Dispatch 10th Anniversary

May 2011

dépêches Mai 2010

Suivre les progrès réalisés dans la Campagne pour éliminer les fistules

TCEF

TÉMOIGNAGE V I V A N T La Fistule Obstétricale et les Inégalités en Santé Maternelle

Tanzania

Mobile phones help fight fistula

Haïti

Les enquêtes portent aussi sur la fistule obstétricale

L’un des pionniers

Global

troper launna

Fistula initiatives will be mapped page 7

‫حملة القضاء على الناسور‬

‫ناسور الوالدة‬

‫ أطلق صندوق األمم املتحدة للسكان وطائفة كبيرة من‬،2003 ‫في عام‬ ‫الشركاء احلملة العاملية للقضاء على الناسور مبا يحقق ندرة اإلصابة به في‬ 49 ‫ واحلملة قائمة اآلن في‬.‫البلدان النامية على غرار البلدان الصناعية‬ ‫ تركز‬،‫ وفي كل بلد من هذه البلدان‬.‫بلد ًا في أفريقيا وآسيا واملنطقة العربية‬ :‫ هي‬،‫احلملة على ثالثة مجاالت رئيسية‬

‫ناسور الوالدة هو إحدى اإلصابات التي تنشأ عن الوالدة والتي كانت‬ .‫مهملة نسبي ًا على الرغم من أثرها املدمر على حياة الفتيات والنساء‬ ‫وتنجم هذه اإلصابة عن تعسر الوالدة دون القيام بالتدخل الطبي املناسب‬ ‫ وتخلف اإلصابة بناسور الوالدة نتائج‬.‫في حينه – مثل اجلراحة القيصرية‬ ،ً‫ ميوت الوليد حتما‬،‫ فنتيجة لطول فترة املخاض املتعسر‬.‫مدمرة للحياة‬ ‫ وإذ تصبح املرأة‬.‫وتترك املرأة في حالة مزمنة من حالة سلس البول والبراز‬ ‫ ميكن أن يتخلى عنها‬،‫عاجزة عن التحكم في البول أو البراز أو كليهما‬ ‫ وما لم تعالج من هذه اإلصابة تصبح‬.‫زوجها أو أسرتها وأن ينبذها املجتمع‬ .‫فرصها في العمل أو في احلياة األسرية شبه منعدمة‬

‫• منع حدوث اإلصابة بالناسور‬

‫حملة القضاء على‬ ‫ناسور الوالدة‬

‫• معاجلة النساء املصابات‬ ‫• دعم النساء بعد اجلراحة‬ ‫ميكن لدعمكم أن يساعدنا على استعادة الصحة واألمل واإلحساس بالكرامة‬ .‫للنساء املصابات بهذا املرض املدمر‬ cover_backcover.pdf

16:22:20

‫ ميكنكم زيارة املوقع‬،‫ أو لتقدمي الهبات‬،‫للحصول على املزيد من املعلومات‬ www.EndFistula.org :‫التالي‬

Fistula Fundraiser Nets £70,000

A L U T S I F D N E O T N G I AP M A C

13 September 2007

:‫ يرجى مراسلتنا على البريد اإللكتروني‬،‫لتوجيه أسئلة عن احلملة‬ fistulacampaign@unfpa.org

Photo: Chris Woodage

WEIVER NI RAEY EHT

18/12/2007

December 2006

Natalie Imbruglia urges guests at a London fundraiser to support the Campaign to End Fistula.

LONDON, United Kingdom — A celebrity The weekly UK magazine Hello! ran a bowl-a-thon at London’s All Star Lanes hosted by 9-page article on the charity bowl-off, with Australian singer/actress and exclusive photos of Virgin Group ‫حق كل‬ ،‫دولية‬ ‫ إمنائية‬Natalie ‫وكالة‬Imbruglia ‫ وهو‬،‫للسكان‬ ‫املتحدة‬ ‫صندوق األمم‬ ‫يدعم‬co-founder Virgin Unite, the charitable arm of the Virgin Richard Branson, “Spice Girl” Geri Halliwell, ‫ويقوم‬Group, .‫الفرص‬ ‫وبتكافؤ‬ ‫بالصحة‬ ‫التمتع بحياة تتسم‬ ‫ في‬star ‫وطفل‬ ‫ورجل‬ ‫امرأة‬Australian raised more than £70,000 for the UK football Jamie Redknapp, Campaign to End Fistula. singer Kylie Minogue, British actor Orlando ‫الالزمة‬ ‫البلدان في استخدامها للبيانات السكانية‬ ‫الصندوق أيضا بدعم‬ “Sir Richard Branson told me about the Bloom and other celebrity guests in to End and suggested I find attendance. ‫حمل‬Campaign ‫يكون كل‬ ‫أن‬Fistula ‫متكن من‬ ‫الفقروللبرامج التي‬ ‫لسياسات وبرامج مكافحة‬ out more,” Imbruglia told a 200-plus audience of As many as 800,000 women are living with ‫نقص‬entrepreneurs, ‫من فيروس‬ ‫خالي ًا‬actors, ‫وشابة‬ ‫ وكل شاب‬،‫مأمونة‬ ‫ مرغوبا‬20,000 Hollywood international fistula in ‫والدة‬ Nigeria, ‫وكل‬ and an،ًestimated pop singers and supermodels.

“I went to Nigeria‫وكل فتاة‬ new cases occur there each‫املناعة‬ year. Through the .‫واحترام‬ ‫ُعامل بكرامة‬ ‫وامرأة ت‬ ،‫اإليدز‬/‫البشرية‬ and learned a lot. Frankly, I was horrified.” joint UNFPA-Virgin Unite project, launched in As Spokesperson for the Campaign, Imbruglia July 2007, community health workers are has worked tirelessly to build awareness and trained in prevention, fistula survivors ‫مهم‬ ‫شخص‬ ‫كل‬ ‫ألن‬ ‫ــ‬ ‫للسكان‬ ‫املتحدة‬ ‫األمم‬ ‫صندوق‬ support for this cause. Together with Virgin receive free surgical treatment, and women Unite, she hosted a benefit dinner in November are empowered with skills to rebuild their 2006, raising more than £500,000 for a fistula lives after surgery. prevention and treatment project in Nigeria.

Additional funds raised through the September Look for news about Natalie’s December bowling event will ensure the project reaches visit to Nigeria in our next issue of dispatch! many more women.

dépêches

‫ وهي حتدث‬،‫واإلصابة بناسور الوالدة ميكن الوقاية منها وميكن عالجها‬ ‫ السيما الالتي‬،‫بصورة غير متناسبة بني الفقيرات من الفتيات والنساء‬ ‫ وهؤالء النسوة والفتيات هن‬.‫تعشن بعيد ًا عن مجال اخلدمات الصحية‬ .‫أنفسهن األكثر عرضة للوفاة أثناء الوالدة‬

K

Photo: Dima Gavrysh for UNFPA

CY

THE MATERNAL HEALTH THEMATIC FUND

‫لكن عزيزة في نهاية املطاف عوجلت في مستشفى األمومة‬

‫ وقررت عزيزة أن حتول جتربتها املأساوية‬،‫وأعيدت لها كرامتها‬ ‫ فتدربت على أن‬،‫إلى مصدر قوة لها ولألخريات من بني جنسها‬ .‫تكون قابلة‬

Monde

‫ إحدى‬،‫ سنة‬45 ،‫ريتا سواريز‬ ‫املصابات بناسور الوالدة في‬ .‫أحد املستشفيات في ديلي‬ ،‫ رون حبيب‬:‫تصوير‬ ،VII Photo Agency .2010 ،‫تيمور ليشتي‬

Les champions et ‫بناسور‬ ‫حالة‬contre 5 000 ‫وهناك ما يقدر عدده بنحو‬ avocats de‫جديدة‬ la ‫إصابة‬ lutte ،‫دارفور‬ ‫ جميع أنحاء منطقة‬des ‫ وفي‬.‫الوالدة في السودان كل عام‬ la fistule reçoivent ‫ أجل‬à ‫ من‬Maputo ‫يواصل صندوق األمم املتحدة للسكان تقدمي التسهيالت‬ éloges page 2،‫تعافي النساء من خالل تدريب مقدمي خدمات الرعاية الصحية‬

.‫ وعرض القيام بحمالت التوعية‬،‫وتعزيز قدرة املرافق الطبية‬

:‫صورة الغالف‬ ،‫ بصحبة أوديت كوسيكو مباكو ماسواكو‬،‫ شابة كونغولية مصابة بالناسور‬،‫ سنة‬15 ،‫نزايه فيراليني‬ ‫على أن أرتدي‬ َّ ‫ “لقد تعني‬:‫ تقول نزايه‬.‫إحدى الناجيات من املرض والداعيات إلى الوقاية منه‬ ‫ولم نكن ندري‬.‫‘احلفَّاطات’ كما تفعل الصغيرات كي ال أتبول على نفسي حينما أذهب إلى املدرسة‬ ‫حقيقة املرض إلى أن جاءت أوديت ورأتني وشرحت لي أنني مصابة بالناسور وأنه باإلمكان عالج‬ nding bstetric ‫للمراهقات األخريات‬ ‫األمور التي ميكن‬ ‫عاجزة عن التمتع بكل‬istula ‫ ومما يحز في نفسي أنني‬.‫هذه احلالة‬ ‫ لكنهن يحدثنني عن الرائحة‬،‫ وصديقاتي ال تعرفن أنني مصابة بالناسور‬.‫في سني أن يتمتعن بها‬ .”‫ ويطردنني لكي أبتعد عنهن‬،‫الكريهة التي تنبعث منى‬ .2010 ،‫ جمهورية الكونغو الدميقراطية‬،‫ صور بانوس‬،‫ روبن هاموند‬:‫تصوير‬

e

The Global Campaign to End Fistula United Nations Population Fund

Obstetric fistula is a preventable and treatable childbearing injury that leaves women www.unfpa.org incontinent, ashamed and often isolated from their communities In 2003, UNFPA and partners launched a global Campaign to End Fistula The Campaign is now active in more than 40 countries across Africa, Asia and the Arab region The Campaign focuses on three key areas: preventing fistula, treating affected women, and supporting women after surgery For more information, or to make a donation, visit www.EndFistula.org

fistulacampaign@unfpa.org www.EndFistula.org Campaign to End Fistula UNFPA 220 E. 42nd Street New York, NY 10017 email: fistulacampaign@unfpa.org For more information on the global Campaign to End Fistula, please visit www.EndFistula.org

Production: Julie Weber

Design: LuccaCo.

Contributing Writers: Saira Stewart and Julie Weber Campaign Donors (since 2003) Americans for UNFPA Bill & Melinda Gates Foundation through EngenderHealth Government of Australia Government of Austria Government of Canada Government of Finland Government of Iceland Government of Luxembourg Government of New Zealand Government of Poland Government of Spain Government of Sweden Government of Switzerland

o

F

Kenya

Une survivante de la fistule devenue avocat à l’échelle mondiale page 7

dispatch is a biannual newsletter highlighing developments in the Campaign to End Fistula Editor: Saira Stewart

December 2007

Preventing Harm and Healing Wounds

Y

MY

CAMPAIGN TO END FISTULA

‫إصابتها‬ ‫ مت ترميم‬،‫هناك‬de .‫بالسودان‬ ،‫ السعودي في الفاشر‬pour éliminer les fistules Suivre les progrès la Campagne

M

CM

‫ وهي‬،‫في العاشرة من عمرها‬ ،‫بعد في هذه السن املبكرة‬ ‫ وأصبحت‬،‫تزوجت عزيزة‬ Novembre 2011 ً ‫حام‬ ‫ال فور زفافها بوقت‬ ‫ ونتيجة للمضاعفات‬.‫قصير‬ ‫التي حدثت لها أثناء عملية‬ ،‫ مات وليدها‬،‫املخاض‬ ،‫الوالدة‬ ‫وأصيبت هي بناسور‬ ANNUAL REPORT 2009 ‫وهي حالة مرضية كان عليها أن‬ ‫تتعايش معها على مدى السنوات‬ ‫زوجها‬Progress ‫عزيزة تخلى عنها‬towards .‫ التسع التالية‬Millennium Development Goal 5 Accelerating ‫بسبب الرائحة الكريهة الناجمة عن اإلصابة‬ .‫باملرض‬

Campaign to End Fistula 10th Anniversary

C

CMY

‫قصة عزيزة‬

Photo: David Rose/Panos/UNFPA

8002 page 3

Lacunes dans les données

SPECIAL EDITION

Voices of Fistula Survivors

I

n 2013, we will mark the 10th anniversary of the Campaign to End Fistula.

attention of policymakers, health officials, communities

Over the last decade, many people, from experts

and individuals, as well as the general public to the

to activists, have dedicated their lives and professional efforts to raise awareness about this devastating

In the past ten years, the Campaign has drawn the

issue of fistula.

We have made good progress but the needs

condition, increase access to prevention and treatment,

are still enormous. Ending fistula worldwide will

and give women and girls suffering with fistula another

demand enhanced political support, strengthened

chance in life.

collaboration between governments, partners and

This has been no easy task. In 2003, when UNFPA and its partners launched the Campaign, international

civil society, along with intensified resources and efforts.

targets to improve maternal health help set the goal

The Campaign, in conjunction with its partners, is

of reducing the number of obstetric fistula patients

now working in more than 50 countries across Africa,

in affected countries.

Asia, the Caribbean, and the Arab region.

2003 The second meeting of the working group for the prevention & treatment of obstetric fistula. Addis Ababa, 30 October - 1 November 2002

The Campaign to End Fistula, 2005 Annual Report

Dispatch, December 2007

South Asia Conference for the prevention & treatment of obstetric fistula, 9-11 December 2003

Natalie Imbrugliia urges guests at a London fundraiser to support the Campaign to End Fistula

2

In each country, the Campaign focuses on:

The average cost of fistula treatment—including

• Prevention

surgery, post-operative care and rehabilitation

The most effective way to prevent fistula is to

support—is $300. The Campaign supports all areas

increase access to quality maternal health care,

of treatment, from training doctors in fistula repair

including family planning, skilled birth attendance,

surgery to equipping and upgrading fistula centres,

and emergency obstetric care. Prevention also entails

in addition to patient recovery and follow-up.

tackling underlying inequities to empower women and girls, enhance their life opportunities and delay

• Rehabilitation

marriage, as well as pregnancy, until adulthood.

Fistula treatment goes beyond repairing a woman’s damaged tissues. Many patients—

• Treatment

especially those who have lived with the condition

While prevention is key, there is a strong commitment

for years—need emotional, economic and social

to providing treatment for fistula patients.

support to fully recover from their ordeal.

The Campaign to End Fistula, 2006 Annual Report

The Campaign to End Fistula, 2007 Annual Report

Neglected No More

Living Testimony: Obstetric Fistula and Inequities in Maternal Health

3

dispatch

in high burden countries. This brings together

Through the Campaign, women receive counseling and skills training to help them develop

stake-holders working on all aspects of fistula.

income-generating activities and to empower them

Over 30 countries have integrated fistula into national

after surgery. Working with communities is also

reproductive health policies and plans. Many

fundamental to ensure women are accepted back

countries have shown increased national

into society without being stigmatized.

engagement on the issue—with governmental

Since the Campaign to End Fistula was launched, at least 38 countries have completed a situation analysis on fistula prevention and treatment.

To enhance coordination of national fistula

funding increasingly provided to support programmatic efforts.

The majority of Campaign countries are now in full implementation phase (along the three phased

programmes and partner collaboration, increasing

Campaign process of needs assessment, national

numbers of Minister of Health-led National Task

strategy and implementation), a shift that illustrates

Forces for Fistula are being successfully established

good momentum.

Fistula survivor Gul Bano

The Campaign to End Fistula, 2008 Annual Report Dispatch, June 2008

Preventing Harm and Healing Wounds, Ending Obstetric Fistula, 2008

Dispatch, December 2008

4

Thousands of health personnel, including doctors,

In response to an external evaluation of the Campaign

nurses, midwives and paramedic staff, have received

in 2009-2010, UNFPA developed an Orientation Note for

training in fistula management, thereby increasing

obstetric fistula that builds on experience and previous

national capacity to address this largely neglected

work to provide a vision for the future.

maternal health and human rights issue.

More than 27,000 women and girls have received

This includes a focus on national programming and sustainability; a gradual programmatic shift from fistula

fistula treatment and care with direct support from

camps/campaigns to ongoing and integrated holistic

UNFPA, and many others have received treatment

fistula services in strategically selected hospitals; and

through partners such as EngenderHealth and

initiatives to ensure the survival of mother and baby, and

MÊdecins Sans Frontières, as well as through trained

to prevent a new fistula from occurring in the subsequent

expert fistula surgeons and teams who dedicate their

pregnancies of women who have received fistula surgery.

lives to restoring dignity to fistula survivors around the world.

More than 18 Campaign countries are working with fistula survivors to sensitize communities, to identify

The Campaign to End Fistula, 2010 Annual Report

The Maternal Health Thematic Fund, 2009 Annual Report

Neglected No More, 2010

Dispatch, May 2010

5

dispatch

and help other women with fistula and to advocate

repair surgeries in 40 countries, spanning Sub-Saharan

for improved maternal health at both the community

Africa, Asia and the Arab States.

The map is a major step forward to enhance

and national levels. There is no more powerful vehicle to deliver these important messages than a fistula

understanding of overall fistula treatment capacity.

survivor who, having suffered this life-shattering

While some progress has been made, the map clearly

condition herself, uses the experience to work as a

shows enormous treatment gaps in certain countries

fistula advocate or safe motherhood ambassador.

and globally, with only 14,000 (of the estimated 2 million cases) receiving treatment in 2010.

Together with Campaign partners Direct Relief International and the Fistula Foundation, UNFPA helped

The map is an evolving collaborative initiative and

create the largest and most comprehensive map of

will be expanded and continuously updated by experts

available fistula treatment services worldwide.

and practitioners from around the globe in the future.

The Global Fistula Care Map, launched in early 2012, highlights over 150 health facilities providing fistula

In collaboration with key partners, the Campaign to End Fistula has developed vital tools and guidance

Dispatch, May 2011

Dispatch, November 2011

Fistula survivor Sarah Omega

The Maternal Health Thematic Fund, 2010 Annual Report Dispatch, November 2010

66

to support countries in their work to address fistula.

The U.N. Secretary-General reports on obstetric fistula

Such tools include the FIGO-led competency-based

have noted encouraging progress in addressing the

training manual for fistula surgeons, a costing tool

condition in recent years. Despite these developments,

to assess costs of pre, post and operative care, as

the 2012 report emphasizes that, in the 21st century,

well as innovative fistula repair kits, supplying crucial

it is a grave injustice that fistula continues to affect the

specialized instruments and materials for fistula

poorest, most vulnerable women and girls, and that

surgery and care.

vastly intensified resources are urgently required,

Advocacy and awareness raising efforts have been targeted at a variety of audiences in both developed and developing countries, including policy makers,

including for the Campaign to End Fistula, to fight fistula and to help improve maternal health globally.

We know that much more needs to be done, however,

health professionals, media, and the public in general,

through the power of partnerships and the on-going

also contributing to resource mobilization for fistula

collaborative efforts of the Campaign, we are confident that

programmes, within and outside of UNFPA.

we are paving the way forward. Together, we can end fistula.

2013 Dispatch, Spring 2012

Dr. Lauri Romanzi, a New York-based fistula surgeon

The Maternal Health Thematic Fund, 2011 Annual Report

7

dispatch

International Day to End Fistula The UN recently designated 23 May as the International Day to End Obstetric Fistula, to be observed for the first time in 2013, during the 10th anniversary of the Campaign to End Fistula.

This follows the General Assembly’s Social, Humanitarian

The Resolution reaffirms the ICPD Programme of

and Cultural Committee’s adoption of a new resolution on

Action and the Beijing Declaration and Platform for

“Supporting Efforts to End Obstetric Fistula,” presented

Action. Moreover, the document notes that a human

by the African Union (AU) and adopted in 2012 with the

rights based approach to eliminating obstetric fistula

support of 168 co-sponsors from all regions.

should be underpinned by the principles of accountability,

The Resolution calls for further support in countries

participation, transparency, empowerment, sustainability,

with high maternal mortality rates, to accelerate progress

non-discrimination and international cooperation.

towards the achievement of MDG5, to reduce maternal

The fourth UN resolution to address the theme in

deaths, and to eliminate obstetric fistula. It also highlights

all history, “Supporting Efforts to End Obstetric Fistula”

the urgent need to address child marriage, to help raise

calls upon Member States to firmly support the activities

awareness and intensify actions towards ending

carried out by UNFPA and partners in the global

obstetric fistula.

Campaign to End Fistula.

Why the Campaign?

Every year, 7 to 10 million women suffer severe or long-lasting illnesses or disabilities caused by complications during pregnancy or childbirth, including obstetric fistula.

Obstetric fistula is a preventable and, in most cases, treatable childbirth injury that leaves women incontinent, ashamed and often isolated from their communities.

Campaign to End Fistula

605 Third Avenue, New York, NY 10158 email: fistulacampaign@unfpa.org

At least 2 million women live with obstetric fistula in the developing world, and up to 100,000 new cases occur each year.

dispatch is a biannual newsletter

In 2003, UNFPA and partners launched the Campaign to End Fistula. The Campaign is now present in more than 50 countries, with more than 80 international agencies involved and many hundreds more working on the ground in fistula affected countries.

highlighting developments in the Campaign to End Fistula

Editorial Process: Etienne Franca

Since 2009, UNFPA’s contribution to the Campaign has been programmatically integrated into the Maternal Health Thematic Fund, launched in early 2008 by UNFPA to support priority countries in their efforts to improve maternal and newborn health.

Special Collaboration: Gillian Slinger, Erin Anastasi and Christine Long Design and Printing: Prographics, Inc. Contributors: UNFPA wishes to acknowledge with gratitude the multi-donor support generated towards strengthening and improving maternal health in the world, through its core resources, through the Maternal Health Thematic Fund and through specific funding for fistula. Our appreciation is also extended to the numerous partners and individual donors for their collaboration and support to the Campaign to End Fistula since its inception.

With the Midwifery Programme, this integrated approach is contributing to further strengthen efforts to prevent obstetric fistula through improved access to quality maternal health services.

The Campaign, with its many partners around the world, focuses on three key areas: preventing fistula, treating affected women and supporting women as they recover from surgery and rebuild their lives.

For more information, please visit: endfistula.org

Afghanistan Pakistan

Bangladesh

Haiti

India

Guyana

Mauritania Mali Niger Chad Eritrea Senegal Yemen Sudan Burkina Gambia Faso Djibouti Guinea Bissau Guinea Nigeria Côte Sierra Central South Ethiopia d’Ivoire Leone African Sudan Liberia Cameroon Republic Ghana Benin Somalia Uganda Togo Congo Kenya Equatorial Gabon Democratic Guinea Rwanda Republic Burundi of Congo United Republic of Tanzania Angola

The designations employed and the presentation of material on the map do not imply the expression of any opinion whatsoever on the part of UNFPA concerning the legal status of any country, territory, city or area or its authorities, or concerning the delimitation of its frontiers or boundaries. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties.

Nepal

Namibia

Mozambique

Madagascar

Swaziland South Africa

Cambodia

Timor-Leste

Zambia Malawi Zimbabwe

Lao PDR

Lesotho

Campaign to End Fistula countries