Category: International

A foretaste of Haiti’s impending rains

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We return to Base Camp for a security briefing. There is a strict 6pm curfew, and great care is taken to ensure the safety of our teams. There have been some violent incidents as frustrated people show their anger.


Then it’s day’s end, and our mass sanitation team members review progress – pits dug, latrines built, timber (in impossibly short supply) sourced for next week, the warehouse cleared and sorted.

I say how pleased I was with the cleanliness of the camps, how proud of all their hard work. They smile and exchange glances.

At supper time it starts raining. Sheets of solid water sluice down from a black sky. We sit out for a while under an awning.

Soon we are soaked from the splash back. I trudge to the social tent, wet through, and meet Marcel and Ian, who are running the massive Red Cross operation here.

They know that the rainy season is coming, tonight a modest foretaste: it will bring a second wave of disaster and misery for the camps, and Haiti will slide another few steps backwards. No one talks of rebuilding.

Visiting Red Cross camps in Haiti

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Haiti airport approaching midday; the arrivals lounge, a large corrugated hangar, is superheating in the hot sun. We queue for immigration, as cases and bags are flung in through a hole in the wall.

Flying over Port au Prince, it looks like a dozen other Caribbean islands: green, mountainous, sandy beaches and bright sea. You can see occasional clusters of blue roofed dwellings, but to a seasoned disaster practitioner it is clear these are tents and tarpaulins, sheltering the lucky ones.

A hand grabs my shoulder: Cassius from the Red Cross takes my bag and we fight our way to the truck and drive the short distance to Base Camp.

Here, there are neat lines of white tents, offices set up in a ruined hotel and lunch with the gracious Haitian Red Cross President Madame Gedeon.

Every disaster produces heroes and heroines – here is one of Haiti’s: precisely spoken, neatly dressed, daintily emphatic, she has dragged the Society to its feet after the devastating quake, found volunteers from nowhere, and now directs operations from a dark, dusty, windowless room with quiet efficiency.

The Danish Red Cross chef produces a delicious soup, and pasta salad. There are mangoes. We eat quickly and leave for the Camps, Automeca and La Piste, where British Red Cross is building latrines and organising the sanitation for 12000 and 48000 people respectively.

Automeca is a clean lively place, a collection of makeshift huts and shelters built on some waste ground beside the main road. It seems calm and cheerful on a Saturday afternoon, the residents taking their weekend ease, squatting in shady doorways, a few feet from their neighbours.

We visit latrines – there is one for every 209 people. They are spotless. The community committee demonstrates how well built they are, and we watch a gleeful gang of small local children dancing around two clowns who teach them a hygiene chant: “After I poo, I wash my hands” they sing, to howls of mirth, as the kids wave their arms and jump about in the gravel.

Two small boys fly a kite, a ragged tangle of sticks, string and scrubby plastic. Up and away. They wish.

We drive on to La Piste, bigger, built on some kind of ceremonial parade ground. Here there is washing going on by the grey scummy waters of a storm drain.

We are building a shower block here, the carpenters already at work. The latrines are clean here too, but scraps of used paper still end up on the path outside.

This is a crammed, edgy place, the wind scurrying busily around the shacks, all built from tarpaulins and scraps of wood from fallen homes and offices.

They lean on each other at crazy angles; here is a small shop, there a bar, now a guy beating out some sheet metal; it looks incredibly well-established, as if this has been home for years. It probably won’t look much different in 5 years time.

Disgracefully, for some Haitians, these are the best living conditions they have ever had. You sense that the good weekend mood could shift in an instant, the tension there just waiting for the excuse to erupt. They have reason to be angry, these unlucky folk.

Follow Nick’s visit to Haiti on Twitter.

Global snapshots: TB control in Kazakhstan

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“We are the only lifeline that people have”: How the Red Crescent helps to control HIV and TB co-infection in Kazakhstan

Itemirtau kazakhstann Kazakhstan, the figures for HIV / TB co-infection illustrate a stark reality: TB is the biggest killer of people living with HIV. There are an estimated 12,000 people living with HIV in the country and more than a third of die of TB, despite it being curable.

Five years ago, the Kazakhstan Ministry of Health (MoH) was providing medical treatment to those living with HIV (many of them from the most vulnerable sector of the population) but was struggling to deal with the social aspect of the work. Their dilemma was how to reach those people in need and ensure they completed the full course of treatment in a culture where there is still huge stigma attached to HIV – and where many of those affected have been ostracised and forgotten.

When the Kazakh Red Crescent Society approached the authorities in the industrial town of Temirtau – which has the highest rate of HIV in the country – with an offer to work in partnership on providing HIV and TB co-infection support, it was exactly what they had been looking for.

Sholpan Baimurzina, Temirtau AIDS centre director from the MoH explains: “To reach these people and ensure treatments are followed, we need the social support that the Red Crescent provides. This is what was missing in our programme, so when the Red Crescent came to us to suggest this partnership, we were very enthusiastic.”

The Red Crescent is one of just a few organisations in Kazakhstan that specialises in HIV and TB co-infection support. Controlling TB and HIV co-infection has been singled-out as vital to making progress in reducing TB incidence and mortality.

The programme, funded by Astra Zeneca via the British Red Cross, is co-ordinated by Red Crescent multi-disciplinary teams, including a psychologist, a social worker and a lawyer. It targets those with co-infection who are considered most likely to default on their treatment. Clients are usually referred by the AIDS Centres and may also come on their own. Nearly three quarters of clients are former prisoners – of which over half are injecting drug users or homeless people.

The project is already seeing impressive results. Sholpan says: “By providing social support to our patients, we have seen the mortality rate in Temirtau start to decrease in 2007 and 2008 by roughly 25 percent since the co-infection project started. This positive trend is so encouraging; we are seeing these people get better and seeing our strong relationships with them grow.”

For those like Alexander (36), an ex-drug addict and ex-convict from Karaganda, the programme was literally a life-saver. Alexander’s life was turned around through the Red Crescent’s support and he now volunteers for the co-infection programme. “Helping others to live with the same diagnosis of co-infection became my mission in life,” Alexander says. “This programme is about survival. Sometimes we are the only lifeline that people have.”

Images © Claudia Janke/British Red Cross

In search of the perfect toilet: mass sanitation in Haiti

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I’m Paul O’Sullivan, a hygiene promoter currently working in Haiti, where the British Red Cross is working in two large camps in Port-au-Prince; La Piste camp, which has around 40,000 people and Auto Mecca which has 15,000. Our work in these camps includes constructing latrine, hand washing and shower facilities. We are also doing hygiene promotion in the form of community health education, which means making sure communities take ownership of the work by linking with community sanitation committees and local community volunteers.

As part of this work, we are continually assessing not only the quantity, but also quality of the services we provide. It is obviously important that there is sufficient number of latrines for population sizes. The SPHERE Project defines the minimum standards and ratios that humanitarian agencies should strive for throughout all sectors within an emergency response. For example one toilet to 20 people, a figure that is frequently difficult to achieve within the initial phase of an emergency, but which acts to guide minimum standards.

However, in addition to the numbers of latrines provided, it is also essential that we assess and meet locally acceptable quality standards. For the hygiene promoter this is a crucial part of our role. All health promotion work strives to limit the barriers that prevent good health and hygiene behaviour.

To ensure that toilet design, location and maintenance act to support, rather than obstruct successful toilet use, we need to make sure that the use of the latrine facilities that we put in place is the preferred choice for the population using them. Site visits and observational walks allow us to see how well latrines are used and maintained, as well as whether the local populations are using other sites as latrines, defecating in the open (an issue that any festival goer may have experienced), returning to their ruined houses to defecate in existing latrines or defecating in plastic bags.

Boys brainstorming good toilet design

Focus group discussions are also useful. In the urban camps of Port-Au-Prince, community members complained they did not like the design of the latrines, so I met with the sanitation committee of the camp to discuss latrine design. The camp is made up of people from a number of populations who come from diverse communities affected by the earthquake so we are potentially working with population groups who may have very different original experiences of hygiene practices and latrine design, management and maintenance.

We also need to take into account that the effects of a major disaster and change of normal environment, with vastly reduced resources and support systems, frequently leads, at least at initial stages of an emergency, to highly compromised health behaviours. In effect people don’t necessarily behave as they would…again, something that festival goers may appreciate.

Dramatic increases in the population of these camps means we need to work with them in smaller groups or zones in order to be able to respond effectively. To identify the layout and demographic mix within the camp, we completed a community mapping exercise, in which people developed their own overview of the camp, adding various water and sanitation details, where there are toilets and open areas people have been using, where they access water,  dangers like areas of large fly or mosquito populations.

Community sanitation mapping

It also showed us where there were populations with no latrine or water sources, providing an overview that is difficult to gain otherwise, and all from a community perspective.

Our aim is to have the sanitation committee identify managers for these zones who will organise latrine attendants and garbage cleaners to improve environmental hygiene and latrine cleaning.

Following the mapping, we began our focus group discussions. We did this with both adults and children, to see if there were specific needs for children we should also consider. Firstly we brainstormed, ‘what makes a good toilet?’ The factors they came back with were many, but included: a seat with a lid, a solid structure made from wood, that it can be locked, enough space, cleanliness, availability of toilet paper and hand washing facilities. It isn’t rocket science, but we need to ensure that we are aware of these things in our planning.

Girls designing toilets

There are currently four different types of latrines in the camp. To get feedback on each of them we visited them individually….and the committee explained their likes and dislikes for each design. This then led to discussions about what they really wanted.

Wooden latrines

Following visits to the latrines, brainstorming and the Focus Group discussion, the steering group divided in to groups of men and women and designed their perfect toilet. The designs were then presented and discussed by the whole group. A final design was agreed by all.

New latrines under construction...

New latrines under construction...

As a result of this exercise asking communities what they wanted, the Red Cross has designed a prototype which will be presented to the sanitation committee as soon as possible. We hope that through this work we are now able to provide secure, safe and desirable latrines which will not only improve the living conditions in the camp but perhaps restore some dignity for the earthquake affected people in Haiti.

...and the finished product!

Global snapshots: the Spanish Red Cross

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What do a group of ex prisoners in Russia, a community of pensioners in Bulgaria and a team of young people in the Netherlands all have in common?

They are all Red Cross volunteers.

During the last four months of 2009 I worked as part of the team in our Europe Zone office based in Budapest looking at how the Red Cross is reaching out to vulnerable people in all these different countries.  I spoke with colleagues from far and wide as Uzbekistan and Malta, Ukraine and Montenegro and heard some inspiring stories of how the Red Cross works all over the world to help vulnerable people, whoever and wherever they are.

The Europe Zone team helps to support the work of the Red Cross and Red Crescent across 52 countries in Europe and Central Asia. They are part of a wider body, the International Federation, who co-ordinate the work of the staggering 186 National Societies across the world.

Over the coming weeks, I will be posting some of the stories that colleagues from across the continent shared with me about what they are doing and the people they help – starting with the Spanish Red Cross, or Cruz Roja Española.

“We call them ‘udjana’, which means extended family”: How the Spanish Red Cross helps migrants washed up on the Canary Islands coast

Twenty-four-year-old Omar Seco worked for nine months in a metal factory to pay for his passage from Mauritania to Spain. In February 2009 he embarked on the sea journey on a large canoe – an experience more terrifying than anything he had imagined. “I was very frightened for three days,” he recalls. “I often feared that I would drown. The waves were huge and we were thrown around like rag dolls”.

Thousands of men, women and children risk their lives each year to make the voyage over to Spain from Africa, often in small wooden boats, ‘cayucos’, packed with 80 or 90 people. The Spanish Red Cross has been working to provide humanitarian aid, such as providing medical relief to those washed up on coasts, for 10 years.

In 2006, however, a dramatic increase in the number of arrivals by boat to the Canary Islands (more than 25,000 people reached its coasts, mostly from sub-Saharan countries) meant the Spanish Red Cross was called upon to play a crucial role in supporting the government’s efforts to respond to the crisis and increase the scale of their support.

Mila Núñez Sachetich from the Spanish Red Cross recalls: “Not only was there a dramatic increase in the overall numbers of irregular migrants arriving on the coasts, often exhausted from very dangerous journeys, but we also began to see a lot more women – including pregnant women and children, as well. Some were very ill or dehydrated, others had died during the voyage. It was a very traumatic situation.

Reception centres run by the Red Cross, where migrants like Omar can stay after they are released from detention centres for up to 15 days, were expanded to accommodate the increased number of arrivals. Omar recalls: “The Spanish Red Cross brought me to this centre that we are in now. We call them ‘Udjama’ which means ‘extended family’. Now I have a place to live and have food every day. On top of this, I am attending Spanish classes and other workshops which are vitally important for me to be able to find work.”

Omar’s story, along with many others, has been featured on a weekly show, ‘Golden Stories’, hosted by the Spanish Red Cross and broadcast on the biggest radio station in Spain, La SER. The slot offers those who have benefited from the support of the Red Cross – in all aspects of its work – to publically share their experiences.

The programme is listened to by more than 480,000 people a week and represents just one of the ways in which the National Society is working to raise public awareness of the situation and the conditions that drive people to put their lives in danger to make these journeys.

Since 2006 the Spanish Red Cross have helped over 96,000 people who have arrived on the Spanish coasts. However, volunteers and staff acknowledge there are still huge humanitarian challenges which have been exacerbated by the economic crisis.

The recession has led to a scarcity in work on the market and they are seeing an increased number of those they helped a few years ago returning to the Red Cross, homeless and in desperate need of support. “The majority of people don’t want to be reliant on our assistance. They want to be working,” Mila says. “However, times are very hard. We are now offering assistance to many people who arrived during the 2006 wave and are currently destitute.”

Despite these challenges, there is still a will and optimism amongst new arrivals that they can build a life for themselves. Omar wants to find work and stay on the island: He reflects: “I consider myself very fortunate to have arrived safe and sound in Gran Canaria because I know that many aren’t so lucky – they died at sea or were deported to their countries of origin. I am very fortunate and want to take advantage of this opportunity I have been given.”

Image © Jon Santa Cruz/ Spanish Red Cross