Conflict Fuels HIV/AIDS Crisis

Kamala Sarup, USA

The massive and rapid spread of HIV/AIDS in Nepal is a significant threat to national peace and security. Health workers involved in HIV education have complained that due to the Maoist insurgency they are facing problem to spread the message to the remote villages. HIV/AIDS and conflict also create a double jeopardy for women. Women are the main victims of conflict. When the economy and the social infrastructure are destroyed, and male heads of households are missing, women carry a disproportionate burden as single-parent heads of families.

For a woman living in Nepal and heading a household, the risks of being infected by HIV/AIDS are high. Her efforts to feed her famil! y may put her in a vulnerable situation where she is more likely to be coerced into sex in exchange for money and resources. This situation exposes her to HIV infection.

The situation in Nepal deserved particular attention because the Maoists war had not allowed the country to set up the necessary conditions required to combat HIV/AIDS. The security conditions have directly affected the spread of HIV/AIDS, and that conflict and civil unrest can increase vulnerability to HIV/AIDS particularly among women and children. Political instability, and political crisis have an undeniable impact upon Nepalese public health. Nepalese public health can be effective only in as much as the security of victims or armed conflict is guaranteed.

The impact of this sexual victimization of women on the spread of HIV/AIDS is compounded by the general absence of condoms in areas affected by conflict. The collapse of educational systems associated with conflict further exacerbates problems! and has the double effect of curtailing prevention efforts taught in the classroom and pulling children away from their studies, often into a chaotic and predatory environment.

Medical doctor Dr. Hari Mehata, while speaking with the Telegraph, not only made these queries but also said, "Young women and poor children without social protection are the first to be constrained into sexual transactions and prostitution by the lack of alternatives. In western Nepal, displaced people said the spread of HIV/AIDS was hastened by poverty, lack of occupation, and the lack of reproductive health services. In big cities girls and women exchanged sex for food.

In war-affected parts of Nepal too, studies showed that girls and mothers became sex workers to earn a living because of their social and economic vulnerability, they exposed to coercive sex, especially in conflict situations. Young people should not have to exchange sex for basic survival items! ". He said "Widespread rape, and sexual exploitation of young people in conflicts are a serious violation and greatly increase the risk of HIV transmission".

Now we have questions how to assure as a condition of support that disarmament and reintegration programs and reconstruction programs take appropriate consideration of HIV/AIDS? How Nepal government will provide adequate funding within peace operations budgets to incorporate HIV/AIDS awareness, prevention and treatment programs for all military forces and combatants?

How to ensure that HIV/AIDS prevention and conflict prevention activities go hand in hand ? How to ensuring that HIV/AIDS is fully taken into consideration as part of humanitarian accords, peace negotiations? How to adopt a multi-sectoral approach to tackling HIV/AIDS, including the security and defence sectors? How to provide condoms as part of the standard equipment for all members of the armed forces ? What hinders success in building t! he capacity of people affected by conflict, to prevent HIV infections and provide essential services to those who are directly affected by HIV/AIDS?

Investing in the health sector makes good sense for conflict prevention as well as for socio-economic development. Health can help peace also in operational terms. On other hand, media can play a great role in creating awareness among the general public. Education and awareness are the two powerful instruments, which can check the spread of the disease. Dr. Mehata further said "HIV/AIDS should be addressed during a conflict rather than waiting until it has ended. Humanitarian pauses and ceasefires should incorporate the opportunity for prevention education, distribution of condoms and voluntary testing. Negotiations for peace agreements should include the possibility for the full range of prevention, testing, counselling and, to the extent feasible, treatment programs for all combatants, whether regular or irre! gular forces, as well as among displaced civilians.

It should be on the agenda during peace negotiations, which would require including public health officials on negotiating teams or at least among those providing facilitation. Consideration should be given to offering assistance, as an inducement to stop fighting, to combatants with HIV/AIDS, including treatment for diseases like pneumonia and tuberculosis that attack those whose immune systems have been weakened and, when they are medically indicated and can be sustained, anti-retroviral medicines".

HIV/AIDS, moreover, can make it harder to bring conflict to an end. To ensure a sustainable and lasting peace, it is not enough simply to halt the fighting and implement disarmament and reintegration programs. Law and order and governance have to be re-established quickly, regional and local administrations set up, schools and clinics opened.

Dr. Mehata further said " Lack of negotiating power, unsafe sex, a! nd disbelief about HIV/AIDS are factors that greatly increase the risk of HIV infection in conflict situations . For HIV to be addressed in situations of conflict may well require a psychological and political revolution. The invisible will need to become a political priority. The HIV epidemic rages in situations where power is exercised without regard for others, whether that power be economic, social, sexual, psychological or the power of force. It spreads where there is a disregard for life, an intolerance of difference, a devaluing of women, a lack of a will to live, a breakdown of community values, violence and conflict".

Once our leaders have acknowledged that a problem exists, educational and preventive programs can be instituted to help contain the spread of the disease. The capacity to see beyond the visible immediate, to encompass prevention as well as treatment, causes as well as symptoms, will need to be developed for HIV, as it has been for conf! lict traumatised children, for example. "A child out of school for any time at all is immediately more vulnerable to violence, to sickness and disease, exploitation and abuse," he said. "A child denied an education is in the long term more likely to be poor, to die unnecessarily young, and to have children while they are still children themselves."

Though this year budgets for humanitarian aid have increased, but funds are disbursed with short-term commitments. Within a complex emergency, with thausends of displaced people who suffer recurrent epidemics of meningitis, malaria and other infectious diseases, should have assess the response to HIV/AIDS within the larger context of the humanitarian response. Loss of health infrastructure is terribly destructive, but can also represent an opportunity for rebuilding a health care system that is more responsive to public health and needs at the grassroots, and that involves traditional healers.

It is important to consider how the HIV/AIDS pandemic in Nepal contributes to further instability and conflict on the continent and how violent conflict in turn creates conditions favourable to the spread of the virus. Nepal governments still fail to recognize that AIDS is more than a public health issue. The spread of HIV also serves to prolong conflict as it places new strains on health and economic infrastructures and destabalises family and social structures. There are several factors that contribute to the spread of HIV/AIDS in emergency situations and which subsequently effect gender relations.

Warfare is an amplifier of disease, creating ideal conditions for its spread, including famine, destruction of health and other vital infrastructure, large population movements, and the breakdown of family units. In such situations, defences are weak. Awareness of HIV/AIDS is low; denial and stigma are widespread. Health services, destroyed or overwhelmed, are severely under-resourced and do not offer adequate care or effective protection against HIV/AIDS. Violent conflict in some part of Nepal is protracted and almost endemic. Successful HIV-AIDS programs appear to depend on strong community involvement. In emergency environments, the health priorities are to save lives and then to preserve health. It is at the second stage that it is critical to mainstream HIV/AIDS issues, psychosocial care. Psychosocial care is extraordinarily important.

The relationship of the HIV/AIDS pandemic to violent conflict in Nepal must be addressed how the explosion of HIV/AIDS may contribute to further instability and conflict on the continent in coming years? and how instability and violence encourage conditions favorable to the spread of the HIV virus?

Deeper psychological Trauma of Conflict Induced Displacement

Dilli Ram Dhakal, USA

The Nepali people were jubilant when they succeeded in restoring democracy in 1990 after almost 30 years of consistent and assertive struggle against the Panchayat system. that followed 1996 The change in the system in 1990 was an outcome of the agreement reached between the people’s representatives, the agitating political parties and the king. The changes brought by the 1990’s popular movement were positive and encouraging at all fronts. The suppressed, unexpressed needs and silent desires of the people could take shape once the democracy was restored. The newly gained democracy remained instrumental in bringing forward peoples desperate wish for a thriving democracy supported by all round prosperity. When the process of changes were in motion, many unwanted, unsanctioned and anti-democratic forces tried to de-stabilize the hard own democratic polity and the progressive institutions. The parties and several of their top leaders at the helm of power ignoring the ideals, mission and the responsibility towards the people failed to deliver the expected services. At various fronts they even misled and mis ruled the nation. The much required needs of the poorest, oppressed and disadvantaged people of the country was hardly attended. The country misruled for about 30 years had been trapped with all the contributing factors of under-development such as, illiteracy, poverty, inequality was much victimized by the corruption, nepotism and unaccountable service delivery mechanism. Thus it was certain that the re-born democracy had to fight all the social, economic, cultural and political malaise and to transform it into a vibrant entity. But the governments in the post 1991 couldn’t understand this very fact so the resentment among the disadvantaged community did rise. Against this backdrop, he CPN Maoist, that had been opposing the monarchy all along could garner support. The Maoists, with strong reservations to the parliamentary system and within their ideological parameters also participated to the general elections and won nine seats in the parliament, but simultaneously there was a group that remained active in arms struggle should the situation demands so. It culminated to the submission of a 40 point demand to the government and when there was no response to their demand, finally, in Feb 1996, the Maoists with sheer frustration, opted arms rebellion. The rebellion started within the first six years of the promulgation of the constitution of 1991. It was observed that at the initial 2-3 years, of Maoists movement better known as people’s war grew in geometrical proportion, but in the later years it failed to muster same level of support because of several detractions and unimagined level of violent actions. The people residing in the remote villages and far flung areas, who were undergoing through numerous hardships, were further victimized by the prolonged conflict between the state and the Maoist.

The worst effects of the conflict on lives and the properties has been one of the major reporting issues for Nepali media. The human and physical damages of the conflict abound; over 10,000 of known deaths and 15-20,000 injuries, pathetic condition of hundreds of orphaned & abandoned children, closure of schools, hundreds of thousands of population rendered homeless and displaced and the mounting pressure on women due to displacement are some major consequences. The civilian population in scores of districts in Nepal have been shaken, frustrated and traumatized because of the conflict. A large number of civilian population and the existing public facilities are compelled to be displaced due to fear, threat and unbearable pressure on them. The pace of displacement has been in the rise.

The humanitarian side of the damages caused by the conflict has become grave. It would be unfair to blame one warring side for forcing out people from their homes/villages. It’s the conflict and its expanded consequences to be blamed for. In theory, the civilian population shouldn’t have been affected in such a manner, but it in practice civilian population have suffering much than other parties involved in the conflict. Thounds of families are broken, thousands more are missing or feared killed. There is absence of able bodied persons to till the farm and to look after the children, aged and terminally sick people. reduced/worsened situation of job opportunities to work and earn in the villages, closure of most schools, and deterioration in the quality of education, people are threatened, killed, abducted, forced to obey the orders and not only the remaining family members, the displaced persons in their new places are also frightened all the time and there is nil safety and security for their lives. Most displaced population are either illiterate or less educated. They only can sell out their labor provided they are physically able. If they fall sick, the closets friend is the "death" itself, since there is no facilitites and programs that assist the IDPs. Both the displaced persons and their remaining families have been under going through turbulent psychological pressure. Once the persons are out of the villages, generally they don’t feel safe to return without any positive developments or agreement between the two conflicting parties. The displaced population’s psychological trauma is much bigger than the physical damages occurring day by day.

Once the conflict is over the physical side of the damages can be repaired and improved. In regard to the recovery of physical side of the damages, several donor agencies and international community will offer their support. This will help rebuild the physical structure and launch developmental programs, but it wouldn’t be able to replenish the mental trauma of the suffering people. To rebuild the community, neighborhood companionship and to re-establish a peace loving, trusting, caring, cooperating and mutually supportivtive society after the end of conflict will be much harder task. Thus it would be in the benefit of both warring sides and the general population, if all concerned respect the freedom, liberty and human dignity in its fuller sense and the civilian population is not affected and traumatized. The depression, anxiety and the wide spread fear among a larger segment of the population is not in anybody’s favor.

Economic Development for Peace and Democracy

James F. Moriarty, US Ambasador, Nepal

I could not think of a more exciting time to be in your beautiful country. Like most of the people of Nepal itself, the United States wishes to see a peaceful, prosperous, and democratic Nepal. Everything I do, and everything my embassy does, will be geared towards helping Nepal achieve that vision.

For eight years, Nepal has confronted not only the normal problems of development and of attempting to build democratic institutions, but also an increasingly brutal Maoist insurgency. Through extortion, torture, murder, bombings, and abductions, the Maoists have created a reign of terror throughout the country. The recent political instability made the situation even more difficult.

I hope that the newly selected multi-party cabinet will work with the palace to convince the Maoist forces to lay down their arms and come to the negotiating table with a serious intent to bring peace to Nepal. I also hope that those parties that have not yet entered the coalition will either do so or at least come to a consensus of action with the government, so that the government can effectively address the problems facing the people of Nepal.

Let me use this opportunity to lay to rest speculation that a change of ambassadors means a change in US policies towards Nepal. It does not. We continue to seek a peaceful, prosperous, and democratic Nepal. If Nepal slips into anarchy and chaos, it would represent a threat to the stability of South Asia and to vital U.S. interests. We need Nepal to succeed.

And that is why we have provided security assistance totaling nearly 22 million dollars over the past three years to help the Nepali government protect the security of its people. We also continue to conduct joint training exercises in Nepal – two to three such exercises per year – that are primarily focused on providing training in medical trauma, public health, and military law for the nepali side and give our personnel an opportunity to train at high altitudes. While we have some mountains in the US, they’re not as high as yours!

All our military training has a human rights element, as mandated by US congress. We strongly condemn all human rights violations by all sides, Maoist and government forces alike. Assistant secretary Christina Rocca, on her last visit to Nepal in December 2003, made that very clear. She also remarked that government forces must be held to highest standards, and any violations must be prosecuted in a transparent manner.

Ultimately, however, if there is to be a peaceful, prosperous, and democratic Nepal there needs to be economic development – and that is where we have focused our efforts. Since the beginning of formal US. –Nepal relations in 1951, we have provided over 700 million dollars in development aid to Nepal. in the past, this money helped eradicate malaria in the Terai, the former land of fever.

The funding also supported the Royal Nepal airlines corporation at its inception, to develop Nepal’s first automatic telephone exchange, a radio communications network with 57 stations across the country, roads, hydropower, as well as agricultural and forest management. It continues to support the vitamin a program that reaches children in all districts of Nepal and has lowered infant mortality by over 30 percent. And I want to stress that our economic assistance is not only much larger but has grown much more quickly than our security assistance:

Our development assistance jumped from 24 million dollars in 2003 to 40 million dollars in 2004.

Let me close by stressing that we will continue to work with the government of Nepal and civil society here towards a goal of establishing democracy, peace and prosperity.

"Amerikale Nepalma Santi, Sampannataa Ra Prajatnatra Bhaeko Dekna Chahancha.

"Nepallai Yo Lakchyamai Laijane Ko Lagi Hamro Samarthan Huncha.

"Tara Nepallai Yis Bata Tada Laijane Hamro Smarthan Hundaina."

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