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Enhancing Sexual and Reproductive Health (SRH) among ISIS victims in Kurdistan Region of Iraq (KRI)

HUMAN network aims to implement a community health workers' programme to address SRH health issues among ISIS-related victims in KRI

Photo of Goran Zangana
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What specific problem(s) are you trying to address?

The severity of sexual violence, in Iraq is alarming and has life-threatening consequences. Violations are committed with disturbing frequency against women and girls under ISIS control, when fleeing, and while in displacement. ISIS has used sexual violence systematically. While in displacement, women and girls experience high rates of partner violence, honour killings, sexual exploitation, harassment and child marriage. Forty-eight per cent of IDP families live in communities where violence within the home is a top protection concern. Female-headed households, widows, women and girls with disabilities, and adolescent girls, are at risk of abuse and face challenges accessing humanitarian aid. One in 3 child is at risk of sexual violence.

What are some of your unanswered questions about the problem(s) you are working to address?

1. How to address the sexual and reproductive health needs of ISIS victims? 2. Can a Community Health Worker (CHW) program be developed among the affected populations themselves? 3. To what extent can a community health worker program be integrated into the existing health system? 4. Can a CHW to specifically target the sexual and reproductive health needs of ISIS victims be used a starting point for a larger CHW for the whole health system?

Explain Your Idea

We shall select people among the refugees and IDPs themselves to act as CHWs. The selection process will use a number of criteria including: female, literate, able and willing to receive training and able to provide learned services. Victims themselves will be identified and encouraged to act as CHWs. Those selected will receive training in basics of sexual and reproductive health in general and the victims of the ISIS-related conflict in particular. The CHWs will also be trained in how to identify the major sexual and reproductive health issues among refugees and IDPs. They will learn on how to enter data from those individuals that they serve while, of course, preserving the identify of those they serve. The CHWs will be supervised by selected professionals by the Ministry of Health in partnership with HUMAN network. The supervisors will conduct weekly meetings with the CHWs to discuss each patient that they serve during that week. Problems will be addressed and questions will be answered during those supervision meetings. There will be also a referral system in place that allow CHWs to refer patients that need further assessment and management to primary or secondary health levels. CHWs will be provided with basic equipment to measure blood pressure, heart rate and temperature. They will be also provided with simple analgesics, vitamins and contraceptives. This project will be used as a starting point and as a pilot for a wider CHWs program in the region.

Name the three most important ways that your idea will address your identified problem(s).

1. Establishing a CHWs program: There are only 10 CHWs who are specifically working with IDPs and refugees in Kurdistan region of Iraq. Establishing a CHWs is the most effective and easiest way to address the sexual and reproductive health needs of IDPs and refugees. 2. CHWs from IDP and Refugee communities: Humanitarian action is usually criticized as being an 'outside' activity that is not sustainable and less able to genuinely address the needs of the community. Having CHWs from communities themselves will contribute to addressing this problem. 3. The health system is stretched: a CHWs will solve many of the problems of the system by providing simple and effective interventions at the communities.

How is your idea unique?

1. Involving the community itself: Rather than relying on international organizations and the existing health system, this idea will support communities to solve their own problems. This idea allows for the provision of health services that are more sustainable and more effective. 2. Less dependence on the existing health system: CHWs from communities themselves will allow the health system to free resources for other pressing needs. 3. Less dependence on international organizations: training refugees and IDPs to become CHWs will allow the communities to identify and address their own problems with less dependence on donors and international actors.

What are some outstanding concerns or questions that you have regarding your idea?

1. How to select the CHWs? is some prior knowledge in health or sexual and reproductive health necessary for the selection of the CHWs? 2. Formal recognition? is it necessary that the CHWs be formally recognized by the Ministry of Health to be able to function and provide services? 3. Place of work: is it necessary that the CHWs have a dedicated place within the refugee and IDP camps to provide services? what about the IDPs who are not in a camp?

Who are your end users?

IDPs Refugees Women and girls who are exposed to sexual violence Women and girls with reproductive health needs.

Where will your idea be implemented?

  • Iraq

What is the primary type of emergency setting where your innovation would operate?

  • Armed conflict

Tell us more about the emergency setting that you intend to implement in

Iraq is an ongoing emergency and conflict-affected setting. There is always the risk of recurrence of hostilities and further displacement. However, when a CHWs program is in place, such workers can help communities that are on the move or new ones that will be displaced. Culturally, it is always more difficult to address sensitive issues related to sexual violence, rape, forced marriage and other forms of violence. It will not be easy to frankly discuss and attempt to address sexual violence.

What is your organization's name?

Health and hUManitarian Advancement Network (HUMAN)

Tell us more about you.

HUMAN is a network of health organizations in Kurdistan region of Iraq. It is currently composed of 7 organizations. In the beginning, three organizations will be actively involved in this project. Public Aid Organization will be responsible for selecting the CHWs from identified refugee and IDP camps. Public Health Aid of Kurdistan will be responsible for training the CHWs. Health Policy Research Organization will be responsible for reporting, monitoring, and evaluation. The other organizations will be responsible for all other logistical and administrative matters related to this project.

What is the current scale of your proposed innovation?

  • Still in planning phase and does not exist yet

Experience in Implementation Country(ies)

  • Yes, for more than one year.

Expertise in Sector

  • Yes, for more than a year.

Organization Location

Kurdistan Region of Iraq

What is your organizational status?

  • Registered non-profit, charity, NGO, or community-based organization.

What is the maturity of your innovation?

  • Early Stage Innovation: exploring my innovation, refining, researching, and gathering inspiration.



Join the conversation:

Photo of Chelsea Takamine

Posted on behalf of Goran Zangana -

- You have clearly identified need for services among a population with high risk and little access to appropriate services. Bravo!

Thanks for the kind note of support. We actually were able to send our staff and volunteers to the refugee and IDP camps and explore the need for such service further. We are happy to share the result of that work as well.

- We're curious to know more about your practices to ensure the safety and security of the women. For example: protecting the anonymity of the women or providing appropriate service/care to these women in these communities.

We intend to protect the identity of women who access this. This will be done by giving each beneficiary an ID number. The ID number will compose of a letter that refers to the location of the camp. The letter will be followed by the initial of the camp and finally a number that indicates the number of the individual. For example for client number one from Bahrka camp in the governorate of Erbil, the code will be E_B_01. Each person will be provided with such ID that they and their service provider will know.

Individual CHWs will have supervisors. The supervisors will identify and act upon concerns that are raised by the CHWs or women to ensure the safety and security of beneficiaries.

Because the CHWs are from the communities themselves, services provided will be more appropriate to the needs of those communities. An initial survey was conducted during the refinement period to explore the needs of the women in the camps. Information from that survey will be used to tailor the services to the needs of the communities. Finally, continuous feedback will be obtained from beneficiaries continuously during the provision of services to further improve the service provided.

- Tell us more about your relationships with partners in this community. How do you intend to identify survivors to participate in the program? Are there plans to mitigate risks and challenges faced by these communities for participating in the idea?

As indicated in the application, HUMAN is a network of 7 non-governmental organisations in Iraq. More organisations and individuals have expressed interest in joining the network. We are planning on benefit from the knowledge, connections and capacity of those organisations for the purposes of identifying survivors to participate in the program. All of the organisations that are members HUMAN have operations in the refugee and IDP camps in Iraq.

After selecting CHWs from the communities themselves, the CHWs will be asked to identify survivors.

reliable key informants within the communities will also be asked to help identify survivors. The beneficiaries of the services of the partner organizations will be approached to identify survivors among them who might benefit from the services of this idea.

As mentioned above, the identity of the survivors will be kept secret. Each individual will be provided with an ID that only the CHW, survivor, and supervisor will know. Referal to other services will be also made if necessary only after a formal consent is obtained from the survivor.

- Can you clarify your criteria in identifying users? For example: have you considered expanding your approach to include other types of violence than sexual violence in your idea? How will you tailor your approach to provide services to these women?

The following criteria will be used to identify users:
1. Female.
2. Survivor of sexual and gender-based violence
3. Refugee or IDP
4. Other forms of violence against women that have sexual and reproductive ramifications will also be considered. For example, torture can have severe mental health consequences. When faced with users that have mental health needs, they will be either referred to appropriate service providers, or the CHW will receive additional training and support to provide such services.

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