in mid-Belarus to see just why.

Let’s be clear. Drugs are – according to the book and film Trainspottting – great fun but they destroy lives. Nikolay and Irina are two cases in point. All their money goes on “Semechki” as the home-made poppy-seed paste is called. Their families have long since kicked them out. They work, they live, just to use. Their sober hours are spent wishing they’d never started, till the rats start scratching in their brains and no other thought but “shot” is entertained. Then the release, the bliss, the love. Till it wears off and the hate-it-need-it-love-it” cycle starts again.

But amazingly, Nikolay and Irina have purpose in their lives now. Every day they come to a shabby apartment on the edge of Slutsk (pop 70,000, levelled in the second world war), under the shadow of two massive chimney stacks, and start their work.

Each has 40 clients who inject several times a day. Nikolay and Irina bring the used needles (each with a residue of narcotics in them, which without a special agreement between the Red Cross and the police could carry a jail term), they leave the needles for destruction and go out, back to the alleys and tower blocks where their peers are waiting.

“No one I work with uses a dirty needle now, but we all used to”, says Nikolay, ansting to get out the door and bang up. “We know what AIDS can do and we don’t want to catch it.”

That’s the beauty of harm reduction. It’s more than just needles, it’s swabs, condoms, vitamins, special chocolate bars that strengthen the blood, but essentially it’s about needles. If someone’s going to use no power of persuasion will work. An infected needle injects the virus straight and deep into another person who can pass it on and on and on through sex, drugs and rock and roll. Well, ok, not rock and roll, but sex and drugs for sure.

One truly impressive feature of the program is the volunteer manager. She’s about 64, short, silver-haired and looks just like any of our mums. And that’s the secret. She is someone’s mum. She sees the harm drug injection does to her community and she will do what it takes to limit its spread.

Nikolay and Irina know the streets, know the users, know the risks. They are trusted in a way no police, partner, parent or pastor could ever be. That’s why they go to schools and tell kids what life as a user is like. They don’t say “just say no”, they say “this is how it is, you choose”. Irina gives a wistful sigh and says “if only this programme had existed 20 years ago I wouldn’t be in the mess I'm in now”.

But I’m not naïve enough to think that this will persuade my bureaucratic buddy. So here’s a list, a cold, impassionate list, as to why harm reduction is the only game in town, why it works, why we do it.

The first seven points are my own, from personal observation, and then follow the humanitarian and legal/human rights arguments.

1. “Let them die” is not an option for the Red Cross
2. It works. Everywhere that needle exchange has been tried, it works. Where reducing the supply and locking up users (so-called social evils programmes) are tried, the HIV rate, the crime rate, the usage rate all increase. See chapter 5 in this report.
3. It puts health workers in contact with a naturally secretive community
4. Contact between health workers and users makes usage safer and may result in users seeking to come off drugs
5. It helps users feel useful, wanted, trusted.
6. It keeps needles off the pavement
7. The Red Cross emblem is not only for the battlefield or prison. Everyone can avail of its protection, its neutrality, a non-judgemental, safe haven
8. Currently, it is estimated that there are more than 10 million people globally who inject drugs. Of these, 2-3 million people are estimated to be HIV-positive. HIV can rapidly spread through drug using populations and can stabilize at high prevalence rates. Studies indicate that in the absence of preventive measures the prevalence rate can rise up to 40 per cent or more within 1-2 years of introduction of HIV into a community.

9. Transmission of HIV also occurs through sexual contact both between IDUs (injecting drug users) and with other sexual partners, including through sex work, facilitating the transmission of HIV to their children and into the general community.
10. The right of everyone to the enjoyment of the highest attainable standard of physical and mental health, is reflected in Article 25(1) of the 1948 Universal Declaration of Human Rights; Article 12 of the 1966 International Covenant on Economic, Social and Cultural Rights; Article 24 of the 1989 Convention on the Rights of the Child; and Article 12 of the 1981 Convention on the Elimination of All Forms of Discrimination against Women
11. The right to non-discrimination is enshrined in Article 5(e)(iv) of the 1965 International Convention on the Elimination of All Forms of Racial Discrimination. This by definition applies to people who inject drugs, including HIV-positive IDUs.
12. In May 2000, the UN Committee on Economic, Social and Cultural Rights adopted a general comment on the right to health which proscribes, any discrimination in access to healthcare
13. In the Declaration of Commitment, unanimously accepted at the 26th UN General Assembly Special Session on HIV/AIDS, 2001, states made specific commitments relevant to IDUs: By 2005, ensure that a wide range of prevention programmes is available in all countries, particularly the most affected countries, including expanded access to essential commodities, including male and female condoms and sterile injecting equipment. By 2003, all States will have eliminated any laws, policies and practices that discriminate against people living with HIV/AIDS and other highly vulnerable groups.
14. The above outlines the legal basis for states to respect, protect and fulfil, all IDUs’ human rights. This includes comprehensive harm reduction programmes

15. In keeping with the fundamental principles and the role of the Red Cross and Red Crescent in protecting and promoting the health of the most vulnerable populations, IDUs as a vulnerable population merit the strong and privileged voice of social conscience. The Red Cross can lobby governments to fulfil IDUs’ rights to the enjoyment of the highest attainable standard of physical and mental health.

Excuse me, I have to buy my friend a large G and T.

/JL

The Child Brides of Yemen

Immediately prior to the massive earthquake that hit Haiti on 12th of January, Head Down Eyes Open had started to focus on Yemen, a country that has found itself bang slap in the middle of the war on terror and the struggle for hearts and minds in the Middle East. One month on, Haiti has practically consumed our every waking hour. Both myself and Joe were dispatched to Haiti and hence the blog has been inundated with stories and posts from the striken region. Now, though Haiti undoubteldy still struggles, there are signs of recovery and the long road ahead is being chartered. We would like to return to Yemen before resuming the normal mish mash of musings from the margins. We would also like to take the opportunity to thank all of you who voted for the HDEO blog (a mere one year old this month) to be nominated for an Irish Blog Award. We really appreciate it and will continue as best we can to knock out more and better posts (and now tweets too) in the years ahead.

"I'd rather die than go back to him" - the plight of Aisha.

It was every little girl’s dream - she was to get a new dress, jewellery, sweets and a party for all her friends. (Photo, left, Aisha was 10 years old when she was married. Today, two years later, she is still hoping for a divorce).

What 10-year-old Aisha (not her real name) did not know was that after the wedding party she would have to leave school, move to a village far from her parents’ home, cook and clean all day, and have sex with her older husband.

“He took out a special sheet and laid me down. After it, I started bleeding. It was so painful that I was crying and shouting, and since then I have seen him as death.” 

After a week of fighting off her husband every night, Aisha’s father was called. He had received 200,000 Yemeni Rial (US$1,000) for his daughter in `shart’, a Yemeni dowry, which he could not pay back. 

“My Dad made a cup of tea and put some pills in it, which he gave me. The pills made me feel dizzy,” said Aisha. “My Dad told me to sleep with my husband, or he would kill me, but I refused.” 

Instead Aisha broke a glass bottle over her head in a desperate attempt to stay awake. “My Dad hit me badly. I was bleeding from my mouth and nose,” she said. 

After spending a few months in her husband’s home, where she said he would regularly drug her and beat her, Aisha managed to escape. Now, two years later, aged 12, she is unable to divorce him. 

No Child Protection

A bill passed in parliament in February 2009 setting the minimum age for marriage at 17 was rejected by the Islamic Sharia Codification Committee which said it was un-Islamic, according to local women’s rights organizations. 

So, for now, there is no law protecting children against early marriages in Yemen. 

”I don’t call it marriage, but rape,” said Shada Mohammed Nasser, a lawyer at the High Court in Sanaa. She has represented several child bride divorce cases in court, but admits she has lost most of them. Only a handful of child brides have successfully managed to divorce their husbands. 

“The law on marriage stipulates that a girl should not sleep with her husband until she is mature,” said Nasser, which according to the law is the age of 15. “But the law is not enforced.” 

A girl can be married at just nine, but cannot legally seek a divorce until she is 15 or older.

Just under half of Yemeni girls, 48 percent, are married before they turn 18, according to the Washington DC-based International Centre for Research on Women. This is classified as underage, according to the UN Convention on the Rights of the Child.

Yemen has signed the Convention on the Rights of the Child and the Convention on the Elimination of Discrimination against Women (CEDAW).

"The greatest problem facing Yemeni women today is child marriages," said Wafa Ahmad Ali from the Yemeni Women’s Union, which has long campaigned for a raise in the minimum age of marriage.

"These early marriages rob the girl of the right to a normal childhood and education. The girls are forced to have children before their bodies are fully grown instead of going to school and playing with other children," she said. 

While politicians wrangle in parliament, young girls like Aisha are caught up in a violent world of adults which they are too young to understand, let alone escape. 

”These are our traditions,” said Aisha’s father. However, he admits that Aisha might have been too young for marriage. Though she now has a lawyer, Aisha cannot divorce until the two men who control her (her father and husband) agree on how much money each will receive. (Photo, right, Shada Mohammed Nasser, a lawyer at the High Court in Sanaa, talking to the parents of a child bride outside court.)

What Aisha wants is clear: “I’d rather die than go back to him,” she said, wiping a tear from behind her veil.

This post and photos was based on an original report with our friends in IRIN.

/PC

Haiti, one month on: Transforming tragedy into opportunity

The scale of the disaster left even veteran disaster responders stunned, people who had seen first hand the savagery of nature elsewhere, in the Americas, in sub-Saharan Africa and in countries like Iran, Indonesia, Pakistan and China. The magnitude-7 earthquake – the biggest to hit Haiti for 200 years – may have left as many as 200,000 people dead and up to a million homeless. But figures cannot express what happened. The capital, Port-au-Prince, and outlying areas lay in ruin.

No one escaped the tragedy. As always when disaster strikes this Caribbean nation, Haitian Red Cross volunteers were among the first to respond but this was like nothing they had known before. As they scrambled to assist their communities they themselves were grieving. They, too, had lost homes and loved ones, and friends and relatives were among the missing. The perseverance of 2,000 of them was nothing less than heroic.

Within a week of the 12 January quake, more than 400 Red Cross and Red Crescent workers from around the world were with them and many more were on the way. Before the end of the month 600 had been deployed with 30 National Red Cross or Red Crescent Societies in country, a strong regional presence – Caribbean, Central and South American – among them.

They set up emergency hospitals, got basic health care functioning, and by month’s end were treating 1,600 patients a day. Relief supplies had been delivered to more than 122,000 people, 14 million litres of water provided, and 70 relief flights had landed in Haiti or the neighbouring Dominican Republic to support what was fast becoming one of our largest and most complex operations in recent memory.

Roots of catastrophe

Amid the rubble of Port-au-Prince, Tadateru Konoé, President of the International Federation of Red Cross and Red Crescent Societies, summed up the challenge. “We must confront a natural disaster that is not only one of the biggest of the past decade,” he said, “but is affecting one of the very poorest countries in the world.”

Poverty lies at the root of the catastrophe and countless lives were lost because little had been invested in measures to limit the impact of natural hazards. The level of damage and the resulting overwhelming needs are a direct result of poverty and under-development.

The disaster of Haiti is not the earthquake. What we are seeing here is what happens when an extreme natural event occurs in the lives of people who are already frighteningly vulnerable.

Our challenge now is to help Haiti recover from the earthquake and to overcome its past deprivation. The experience the Red Cross and Red Crescent has gained from five years of post-tsunami work will be invaluable, for we must ensure that Haiti’s devastated communities receive not only the help that they need now but the help they will need for a long, long while to come.

This is a rare opportunity to affect large-scale change where it is so desperately needed. It is also an opportunity to put power into the hands of the people affected by the disaster. This is already being done as we prioritize community outreach and beneficiary communications that empowers and equips people to be true partners in thier recovery. The recovery process will take years – perhaps even a generation – but it is our best chance to turn Haiti’s fortunes around. Together, we must transform tragedy into opportunity.


If you are interested you can view or download a special one month anniversary report here.


/PC

Haiti: One Month on - C'est l'heure pour le patience

Its already been one month since a devastating earthquake brought Haiti to its knees. Here is a video we have put together as a short retrospective. A one month report will be issued in the coming hours that tries to capture not only the consequences but the unimaginable challenges that lie ahead. Needs for shelter, sanitation, health, economy - that collectively are basically unprecedented for one single country. It will be a long road. As my Haitian colleague so wisely counselled, Ce'st l'heure pour le patience.

Out of the Rubble ¦ Audio Slideshow from Haiti

Funny how the lone photographer, one of journalism's quintessential observers, has for so long been muzzled, leaving their work open to interpretation by others who never stood in their shoes. I am a big fan of the way photographers are now more and more providing commentary and narrative to their work. It often brings deeper insights, new perspectives to the broader context of split-second snaps, allows for greater understanding and more powerful story telling.

Here is a sample I came across from New Yorker Evan Abramson which I thought was particularly illuminating. The people of Haiti are "within their own worlds of survival" says Evan who never felt threatened or unwelcome despite what conclusions we might otherwise have made from some of the images. Even more of a reason to hear what photographers experience at the time images are captured, what is going through their minds and how they see things panning out in the future.



/PC

Messaging Millions in Haiti

In Haiti we are working hard to have a real two-way flow of information with people affected by the earthquake who are in need of support from aid agencies such as the Red Cross. This is part of a committment to ensure people are real partners in their own recovery. It is as much about quality and accountability of aid delivery as it is about open and transparent communication. If we are to avoid building back pre-existing vulnerabilities then the people who really matter need to be fully involved every step of the way. Joe Lowry reports from Port-au-Prince.

In Haiti the Red Cross and national mobile phone company ComCel have teamed up to take so-called beneficiary communications to a new level. For the next ten days more than a million ComCel subscribers per day will receive health, shelter and sanitation messages to reduce their exposure to epidemics (photo shows a man with a phone-charging business on the streets of Port-au-Prince).

“The threat of epidemics is very real, even in the current dry season,” says Dr. Richard Munz, head of the health team working in Haiti. “This initiative allows us to do with the push of a button what would normally take an army of volunteers several days to do.”

As a mass vaccination campaign is planned for the coming days, the first message “Haiti Red Cross says vaccination campaigns help prevent epidemics in the community; it is important to attend them” is timely. Future messages will concentrate on hygiene, sanitation and malaria prevention”.

“This brings community mobilisation to new dimension. It complements and perfectly reinforces more traditional methods like leafleting, using megaphones, town hall meetings, passing messages in the local market and so on, which has been the traditional Red Cross role,” says Munz.

ComCel, which had already donated 300 mobile phones to the aid operation, is pleased to be playing such a key role in the relief effort. “There was never any question of us charging for this service,” said Segun Solanke, CEO of ComCel. “This is to help the people of Haiti.”

What is known as the “SMS Blast campaign” is just part of an integrated strategy for communicating with disaster-affected communities which will form part of the plan of action. Irish Red Crosser Will Rogers is working closely with Haiti Red Cross to ensure the National Society can take full advantage of the latest technology.

“We’ve been planning this with Haiti Red Cross every step of the way”, says Will. “They were quick to get on board and are making some great suggestions. And the campaign is not stand-alone – we are already planning to use SMS blasts during the hurricane season as an early-warning device.”

Beneficiary communications should not just be seen as a way to communicate with affected people, it should be recognised as an essential service, one that we as humanitarians take to the next level.

Will and his media colleagues in Port-au-Prince are also working with InterNews and BBC Miami to broadcast interviews with Haiti Red Cross staff all across the country, and there are plans to widen the SMS initiative using other providers and to set up a Red Cross hotline (all free of charge of course).

“Down the road we could be using wi-fi in the temporary camps, doing our own radio programmes, TV, you name it. The technology is there and the Haitian Red Cross has shown they are keen to move.”

In the coming days and weeks the team will work with Haiti Red Cross to get a website up and running. The omens are good – the test Facebook page, which has no content yet, already has almost 1,500 fans.

/JL

Haiti: Aid need not be delivered through the barrel of a gun

There has been much written about insecurity when delivering aid in Haiti. For the Red Cross it is all about the approach you take. Basically, genuine contact and partnership with the community. Good preparation. Involving people and being accountable to them; involving communities in their recovery. Guns, barbed wire and containment often serve to frustrate and provoke people in desperate need into an enraged mob. Aid need not be delivered through the barrel of a gun. Head Down Eyes Opener Joe Lowry reports from Port au Prince on a typical Red Cross relief distribution.

Relief distributions are stepping up a gear in Haiti. Soon the Red Cross relief effort will reach its first target of getting essential household (non-food) items to 5,000 families every week. The distribution are – unlike those reported in the media – generally smooth and secure.

"We’re doing targeted and frequent distributions," says Charles Blake from the Red Cross relief team in Haiti. "We don’t use any armed security, barbed wire or tear gas, we rely on our emblem and the goodwill the public has towards Haitian Red Cross."

Prioritizing women

It works. At the Citée Renault camp for displaced people at the edge of Port-au-Prince hundreds of people wait in line. "First priority are pregnant women, then other women, the elderly and then men," explains Charles. "The Haiti Red Cross volunteers visit the camps two days in advance, work with the committees and distribute tickets. The community feels part of the distribution just as Haiti Red Cross is part of the community." (Photo shows pregnant women, top priority to receive relief, at a Red Cross distribution this week).

Each ticket entitles the holder to a blanket, mosquito net, two boxes of sanitary items like soap, toothpaste and shampoo, and a box of kitchen items including plates, pots, cutlery and knives.

Among the hundreds of women receiving a package is Ismene Caiis, a market woman, who has queued three hours to reach the head of the queue. The distribution is done at a site near the camp, where access can be halted if the crowd gets unruly. "It happens sometimes, especially towards the end of the day when people sense the supplies are running out, but if they have a ticket they will get aid," says Charles.

But Ismene and her cousin Leckson Michel, a teacher, make their way through the good-natured crowd and back to Ismene’s tent, which the 25-year-old shares with her daughter (9) and eight-year-old son. The tent, sheets draped over branches, is about the size of a double bed and has a piece of cardboard on the floor. Nothing else.

Having lost everything

"This is really useful for us", she says, thrilled with the metal plates and pots. "Of course we need food as well but this is welcome as we have lost everything we ever owned."

The Red Cross has installed water points in the camp and runs a clinic nearby. Camp Renault is not ideal, far from it, but at least some basics have been taken care of.

The big worry is shelter, as the rainy period in May will be followed by the hurricane season. "We have been distributing plastic sheeting and tools to thousands of families but the difficulty is the density of the displaced. At least the tarpaulins gives them shade during the day and will help when the rains come," says Corinne Treherne from the shelter team. "The long-term solution is to get them back into their homes or to help them integrate into host families."


/JL (also posted on ifrc.org)