Subject : Humanitarian Leadership and Advocacy for People with Special Needs

Subject: Humanitarian Leadership and Advocacy for People with Special Needs

1. Introduction

This  note about Humanitarian aid workers and persons with special needs –is a subject of discussion about field challenges. We know that in several African countries armed groups have often voluntarily targeted Humanitarian aid workers. This has negatively impacted on their activities increasing humanitarian crisis. Also, people with special needs have not been considered in planning of activities by states and some actors leading to loss of several hundreds of lives. Powerful agents and stakeholder as well as public states should support humanitarian activities including these categories in their programs.

Armed conflict is one of the situations which destabilize African states. During these events, the civilian population is caught between clashes from the opposing groups leading to the loss of several human lives and massive shift towards deemed stable and secure areas. During the displacement, people vacate villages leaving livestock and other valuable items. In these circumstances, the belligerents often attack humanitarians as it was reported in Somalia, Sudan, Democratic Republic of Congo and many other countries. In this regard, the looting of humanitarian facilities including hospitals and health center reduce response capacity for affected populations. Several questions arise: is it necessary to provide military escorts to humanitarian? Humanitarian principles do not permit. Should humanitarian remain and accept to be killed on field? No, because the self-protection principle does not allow it. How can you flee from the conflict zone leaving behind you several lives endangered by the lack of medical assistance? What to do? All these challenges lead to suspension of humanitarian activities when it’s necessary. Besides humanitarian personnel, there are other categories of people who cannot cope with crises in the same way as the others, simply because their physical situation does not allow it. These are pregnant women, the sick people, the older persons, and people with disabilities, who will require an attention. The conflicting parties and other stakeholders should take be aware on strict measures to ensure these categories are well identified and protected. Also, even in post-conflict period, they should benefit from special programs for their integration into society.

This paper does not provide detailed description of these categories and the challenges which they face during internal conflict. Instead, we wanted to reveal that in African countries these issues need more attention to save lives. We make a modest contribution as more researches continue to be done in this regard.

2. HUMANITARIAN LEADERSHIP AND ADVOCACY

2.1. UNDERSTANDING HUMANITARIAN FIELD SECURITY CHALLENGES

1. 2.1.1. Humanitarian aid workers in armed conflicts zones

The word “Humanitarian aid workers” means of all kinds (rescue workers, relief workers, staff and administrators at refugee camps and shelters, health care workers) and those seeking to understand the causes and effects of the disaster (e.g., government officials, journalists, human rights workers, researchers) (1).

The environment in which humanitarian agencies and their staff aid populations affected by armed conflict and natural disaster has changed in significant and concerning ways over the past decade. The majority of conflicts taking place in the world today are non-international in character, with national and/or multinational forces fighting a variety of armed groups, often with significant asymmetry between the parties.1 Characteristics of contemporary armed conflicts include the deliberate targeting of civilians, large scale population displacement, grave violations of international humanitarian and human rights law, the targeting of international humanitarian personnel, and restrictions on humanitarian access to civilians (2).  Recent decades have also seen a significant increase in the number of people in need of humanitarian assistance in the aftermath of natural disaster, (3) with similar restrictions imposed upon humanitarian access. In 2004, the UN General Assembly estimated that more than 10 million people in 20 countries affected by complex emergencies (including both natural disasters and conflict situations) were inaccessible to humanitarian agencies (4). For many of these people, restrictions on humanitarian assistance mean restrictions on the basic food, water, sanitation and shelter necessary for survival.

• High security risks in conducting activities

Humanitarian aid workers have been designated as a category of people that has been active in rescuing thousands of lives in most of remote areas. However, in most of rural areas deploying aid in patchwork of shantytowns is particularly complicated and thus, they do not escape from the strife.  Due to a low education of belligerents as well as lack of willingness certain of Humanitarian aid workers can be blocked on their way towards or from the field. Also, they can be intimidated and prohibited of moving from their base. Most of them are often submerged by the work due to numerous IDPs reaching their humanitarian bases or hospital. In several occasions, humanitarians’ convoys, bases, edifices or residences are targeted by armed groups aiming at pillaging valuable items, medicine or other material. Humanitarian principles of providing neutral and impartial medical care constitute another issue in armed conflict zone. In several occasions, some armed groups consider that medical staff should not take care of their opponent (armed group element, civilian from a certain tribe…). Without any respect to the International Humanitarian Law, certain armed groups elements can decide to abduct, arrest a sick or wounded person from a hospital. In such cases, humanitarian staff cannot protest any more fearing for their security. Protesting can be interpreted as complicity with the enemy.

In 2008, 260 humanitarian aid workers were killed or injured in violent attacks. Such attacks and other restrictions substantially limit the ability of humanitarian aid agencies to aid those in need, meaning that millions of people around the world are denied the basic food, water, shelter and sanitation necessary for survival (5).

In 2009, in the Northern side of D R Congo, in Goma city and rural areas, the trend suggested that NGOs were at higher risk when working in rural areas (86%) comparing with UN staff (14%). It has been understood that the use of military escort by UN has worked as a deterrent against criminal activities. The NGO community was more affected than UN agencies by security incidents in North Kivu because of their greater physical presence at the field level and their strict adherence to humanitarian principles (e.g. no use of military escort). When looking at security incidents in urban areas of Goma city it appeared that any staff, UN or NGOs, were at high risk of criminal activities. Nonetheless, NGOs (59%) continues to be the most vulnerable and affected comparing with UN staff (41%) (6).

In Soudan, in 2009, targeted attacks against humanitarian personnel in Darfur – including physical and sexual assaults, hijackings and abductions – increased dramatically in the years leading up to the expulsions. In November 2008, Under-Secretary- General for Humanitarian Affairs John Holmes reported that attacks on humanitarians had reached ‘unprecedented levels,’ (7) 38 with 11 staff killed, 189 staff abducted, 261 vehicles hijacked, 172 assaults on humanitarian premises and 35 ambushes and lootings of convoys in 2008 alone (8).   Holmes noted that in most cases it was the rebel movements that appeared to be responsible for the attacks, (9) but as one well known Darfur commentator pointed out, ‘assaults on humanitarians, their vehicles, compounds, and equipment must be understood for what they are: actions that are the clear responsibility of the Khartoum regime in areas controlled by Khartoum nothing happens that is not implicitly or explicitly sanctioned by the regime” (10).  From 2011 and 2012 humanitarians witnessed severe incidents when clashes between the South Sudan army, the Sudan People’s Liberation Army (SPLA) and a militia group in Jonglei were taking place. Staff faced the repeated looting, damage and destruction of medical facilities in Jonglei, including Pieri in August 2011, Pibor and Lekwongole in December 2011, Lekwongole in August 2012 and Gumuruk in September 2012. This disturbing trend of targeting medical facilities constituted a major concern to access to healthcare by the people already vulnerable (11). 

Humanitarian staff can be also being abducted or by armed groups aiming at receiving ransom or discouraging other humanitarians to continue in conducting activities in the conflict area. In October, two MSF staff members were abducted from a refugee camp in Kenya, where thousands of Somalis had fled (12). Following the situation in eastern Dr Congo, Colette Gadenne, MSF head of mission in Goma declared “We strongly condemn the intimidation of humanitarian workers and cannot accept threats directed at our staff,” (13).

Furthermore, armed groups hate humanitarians on ground because they witness all the suffering of people in areas under their control, and thus, their evacuation and suspension of activities gives them an opportunity to operate and forcibly rule over poor civilians far from vigilant humanitarians. One humanitarian declared: “It is now critical that everyone work together to identify and meet the population's needs, while remaining very watchful. The deadly attack reminded us that periods of calm are often temporary in Mogadishu” (14).

1. 2.1.2. Suspending humanitarian activities: “ultimate decision”

It is better known that the voluntary sacrifice in reducing suffering of population exposes humanitarians and especially “Medical staff”. Nevertheless, crucial decisions need to be taken when the situation becomes more critical. Suspension of activities! Sometimes, humanitarians suspend activities after death or attack against their staff of premises. Several cases were observed in Somalia, Soudan, Democratic republic of Congo and other countries. This measure leads to challenges and defies in term of lack of continuation of humanitarian responses while belligerents are not competent to continue with humanitarian actions. Some of key causes for suspending activities include:

• Attacks against humanitarian premises: in Somalia, In March 2011, MSF suffered two consecutive grenade attacks on its compound in Wadajir district, west of Mogadishu, in less than a week. MSF was forced to suspend activities temporarily, putting at risk the lives of 414 children enrolled in the nutrition program. In North and South Galkayo, MSF treated patients wounded in separate incidents, and in Daynile, nine kilometers (5.5 mi) northwest of Mogadishu, of the more than 3,500 patients admitted to the emergency room, 44 percent had war-related injuries (15).  
• Repetitive threat against Staff: on 9 August 2013, Doctors without Borders/Médecins Sans Frontières (MSF) has been forced to suspend medical activities in and around the town of Pinga, in the east of the Democratic Republic of Congo (DRC), following a threat targeting its humanitarian staff. Ethnic tension and active fighting between armed militias in the area has led to the displacement of tens of thousands of people into surrounding forests, where no medical care was available (16).  As a neutral, independent, and impartial organization firmly guided by medical ethics, MSF continued its medical activities elsewhere in North Kivu Province and the rest of the Democratic Republic of Congo. Since 1981, the organization has provided free, quality medical care to all communities throughout the Democratic Republic of Congo without prejudice or distinction regarding race, ethnicity, religion, or political affiliation. Last year, MSF carried out more than 1.6 million outpatient consultations in DRC, more than in any other country where MSF was working. 
• Killing of medical staff: Given the scale of medical needs, MSF took the decision to send international staff to take up permanent posts in south-central Somalia for the first time since 2009. Tragically, on December 29, 2011, two long-serving MSF staff members, Philippe Havet and Dr. Andrias Karel Keiluhu, were shot dead in their Mogadishu compound. This forced MSF to close two programs, which had been serving a population of 200,000 displaced people and residents, halving the medical assistance provided by MSF in Mogadishu (17). 
• Worsening of health situation: abandoning wounded and not able to walk back themselves, sick persons, pregnant women, persons living with disability, wounded and other persons hidden in bushes constitutes a high challenge. Why? Due to absence of protection and security, staff goes physically while their hearts and conscience beats hundred folds: “I leave behind me people in needs and surely some of them will face death”. Malnourished children are more vulnerable to measles infection, which in turn aggravates malnutrition until death. Unhygienic living conditions provide a breeding-ground for water-borne diseases like cholera.

• Fear and displacement reducing access to health care: when humanitarians suspend and move towards another safe zone, people wish to follow them and get care. But since the cause of the violence remain, the risks increase. Due to fear of facing armed groups on the way, population decides to remain in suffering.

Due to the insecurity, the populations of Gumuruk and Lekwongole fled their homes to seek refuge in the bush during August and September. MSF was forced to suspend temporarily its medical activities in Lekwongole and in Gumuruk. These two health facilities provided the sole medical care available to 90,000 people in these outlying and difficult-to-access areas of Pibor County. People from these areas and patients had walked for 5 to 7 days before being able to reach MSF in Pibor health center four weeks after being attacked and arrived with badly infected wounds. Other patients expressed fears about military presence on the roads in remote areas outside Pibor town. Where people hesitated to travel to seek medical care, they reported turning to various strategies for accessing care safely, including waiting for a larger group to travel together, travelling early in the morning or self-medicating (18).

3. ADVOCATING FOR HUMANITARIAN ACTIVITIES

​​​​​​​3.1.  Deliverable message to belligerents

Agencies and all stakeholders included de facto authorities should be involved in reducing suffering of population. This task is not easy in armed conflicts and mostly about what to plead for in a context when everything get worsen.

Generally, armed conflicts oppose visible groups supported by invisible actors, known or not known who often communicate with them even secretly. Through negotiations and advocay, key messages should be addressed to belligerents via Medias and other means of communication.

• Safety and access to healthcare and aid: belligerents and their supporters must use all their possible influence to ensure the population’s safety and ability to freely access urgently-needed medical care and other essential services in still available. Belligerents must allow free corridor for humanitarians to reach the desperate population.
• Respect for health structures: all belligerents (armed groups, national forces) and their supporters as well as local communities must avoid targeting health structures.
• Respect for human being (medical team, patients, non-armed people): all belligerents and their supporters as well as local communities must respect the safety of patients and the neutrality of medical facilities and staff as well as other civilians not engaged in fighting.
• Respect for humanitarian premises and properties: all belligerents and their supporters as well as local communities must respect all humanitarians’ properties (all domains included) without any discrimination to facilitate continuation of humanitarian actions. 

Emergency response capacity: all humanitarians’ organizations and UN agencies through Clusters (Protection, Logistic, health …), Ministries, donors, must meet regularly to analyze received information from the conflict in the objective of building up emergency response capacity to respond recent and future health and humanitarian emergencies. Safe heavens areas and buffer neutral zone should be also created to allow civilians to get protection and other services

In Somalia crisis of 2011, in the Afgooye corridor, where close to half a million people have sought refuge, MSF supported the district hospital, covering the needs of 180 surrounding villages. Staff conducted more than 27,000 consultations and treated over 3,300 malnourished children in Afgooye (19).

• Pleading for using telemedicine as Emergency response: in Somalia MSF has increasingly used telemedicine to bring specialized care to Somalis in areas where the risk is too high to fly doctors in. Via an audiovisual link, specialist doctors based in Kenya supported medical staff in Somalia during consultations. More than 500 new patients received medical attention through this technological innovation in 2011 (20). 

1. 3.2. Advocating for people with special needs

Although armed conflicts affect all people, most of aware people agree that there is a certain category of persons considered as persons with special needs. This is since they cannot react to the strife equally as the other affected people. Their physical status, environment increase their vulnerability leading to high risk in facing the danger. This category includes women, girls and pregnant women inmates, people with disability, sick people and old person. On 15 March 2002, the Security Council adopted an aide memoire (S/PRST/2002/6) to facilitate its consideration of issues pertaining to protection of civilians and decided to review and update the document as appropriate. The aide memoire contains a section on 'vulnerable populations' in general. So far, in his report on the implementation of the Millennium Declaration, the UN Secretary-General has drawn attention to the needs and contributions of older persons as a vulnerable group and has called on the international community to make full use of their capabilities and talents (21).

1. 3.2.1. Women, girls and pregnant women inmates

Researches as well as experience have shown that female prisoners have different needs than male prisoners. Also, female inmates experience high rates of rape and sexual violence while incarcerated. Research documents numerous cases in which women are at a significantly higher risk than men for being sexually abused before and during prison. Sexual aggression and abuse by male prison staff is widespread. Most women incarcerated experience abuse before prison and while incarcerated and suffer from post-traumatic stress disorder (22).  Sexual offenses against women prisoners can include rape, assault, and groping during pat frisks.

The needs of mothers during of pregnancy and childbirth often conflict with the demands of the prison system. Very few of these women receive prenatal care, which can be very detrimental to both the mother and child, especially when coupled with inmates’ histories of inadequate health care as well as sexual, physical and substance abuse. Most of these pregnancies are deemed as high risk. Additionally, a lack of maternity clothes and resources to deal with premature births, false labors, and miscarriages pose serious challenges to prisoners. Furthermore, incarcerated women are a source free labor for detainers.

1. 3.2.2. People with disability

Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others (23).

During armed conflicts, people with disability can be jailed following ethnic, political or other reasons. The absence of trained people to deal with their case during incarceration and no access to justice as well as lack of State authority in the area constitutes major concern (24).  Most of them do not withstand conditions and face death before any rescue reach them.

1. 3.2.3. People with chronic diseases

People suffering from chronic diseases (such as diabetes, heart disease, and hypertension) and older people might suffer until death. Also, “The Prison Act” requires the segregation of sick prisoners from other prisoners. (25)  Furthermore, the confinement leads to contamination and potential death. All patients with terminal illness, whether in prison or not, have special medical needs related to their disease, as well as psychological and spiritual support needs related to the prospect of impending death. Such needs are intensified in the isolating environment of prisons, where the requisite medical and psychological care is most often lacking (26). Thus, prisoners with a terminal illness need to be accommodated in an environment that does not exacerbate the suffering inherent in their condition and that enables ongoing medical supervision.

1. 1. 3.2.4. Old persons

In African rural areas, old persons represent the history and other cultural traditions. Some of them represent the customary authority and keep the secret of myths and other customary habits. Also following their ages, old persons are often consulted by people regarding land conflicts and other matters, and thus become opinion leaders. In armed conflicts, these people are mostly targeted either by armed groups. Besides this, old persons have special needs that must be considered. 

Some instruments of humanitarian law allow for special consideration to be given to age in certain circumstances (Third Geneva Convention, arts. 16, 44, 45 and 49; Fourth Geneva Convention, art. 27 para.3, 85 para.2, and 119 para.2). The Fourth Convention also includes special protections for older persons about the establishment of hospitals and safety zones (art. 14, para.1), and evacuation from besieged areas (art.17). The Refugee Convention provides for inclusion of refugees in old age pension schemes in the host country (art. 24(b)).

Regarding their age and lack of force, old persons are sometimes left behind by fleeing population. Neither their families nor other actors satisfy completely their needs since they are separated from their families. Challenges and defies in the context of conflicts were revealed recently by the international community that has begun to act to redress this neglect.  In 2001 the UN High Commissioner for Refugees adopted a policy on older persons and in 2002, the Second World Assembly on Ageing adopted specific policy commitments concerning older persons in emergency situations (27).

In armed conflicts situations old persons are exposed to danger like other civilians, but in addition, they have vulnerabilities and needs associated with ageing that place them at risk. Also, incarceration of older persons far from their family members constitutes a major concern. The loss of family links and the death of family and friends influence the mental well-being of older prisoners and their prospects of successful resettlement following release. Older female prisoners suffer particularly from separation from their families and communities, and especially in societies where the family, extended family and the local community are essential elements of the social fabric, in which women have the central role as caregivers (28). 

4. LEADING AND COORDINATING RESPONSES FOR OLD PEOPLE

During the mobilization of the response, humanitarian leaders need to identify key challenges and some of habits installed among population regarding old people.

1. 4.1. Identifying defies for older people

 For any humanitarian response to older people, several defies should be considered especially:

• Loss of livelihood to survive: during conflicts, houses are often burnt, and other infrastructures destroyed. In rural zones, opposed armed groups occupy farms and fields hindering any access to agricultural products. In cities, shops and other welfare buildings are often pillaged hindering any possibility in supplying families. In case of displacement, old persons left lands and other livelihood resources for living in IDPs camps. All these situations lead to poverty and vulnerability of old persons.

The inter communal attacks of 2011 and early 2012 in Jonglei have had a devastating impact on communities. Whole villages have been destroyed and livelihoods affected, as people have lost their homes and belongings. During the attacks, food reserves, crops and seeds were burned, and many people feared tending their fields because of the insecurity. As was the case during the last peak of violence in 2009, (29) villages, in addition to cattle camps, were attacked, and many women and children were wounded in the attacks.

• Lack of physical strength to access humanitarian aid: in the competition and fighting for resources (aid, water, food, etc.), old person does not gain the battle. Old person has no strength to stand for a long time to receive assistance.
• Age and gender discrimination: old persons from the two genders suffer from different forms of discrimination during conflict and post conflict periods. Being unproductive, unable to obtain micro-credit or self-sufficiency and playing a role in rebuilding their society in post conflicts periods, old persons are rarely consulted in decisions affecting them and excluded from emergency responses.
• Isolation: during armed conflicts older people may be deliberately left behind to guard land and property and abandoned in the chaos as other family members escape. Through desperation they decide to live in isolated huts or demolished structures where no one takes care of them. Widows are often excluded from the public accusing them of witchcraft. Even when agencies provide tracing and family reunification, they do not memory to provide clear information.
• Lack of visibility: during armed conflicts and post conflict periods, old persons do not appear in any scene (in supporting or demonstrating). While active people move or act, they do not have any possibility to be seen. Older persons wish to be 'seen, heard and understood (30) and to be considered full partners in reconstruction and rehabilitation measures. Due to generalized violence, local associations militating for older persons flee and vacate the area leading to a total absence of advocacy for that category. Few association working for older people have funds to publish statistics, problems and other issues related to old persons.

• Lack of protection measures: during armed conflicts, old persons do not have strength to move far away with others in displacement. Also, belligerents whose knowledge is low in International Humanitarian law consider old persons from the opposite side as enemies even not keeping weapons. In these situations, it is important that the responsibility for protection of vulnerable groups, including older persons, is clearly identified. Generally, contingency plans should be implemented by the agencies and the community provide a neutral and nearby safe heaven area for protection of old persons.
• Non-respect of right of being consulted in decisions affecting them: Older persons are rarely if ever consulted in decisions affecting them, their families and communities. Therefore, emergency delivery and shelter arrangements may be incompatible with the cultural norms and beliefs of older people, leading de facto to their exclusion from emergency responses.

​​​​​​​4.2. Addressing defies and challenges for older persons

Humanitarian and all actors including public services should act to ensure that the specific rights and needs of older persons for assistance and protection are addressed before opening of hostilities. They should provide responses in term of protection, equal access to food, shelter, medical care and other services primarily preventive evacuation. In response to increased international concern about the plight of older persons in conflict situations, both ICRC and UNHCR have adopted several concrete initiatives to improve awareness of needs and strengthen protection that need to be experienced in several African zones (31).  Such strategies will be implemented prior to the opening of hostilities, during conflict and in the post conflict period.

• Advocate for food and rights to participate in society reconstruction: The Madrid Plan of Action contains detailed recommendations under two main objectives: to ensure equal access by older persons to food, shelter and medical care and other services during and after humanitarian emergencies; and to enhance their contributions to the reestablishment and reconstruction of their communities and societies. (Ch. I,8) The General Assembly endorsed these documents in resolution 57/167 of 18 December 2002 and called upon Governments, the UN system and all other actors to take the necessary steps to implement them.
• Special measures to protect older persons in emergencies: as preventive measures all stakeholders should locate and identify older persons at risk. They should also have an attention to the problems faced by women. By this way, they should facilitate evacuations. All stakeholders should provide preventive measures by implementing safe heavens and neutral areas respectable by all belligerents.
• Provide tracing and family reunification programs: Agencies should provide tracing and family reunification programs for older adults to avoid a permanent abandonment and neglect. This should include their identification, location of their family members or safe transit area where they will be hosted temporarily, regular assessment of their situation after reunification
• Respect of right of being consulted in decisions affecting them: Older persons should be consulted in decisions affecting them, their families and communities. This method has more advantages in delivering emergency responses compatible with their cultural norms and beliefs. Submission of projects and planning of activities in destination of conflict and post zones areas including wishes of older persons should be considered as an imperative condition for the States to approve NGOs programs.
• Provide special programs to rehabilitate the situation of old persons in conflict or post conflict zones: in post conflict periods older persons should benefit from recovery and rehabilitation programs particularly micro-credit. This can be implemented with the assistance of experienced agencies in collaboration with “Older persons’ associations”. Such activity will reduce the alleged unproductivity and 'poor investment' with the advantage of ameliorating livelihood, social adaptability and re-establishing self-sufficiency that will allow them to play a role in rebuilding their society.

5. Conclusion

The intensification of armed conflicts in many African countries is a concern requiring an attention from all actors. Internal armed conflicts have trained enormous difficulties caused by not groups operating without compliance with any standard of international humanitarian law or human rights. This situation leads to generalized attacks and without distinction between humanitarian personnel, unarmed civilians and public buildings several atrocities affect the humanitarian situation of civilians. Although most of civilians are concerned, we focused about humanitarian personnel working in conflict zones through an insecure environment. The suspension of humanitarian activities often appears as a crucial decision; and that, advocating for the reopening of humanitarian activities should take in consideration all challenges mentioned. Another part of the article has been consecrated to a category of people named “persons with special needs”. This includes pregnant women, girls, and people with disabilities, sick people, and older persons. Due to their incapacity to face violent and generalized situations as other people; a attention is required in planning of humanitarian activities. This includes strategies of saving their lives before the opening of hostilities as preventive measure, during flight as protection actions and in post conflicts periods through recovery programs. This needs collective intervention of all actors namely the public state, humanitarians and the international community.

Knowing that several researches have been done in this field, we cannot pretend to have developed all aspects. We managed to provide a modest overview indicating how these categories of people need an attention.

6. BIBLIOGRAPHY

1. John H. Ehrenreich, A Guide for Humanitarian, Health Care, and Human Rights Workers, New York, July 2002, p.17

2. UN, Report of the Secretary-General on the Protection of Civilians in Armed Conflict, UN Doc. S/2007/643, 2007, p.6

3. UNOCHA, Office for the Co-ordination of Humanitarian Affairs, Natural Disaster Bulletin No. 8, October 2007, p. 1.

4. UN GAOR, Strengthening the Co-ordination of Emergency Humanitarian Assistance of the United Nations: Report of the Secretary-General, UN GAOR, 59th sess., UN Doc. A/59/93-E/2004/74 (2004), p. 11.

5. Rebecca Barber, Facilitating humanitarian assistance in international humanitarian and human rights law, Volume 91 Number 874 June 2009. Note: Rebecca Barber is Country Program Co-ordinator (Sudan, Somalia, Afghanistan and Pakistan) at World Vision Australia

6. UNOCHA, Security Incidents Against humanitarian workers in North Kivu (DR Congo), 2008-2009, p.8.

7. John Holmes,UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, ‘Briefing to the Security Council on the situation in Chad and Sudan’, 3 December 2008, available at www.reliefweb.int/rw/rwb.nsf/db900SID/EDIS-7LYTBD?OpenDocument (last visited 23 January 2008).

8. UNOCHA, Office for the Co-ordination of Humanitarian Affairs, ‘UN Humanitarian Chief Calls for Continued Co-operation in Sudan’, Press Release, 30 November 2008, available at www.reliefweb.int/rw/rwb.nsf/db900SID/RMOI-7LVMUD?OpenDocument&RSS20=02-P (last visited 24 January 2008).

9. Ibid.

10. Eric Reeves, ‘Humanitarian Efforts in Darfur Face Escalating War by Khartoum’, 28 October 2008, available at www.sudanreeves.org/Article227.html (last visited 20 January 2008).

11. MSF, Soudan hidden crisis; How violence against civilians is devastating communities and preventing access to life-saving healthcare in Jonglei, Jonglei, 2012, p. 1.

12. MSF, Somalia: Extreme Needs, Extreme Choices

13. MSF, MSF Suspends Medical Activities in Pinga, DRC, Following Threats, http://www.doctorswithoutborders.org/press/release.cfm?id=6980&cat=press-release

14. MSF, Somalia: Aid to Displaced People in Mogadishu Still Insufficient http://www.doctorswithoutborders.org/news/article.cfm?id=5555&cat=field-news

15. MSF, Somalia: Extreme Needs, Extreme Choices, http//www.doctorswithoutborders.org/publications/ar/report.cfm?id=6243,02 September 2013.

16. MSF, MSF Suspends Medical Activities in Pinga, DRC, Following Threats, http://www.doctorswithoutborders.org/press/release.cfm?id=6980&cat=press-release

17. MSF, http://www.doctorswithoutborders.org/publications/ar/report.cfm?id=6243, 02 September 2013.

18. MSF, Soudan hidden crisis; How violence against civilians is devastating communities and preventing access to life-saving healthcare in Jonglei, Jonglei, 2012, p. 15.

19. MSF, Somalia: Extreme Needs, Extreme Choices http://www.doctorswithoutborders.org/publications/ar/report.cfm?id=6243, 02 September 2013.

20. MSF, Somalia: Extreme Needs, Extreme Choiceshttp://www.doctorswithoutborders.org/publications/ar/report.cfm?id=6243, 02 September 2013.A/57/270 (2002)

21. Zlotnick, Caron. "Posttraumatic Stress Disorder (PTSD), PTSD Comorbidity, and Childhood Abuse among Incarcerated Women." Journal of Nervous & Mental Disease 185.12 (1997): 761-63. Lippincott Williams & Wilkins. Web. 13 Mar.

22. Convention on the Rights of Persons with Disabilities, Article 1.

23. UNITED NATIONS (UNODC), Handbook on prisoners with special needs, New York, 2009, pp. 47-48

24. FWLD, HIV/AIDS and Human Rights: A Legislative Audit, March 2004,P. 28,  http://www.fwld.org.np, Section 6 (1) (e) of the Prison Act, 2019 (1962).

25. UNITED NATIONS (UNODC), Handbook on prisoners with special needs,New York, 2009, pp. 128-129

26. GLOBAL ACTION ON AGING & HELP AGE INTERNATIONAL, Protection of Civilians in Armed Conflict Unit, Policy Development and Studies Branch, Geneva , 2003

27. UNITED NATIONS (UNODC), Handbook on prisoners with special needs,New York, 2009, pp. 128-129

28. MSF, Facing up to Reality: Health Crisis Deepens as Violence Escalates in Southern Sudan, December 2009.

29. HelpAge International/ECHO/UNHCR, Older People in Disasters and Humanitarian Crises: Guidelines for Best Practice (London, 2000)

30. UNHCR, Policy on Older Refugees (EC/50/CRP.8, Annex I) (2000); Agenda for Protection (A/AC.96/965/Add.1)(2002); 27th International Conference of the Red Cross and Red Crescent, Plan of Action for the Years 2000-2003