"Nobody Remembers Us": Failure to Protect Women's and Girls' Right to Health and Security in Post-Earthquake Haiti

From Human Rights Watch, this report documents the lack of access to reproductive and maternal care and the ways these gaps are harming vulnerable women and girls still displaced after the January 12 2010 earthquake. The report also describes how hunger has led women to trade sex for food and how poor camp conditions exacerbate the impact of sexual violence because of difficulties accessing post-rape care. It looks at how recovery efforts have failed to adequately address the needs and rights of women and girls, particularly their rights to health and security. According to the report, aid efforts that lack effective mechanisms for monitoring and reporting shortcomings compound the problem.

The report is based on research conducted by two Human Rights Watch researchers in the metropolitan area of Port-au-Prince in November 2010 and January, February, and June 2011. Human Rights Watch interviewed 128 women and girls living in displacement settlements who were pregnant or had given birth since the earthquake and conducted 16 female-only group interviews and 11 mixed-gendered group interviews. Human Rights Watch also interviewed representatives from non-governmental organisations (NGOs) and United Nations (UN) organisations.

Communication-related excerpts from the report follow:

"The report finds, 18 months after the earthquake, the voices of women affected by the earthquake have been excluded from the reconstruction process - even though women are integral to the country's economy. Moreover, initial optimism felt by international aid agencies and donors that access to maternal health would improve in areas affected by the disaster has not been realized for all women and girls...

For the women and girls interviewed by Human Rights Watch in the camps, their enjoyment human rights, such as the rights to life and health, remains poor (not withstanding benefits accruing from the presence of free care and experts on the ground), and most of them lack basic information that would allow them to access available services. Indeed, as is widely recognized, Human Rights Watch found evidence of three types of delay that contribute to pregnancy-related mortality: delay in deciding to seek appropriate medical care; delay in reaching an obstetric facility; and delay in receiving adequate care when reaching a facility...

Most women and girls interviewed by Human Rights Watch did not know which organizations worked in and around their camps, when and where services were available, and to whom they should complain if there was a problem. They also face serious obstacles accessing or learning about prenatal and obstetric care and family planning...

Another problem is food insecurity in the camps....Without adequate access to contraception, women and girls face increased vulnerability when they survive by trading sex for food. Moreover, many engage in these practices in secret, making them vulnerable to violence because they lack what little protection may be available to them from social networks or the community.

Women and girls in Haiti also face gender-based violence, a problem even before the earthquake. Human Rights Watch found that some survivors of sexual violence in the displacement camps had difficulty accessing post-rape care necessary to prevent pregnancy or transmission of sexually transmitted disease. Social stigma and shame can create further obstacles to seeking care....The women and girls who reported rape to Human Rights Watch did so in the course of an interview about maternal and reproductive care. Women and girls pregnant from rape face the same obstacles in accessing reproductive and maternal care as others, with the added stigma and trauma of being a rape victim.

The government, which should be exercising oversight in the provision of maternal health care, does not have current and comprehensive maternal health data for women and girls living in camps who do not reach one of its facilities for care. Nor does it have data on women and girls who discontinue care. Without that information, it is not possible to identify and implement measures to develop redress mechanisms for mistakes or grievances, to correct systemic failures, or to replicate effective programs.

Human Rights Watch found that important information that is necessary for the Haitian government to monitor progress related to maternal health is not recorded in camps: for example, none of the five infant deaths recounted by women and girls interviewed by Human Rights Watch were reported or registered with any NGO or government body...

The government should ensure women and girls have access to health-related information and advice, including regarding family planning, the means to decide the number and spacing of children, and prenatal, obstetric, and postnatal care. It has a special duty to ensure that adolescents can access adequate information and services appropriate to their particular needs, and to ensure that all women and girls have equal access to family planning and maternal care services. This may require that it make extra efforts to provide women and girls displaced by the earthquake with information on access to available care, and to design specific interventions to improve access to services for vulnerable women and girls engaged in informal transactional sex. As it did with the cholera prevention informational campaigns, the government may require assistance by NGOs and donors to disseminate this information...

Shortly after the earthquake, the Ministry of Health set up its own NGO registry with reporting guidelines for medical NGOs working in Haiti....Lack of consistent flows of information and complete data means that it is difficult for human rights monitors and the state to monitor the health plan's implementation and its impact on the realization of rights.

...The Haitian government and donors (and donor-funded NGOs) should support mutual and strengthened accountability related to recovery and reconstruction aid, which is necessary for rights-holders to make the government accountable for its human rights obligations....In addition to information about when aid money is disbursed, however, donors should provide sufficient information regarding which projects and organizations receive the disbursement, and must coordinate with the government and implementing agencies to set benchmarks regarding progress that funded projects have made.

Donors should also supply data that allows the government and civil society to better monitor outcomes of their aid. The government and donors should improve the way they coordinate and share information related to internal or independent oversight and monitoring and reporting of project outcomes. Together, these steps should provide the government with tools needed to work towards fulfilling the rights of its citizens and be accountable to them, and help ensure that individuals have current and reliable information related to their rights..."