I work for the International Planned Parenthood Federation (IPPF). We are a global NGO advocating for sexual and reproductive rights across the world, and also during crisis and conflict situations. As part of the NGO, I had a chance to closely interact with the refugee population of Nakivale, Uganda. Nakivale refugee settlement, with an area of 185 sq. km, is in the south-western part of the land-locked east African country of Uganda. It hosts refugees from all the war-torn neighbouring countries.
I travelled to Nakivale to assess the situation of an International Planned Parenthood Federation’s Humanitarian assistance programme-SPRINT (IPPF-SPRINT) intervention, that aimed to provide key sexual and reproductive health services to refugees at ground zero. A chat with the health workers there opened a can of worms. Most of the refugees who have escaped conflict situations and civil wars in their nations of Rwanda, Democratic Republic of Congo, South Sudan, Burundi and Ethiopia have hardly 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. According to Dr. Joy a senior health worker, “In order to tackle HIV and 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 the knowledge to tackle any pregnancies during the infection period, so that we can avoid mother-to-child transmission.” A walk into the reproductive health camps and clinics also re-emphasised the need for SRH (sexual and reproductive health) intervention among the refugee population.
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 socio-economic 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 perpetrators. Other data indicates that girls in the region frequently experience coerced sexual initiation which is often viewed as a normal part of relationships.
SGBV is a public health problem and women and girls who suffer SGBV are more likely to be infected with HIV, other sexually transmitted infections (STIs), and experience other reproductive health problems.
At the settlement, I met Jenna (name changed), a 39 year-old Burundian refugee, who had crossed over to Uganda two months ago, following civil unrest in Burundi. Tears rolled down her eyes, as she started talking about her escape from Burundi. She was 36 weeks pregnant when she was brutally gang-raped by goons at her village, and after ravaging 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 3 days, she managed to reach Nakivale. She was soon attended to by health workers at the IPPF-SPRINT clinic, but, unfortunately, her pregnancy had to be terminated. Jenna broke down as she talked about her 36-week pregnancy. She has been checked for HIV, STI and a cervical cancer screening too has been done. Though she is healing physically, mentally she is far from good. Dr. Joy, who has been treating her, said, “We are counseling her, but the loss of her husband and the rape still gives her nightmares. Her son however, has started going to school.” She hopes that Jenna too shall be able to carry on with her normal life soon.
Violence against women is a commonly practiced method of subjugation during civil unrest and all the refugees have heart-breaking stories to share.
But among the stories of despair, hopelessness and darkness, I got a chance to meet 20 year-old Anunciata. This newly married lady not only got an Intra-Uterine device (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, IUD will help me deciding on when I am prepared to welcome a child,” she adds smilingly.
SGBV and HIV are a curse, and most African refugee households have some bone chilling experience to share. With no land to go back to (as most fear execution in the most brutal forms on returning), these refugees have become families and have formed a strong bonding welcoming each other as newer ones cross the border to enter Uganda.