healthcare – UAB Institute for Human Rights Blog

Attack on Gender-Affirming Healthcare in Texas

After decades of systemic and societal discrimination, an array of hope burst through the clouds of despair for transgender individuals. Recently, greater acceptance of transgender individuals in modern culture has opened doors to accessible and evidence-based transgender healthcare. Budding healthcare infrastructure has helped transgender individuals transition and care for their changing bodies providing relief for the marginalized community. Healthcare professionals and teams of scientists worked for decades through societal judgement and the subsequent roadblocks to ensure that the transgender community had an improved chance at a healthy life as non-transgender individuals. However, increasing vitriol exacerbated by politicians has tightened restrictions for gender affirming healthcare across the United States.

Cube beads spelling the word “transgender”; Source: Unsplash

Introduction

In February 2022, Texas Governor Greg Abbott and Attorney General Ken Paxton released a directive stating that gender transition therapies including hormone therapies, puberty blockers, or surgery given to minors can be investigated as child abuse and given criminal penalties. Officials, teachers, parents, nurses, and anyone involved in direct contact with children were required to report suspicions of such therapies, framing the act more as concern for children’s safety and innocence. Anyone found supporting or prescribing such treatment, including parents or healthcare providers, would be subject to child abuse investigations by the Texas Department of Family and Protective Services. The agency was instructed to prioritize cases in which parents who provide their transgender children with gender-affirming care above all other child abuse cases. Strangely, the caseworkers were told to investigate regardless of whether the standard of sufficient evidence was met and to not record their investigation in writing.

Days after the directive was announced, the Texas Department of Protective and Family Services launched an investigation into a federal employee, a mother of a transgender daughter, after she inquired when the directive would be made effective. A federal judge blocked the investigation only 2 days later. In the immediate weeks following the directive‘s release, at least nine families were already facing child abuse investigations for supporting their transgender children in obtaining gender-affirming care. This past spring, the clouds in an otherwise tranquil sky began to blot out blossoming hope as intimidated healthcare providers canceled hormone prescriptions and the few existing transgender youth treatment facilities closed. Families clamored to find alternative sources of hormones and puberty blockers for their children. Some became afraid to claim the transgender label, many moved out of the state, and hundreds more were at home, fighting for their right to exist as their gender identity and as themselves.

Image of protest with posters listing "Transgender Healthcare" — Image of protest with posters listing “Transgender Healthcare”

Medical Evidence

In a statement to the Texas Tribune, U.S. Surgeon General stated that this directive interferes with the physician-patient relationship which has no place for religion, beliefs, or politics. Abbott’s directive and Paxton’s following opinion sparked intense backlash from the medical community for blatantly ignoring decades worth of research supporting early transitional care.

When children first learn that they are transgender, they face a physical and mental health disorder known as gender dysphoria. Gender dysphoria is a condition where individuals experience severe dissonance between the gender they identify as and the physical manifestations of their biological gender. Depression, anxiety, and suicidal thoughts often follow this sense of “not self” that plagues many adolescents as they begin to come out to the world with their new name and pronouns. To significantly improve the outcomes of transgender individuals, all major medical organizations including the American Academy of Pediatrics, American College of Physicians, and American Psychiatric Association support gender transition as an effective therapy. Transitioning includes gender-affirming hormonal therapy and puberty blockers. Hormonal therapy begins and allows for a smoother transition into the opposite gender while puberty blockers suppress the body’s natural maturation process to increase the amount of time children and their bodies have to transition into a new gender. In the meantime, individuals receive mental health support and preparation for a successful transition and in unfortunate cases, wait for legislation to increase access to gender affirming treatments.

Overhead view of medications and hormone therapy. Source: Unsplash

The most prevalent medical reason for opposing gender transition is the possibility that a transgender individual will have regrets, because what is done cannot be undone easily. Although it is a valid concern, puberty blockers exist for children and individuals who are uncertain about their gender, because they provide ample time for the individual to choose not to change genders, if that is later realized. In addition, regrets are “extremely rare” and can be attributed to adverse social climates more than personal attitude. Proper mental health support and preparation are also important for a successful gender transition to recognize behavioral changes and tackle the paradoxical shared sentiment that transgender people are no longer welcome in conservative society.

Alabama and Florida Response

Governor Abbott’s attempt to restore conservative values in Texas is not a new phenomenon. Texas has seen several bills criminalizing medical care for transgender children which is reflective of a broader trend across the United States. In the past year alone, 21 states drafted bills to deny transgender medical care. Arkansas passed a bill making it illegal to prescribe puberty blockers and for insurance companies to cover transgender care. Other conservative states, such as Alabama, have taken Abbott’s directive as a green light and are preparing legislation to discourage transgender healthcare and marginalize the LGBTQ+ within their borders. Taking a slightly different approach, Governor DeSantis of Florida introduced what is commonly referred to as the “Don’t Say Gay” Bill (House Bill 1557). Also known as the Florida Parental Rights in Education Act, the bill was signed into law and passed by the Florida Senate in March 2022. This bill would effectively prevent gender identity and sexual orientation education in classroom discussion in Florida. Experts worry that the vague descriptions in the law indicate that it be used it to suppress all actions that remotely fall under the literal definition of sex and gender, leading to a dangerous slippery slope that may open a dark path of minority discrimination.

Black and white image of a protest with the phrase "No Body Is Illegal" centered. — Black and white image of a protest with the phrase “No Body Is Illegal” centered.

On April 8th 2022, Alabama Governor Kay Ivey signed into law two bills preventing medical professionals from providing gender-affirming care and forcing individuals to use the restroom of their biological gender. In an unprecedented move, the Vulnerable Child Compassion and Protection Act makes arranging gender-affirming treatment including puberty blockers, cross-sex hormones, and surgery for children under 19 a felony with a possible sentence of up to 10 years in prison if convicted. The second bill is culturally similar to Florida’s “Don’t Say Gay” Bill. This bill prohibits teaching or using words related to “sex” and “gender.”

Current Status

A lawsuit filed by families of transgender children weeks after Abbot’s directive was announced resulted in an injunction from federal courts. Abbott vs Doe reached the Supreme Court in May 2022 during which the court ruled that Abbott had no authority to control child welfare officers and direct them to investigate providing transgender healthcare. The country released a sigh of relief, but the fight is not over. Stopping Abbot’s directive seems more akin to a pause on the right’s crusade against the transgender community than a stop.

Recent reports from The Washington Post also suggest that Attorney General Paxton attempted to collect gender marker changes and other transgender identifying information on driver’s licenses from the Texas Department of Public Safety in early 2022. Human Rights Campaign reports that Paxton’s office requested the names and license plates of these individuals later in the inquiry, as well. This news comes as a new shackle for transgender Texans. Some have changed back their gender identity on their licenses to the way it was prior. If not, police or other government officials would know of their transgender identity with the search of their name during traffic stops or unrelated incidents which could lead to dangerous discrimination.

To support the fight for transgender safety in Texas, support politicians and lawmakers who oppose legislation limiting transgender healthcare. Advocate for the reopening of the University of Texas’s youth transgender clinic, the only one of its kind in the southwestern United States, that closed last November. People in Texas and across borders can also donate Lambda Legal and the American Civil Liberties Union (ACLU) which are organizations working to keep the injunction in place on Governor Abbott’s directive after AG Paxton filed an appeal against the federal court decision. They, in conjunction with the Transgender Education Network of Texas and Equality Texas have also assembled the LGBTQIA+ Student Rights Toolkit which is a set of explanations and guidelines to understand Texas’s current plight as well as additional resources such as TX Trans Kids.

A Firsthand Perspective of the Humanitarian Needs of IDPs in Cameroon

Cameroon, once a bastion of peace and tranquility, is now a nation beset with a series of violent and armed conflicts. Since late 2016, an armed conflict between the state defense forces of Cameroon and the non-state armed groups (NSAGs) of Southern Cameroons’ has ravaged the country. In the last six years, there have been more than 6,000 deaths, 765,000 internally displaced persons (IDPs), and 70,000 registered refugees in neighboring Nigeria, with approximately 2.2 million people in need of humanitarian aid. The Norwegian Refugee Council has referred to the conflict as one of the most neglected in the world. The long-term human capital consequences of this conflict are enormous.

A more comprehensive background of the armed conflict and humanitarian crisis in Southern Cameroons can be found in a previous IHR blog post, “Cameroon, a Nation Divided”.

Map of Cameroon. — Source: via Yahoo Images

It is against this backdrop that the Cameroon Humanitarian Relief Initiative (CHRI) in partnership with the Institute of Human Rights (IHR) co-hosted an international webinar, “Updates on the Humanitarian Crisis from the Ongoing Armed Conflict in the Southern Cameroons” on the 18th of October, 2022. The aim of this event was to discuss the current humanitarian crisis from a multi-perspective panel. The speaker biographies can be found at the bottom of this blog post.

Excerpts from this webinar were edited and woven together for this blog post. The full recording of the webinar is available on request by contacting ihr@uab.edu.

Overview

What are the current humanitarian needs for Internally Displaced Persons (IDPs) in Southern Cameroons?

Atim Evenye: The current context and the magnitude of the ongoing crisis in the Northwest and Southwest regions remain tense. There is continuous violence in targeted areas. We have the destruction of properties. We have abductions and kidnappings of both community people and administrators. We have killings and local arrests. We have continuous attacks on schools and students. Humanitarians face threats and direct [armed] attacks. [These are carried out] by both parties, the non-state actors and the state defense forces.

The population [has] really [been] under duress and stress for over six years.

Food Security: Atim Evenye: When it comes to the current needs for IDPs, at the moment, I would say food security remains one of those outstanding needs. Especially in the rural areas, because these IDPs have fled their place of abort. They don’t have access to their farms. [As such,] they don’t have the economic capital [for even] daily subsistence. So, there is a lot of dependencies now on family members, [or] world food programs, and other humanitarian organizations bringing food assistance in the area.

Education Accessibility: Atim Evenye: There is a strict restriction around education. In [the rural areas] of the Northwest and Southwest regions, we have children who have not been able to go to school until date. In urban areas, there is a possibility of schools for those who can afford it. Currently, in our zone in the Northwest and Southwest regions, we have lost one month [of school this term], because we are only starting now. So, it becomes challenging on how to catch up. There’s a need for accelerated learning. [Additionally,] teachers have been abducted [and] schools have been burned. [To add to that,] there is a lot of psychological trauma, [as] many children have witnessed or experienced violence firsthand. Both the state and non-state actors [are] not conscious of the impact their actions are having on children. The government doesn’t want to hear about community schools as prescribed by the separatist. So, it’s really very challenging to access education.

Dr. Emmanuel Nfor: Education is one of the issues at the origin and at the core of the crisis, and formal education has been used by NSAGs, [the non-state armed groups], as a political instrument. NSAGs have advocated and enforced a “no school policy”, leading to public school closures for the past four years in many areas. More than fifty percent of threats against buildings in communities have been directed against schools, and many school buildings have been taken over by organized armed groups. Accessing education in emergency services, or going to school in such a volatile environment, is proven to be risky for children, as well as for teachers. Pupils who were in school in most rural areas have dropped out, some joining armed groups, others displaced, and some have outgrown their ages for the classes in which they were and cannot continue. Many parents have lost their means of livelihood and are unable to sponsor their children in school. Despite repeated calls from humanitarian and human rights organizations for education to be depoliticized, schools have been burnt, teachers and students intimidated, kidnapped, and even killed, and some have seen their hands chopped off by members of armed groups.

Gender-based violence (trigger warning): Atim Evenye: We see [a great deal] of gender-based violence. In certain assessments we have conducted, for example, [many of these] young girls in rural areas are not able to go to school. What are they left to do? There is a lot of harassment, rape, and [sexual assaults]. They’re looking for five hundred francs CFA, that’s like one dollar, to [be able to just buy] food to eat. So then, they depend on young men to give them that money. And at the end of the day, they [get pregnant and become] teenage mothers. The whole cycle is really detrimental, it’s a really difficult one.

Dr. Emmanuel Nfor: Sexual violence is rampant, as a direct consequence of the crisis but also due to decreasing livelihoods, negative coping mechanisms, and lack of protection structures. The boy child is an endangered species, at risk of accusation and arbitrary killing from GFs [state defense forces], and forced recruitment by the NSAGs. There are no specific programs by both UN agencies and Internal bodies that address the needs of the boys.

Housing: Dr. Emmanuel Nfor: If we look at where the IDPs in particular are, we have IDPs that are living in the rural areas, in the bushes. We have those living within host communities. We have some that have been able to rent. [But if] they are able to pay for accommodation, [there are] a lot of difficulties because they want them to pay upfront, and they cannot do it. In all three groups, they lack basic WaSH and health services, NFIs [non-food items], and protection from natural hazards. Those who fled to other regions face stigma and severe protection risks related to exploitation, and socio-economic vulnerabilities including extortion, sexual exploitation, and child labor.

Healthcare: Atim Evenye: The next principal need I would say is around healthcare. In recent times we have [had] heath centers burned, and the staff attacked. So, it’s really challenging. Statement needs to be completed, even before the crisis, access to health care has been a serious challenge, especially in rural areas. And then, currently, with the crisis, it’s even more exacerbated. It becomes difficult now [for] humanitarians on the ground who are trying to meet the needs of these people. Take, for example, Doctors Without Borders. They have [had] to put their activities on the hold because they had issues around access [and safety] of their staff.

Dr. Emmanuel Nfor: [There is a lot of] healthcare [needs] for the vulnerable. [Safe practices in regard to] water, sanitation, and hygiene are not being followed. People who live in rural areas don’t have a good source of water. But they could be educated on the fact that even though your source of water is doubtful, you could take it, you boil it, you purify it, or you do something to make it [potable]. That education, they don’t have, or the chemicals for water treatment. Additionally, there is a lack of emergency medical and psychological units, to provide emergency care to the wounded and psychosocial support to those traumatized by the violence. We can educate people on how to prevent simple infections. How can you prevent diarrhea infection? How can you prevent malaria? If this education is done, it could be [one] way to [improve basic healthcare].

Healthcare, which is supposed to be a protected area, unfortunately, has not been the case in this conflict. We have had health centers closed; more than fifty percent of the health centers in rural communities have been closed. Not only the health centers, [but] the health workers do not feel comfortable staying there. So, a lot of them have abandoned [the centers]. The [people] left in these communities cannot access healthcare. Women cannot access antenatal clinics. Vaccinations [are] not being done, and thousands of children are at risk of contracting common vaccine-preventable infections.

The population has been abandoned to themselves.

Health centers that are open in semi-urban and urban areas are overwhelmed by people who have [been forced by the conflict to flee]. And what’s worse is that most of those who have [fled] do not have the means to pay for the treatment. We have some health centers that have accumulated huge unpaid bills because those who access healthcare cannot afford to pay those bills. For the facilities that are open, IDPs cannot afford to pay for the treatment that is given to them.

We have [also] had cases of drugs and other medical equipment [being] seized along the way by organized armed groups. So, it’s difficult to render care because the drugs and medical supplies do not reach the vulnerable in the hard-to-reach areas. Free supply of drugs and medical equipment is disturbed by locked downs, roadblocks, and/ or are seized at gunpoint.

Then the last very worrying thing is that healthcare workers are being attacked or kidnapped for ransom. A lot of them have been attacked both by the non-state actors and by the state forces; [health workers are] kidnapped by the non-state actors and/or arrested by the [state forces]. So, it is not safe [from] either side. They see you as collaborating with the other, and [so the question is] whether you should treat wounded combatants or not. According to the healthcare regulation, we take any wounded persons as patients. But unfortunately, when these [combatants are] treated, we [the healthcare workers] are blamed. The non-state actors blame you for treating the state forces. The state forces blame you for treating the non-state actors. It’s really a dilemma in which we are in.

Future Directions:

Looking towards the future, are there any resolutions to the humanitarian crisis in Southern Cameroons that you can think of that can be implemented at this point?

Dr. Emmanuel Nfor: I think the first thing we need to consider for the humanitarian crisis is that we need to speak the truth.

We need to make a truthful appraisal of what is happening on the field. Address the needs. For example, we are told that the crisis in Cameroon is one of the least funded in the world. Why? Because the data and the reposting are for some reason concealed.

So, if we must be able to go forward with the humanitarian situation, we need to know how many people are living in the bushes, how many are living in host communities, in what conditions are they living, and be able to address it. [These] figures are often contested, they say the number is lower, or they want to sway the number for their gain. So, we must start with you right data. If we have the right data on needs, it will be possible to see where the solutions should come from.

Possible resolution options, specifically for the humanitarian crisis, could consider the following:

-A community-based approach to raise awareness of protection risks in the community and identify and support community-based solutions.

-Advocate for access to civil documentation, especially birth certificates, to avoid a stateless generation and mitigate protection risks associated with a lack of civil documentation.

-Support community mediation of localized conflicts to reinforce the dialogue between host communities and IDPs and avoid tensions within the communities.

-Advocate with parties to the conflict to respect the protection rights of communities, and respect International Humanitarian Laws.

-Finding durable solutions for IDPs intending to stay in their host communities, like those who have established businesses in the new areas.

-Shelter support in rural areas as a high percentage of households live in tents or informal collective shelters

Atim Evenye: When it comes to setting strategies that we can use to resolve this conflict, I would say it’s imperative, for the powers that be to consider the roles of different parties in the conflict. There is a need for parties in this conflict to come to the table and talk. There is a need for dialogue. There is a need for unity. We need to have a unity of purpose, to push our agenda in one voice.

True is the fact that they have been the major national dialogue, [there] have been consultation meetings and other forms of dialogue in smaller circles. But the question is, during this dialogue are the needs of the different parties considered?

For example, we have women who have suffered a lot as a result of this conflict. But at the same time, we have that arm of women who are also seeking solutions on how to resolve the conflict. Women are now spearheading and speaking for themselves. And I think, there is a need to give a listening ear to what the women are saying because I think time in memorial, women have always demonstrated that ability to resolve conflict. So, one way to consider the proposals that women are giving here in Cameroon.

Secondly, there is a need to give academia and research a place. There are a lot of people in the academic who are gathering data, but the fear around it is the dissemination of this information. The administrative system is such that once you do a publication that is not supportive of what is happening, you get targeted. And by both sides. Thus, we try to be balanced in all information dissemination. There is a need for that deliberation and freedom of speech, especially in the area of academia. People should not be afraid to publicize or to make public the research and the results of what they have found in the field. So that’s another way that can be an added value to the approaches to conflict resolution.

Also, there is a need to consider the root causes. The conflict did not just start like that, it degenerated along the line. So, there is a need to go back to the drawing board and understand what pushed the Southern Cameroonians to arrive at this point. What are the different trends that have been changing through the crisis?

When it comes to how to resolve the humanitarian crisis, I think the humanitarian needs are more than what the humanitarian organizations can do, funding is very limited. It’s obvious that humanitarians cannot meet all the needs. So where should we turn to? We should turn to other actors who can bring assistance. We have development actors who can bring resilient, [long-term, skills-building] projects so that the communities will not be too dependent. The people of the Northwest and Southwest have never been those who are dependent on handouts.

They are people who are hard-working. We hear the aches of people wanting to be self-sustaining. They want to just be, to go back and be what they had been doing [before the conflict].

Dr. Emmanuel Nfor: If we don’t put away falsehood, if we don’t speak the truth and have the right data and have the right information about what is going on, on the ground, we will continue for many more years doing much but with very little impact.

The people of Northwest and Southwest can lead by themselves. These are hard-working people. They just need to be empowered, to go back to where they have lived before. There are many people who are longing to go back home, but the problem is that they go to homes that have been burnt. They go to farms that have been abandoned. They go to be reminded of the horror. So, we need psychological treatment and support. We need some form of equipping them to be able to cope with what they have lost. We should be able to end the hostilities and give people the opportunity to go back home.

So, we should rather empower them, than continue to give them aid. Let peace reign, [so that] we can empower them to reveal what they have lost and then see how they can bring up that life again. [Then] we can go forward. But hostilities should cease, and we should speak the truth; to face each other face-to-face and speak the truth.

Speaker Biographies

Atim Evenye Niger-Thomas, received a Ph.D. in Student Conflict Management and Peacebuilding at the International University of Applied sciences for Development (IUASD) Sao Tome in partnership with IPD Yaoundé. Since 2016, Atim Evenye has worked and grown in different roles at the Authentique Memorial Empowerment Foundation (AMEF). Currently, she holds the position of Assistant Director and trainer for Humanitarian Negotiation. Under this supervision, AMEF has grown to be one of the leading humanitarian organizations in the Southwest Region. AMEF runs four core programs namely, Education and Child Protection (ECP), Economic Development and Livelihood (EDL), Gender, Protection and Peace (GPP), Health/Nutrition/ WASH (HNW).

Dr. Nfor Emmanuel Nfor, holds a PhD in Medical Parasitology from the University of Yaounde I, Cameroon. In February 2017, he joined the Cameroon Baptist Convention Health Services (CBCHS), as the Malaria Focal Point. While working with the CBCHS, he attended a Peer Review Workshop on Humanitarian Negotiation organized by the Centre for Competence in Humanitarian Negotiation (CCHN) Geneva. After many other online courses, and several National and International Conferences, he was appointed Trainer and Advisor of Humanitarian Projects within the CBCHS. In this capacity, he coordinated projects executed by the CBCHS with funding from WHO, UNICEF, and UNFPA. He has been at the forefront of Humanitarian activities within the CBCHS during the ongoing sociopolitical crises in the North West and South West Regions of Cameroon, working closely with the Cameroon Humanitarian Response Plan.

This is the second in a series of blog posts that will look further into the conflict in Cameroon. Each month a humanitarian need and/or organization working in response to the humanitarian crisis will be featured on the UAB Institute for Human Rights’ blog.

The Implications of an Abusive Command Economy on the Rural People of North Korea

Four young Korean children stare sorrowfully through an open window with blue doors. Their ribs are visible and their arms are skinny. — Malnutrition in childhood leads to long-term physical and cognitive health effects. By limiting resources to impoverished communities, the DPRK holds control over the bodies and minds of these people. Source: Yahoo! Images

Note from the author: This post is the first of my four-part series on the North Korean Regime. To find the other parts, scroll down and click “View all posts by A. Price.” If the other parts are not available yet, check back in during the upcoming weeks when they will be posted.

Content Warnings: mass financial abuse, famine, malnutrition, dehumanization, classism, starvation

Imagine grocery shopping for your family, and instead of finding a variety of food choices, you find a store filled with a surplus of children’s socks, different colored hats, and beach toys even though you live nowhere near the coast. The only food you can find in the store is a few loaves of moldy bread, a small produce section filled with rotting vegetables, and a frozen section with freezer-burned packaged meat. The best you can do is buy a bag full of rotting vegetables and plant them in the ground behind your house, careful not to be caught doing so by the police. The soil you remember being rich with vitamins has turned to gray dust, and everything you plant dies before sprouting. Your family will live off the rotting leftovers from last week’s grocery trip until you can scrounge together enough scraps to make it through. You know that your neighbor has a secret garden that does moderately well, so you sneak over to offer her what’s left of your money in exchange for a few vegetables. If the police catch you exchanging goods, you and your neighbor will be charged for participating in a free market, thrown in a prison camp without a fair trial, and held for an unregulated amount of time.

The only media you’ve ever seen tells stories of a utopia; the Kim family is sent from heaven to make the Democratic People’s Republic of Korea (DPRK), also known as North Korea, the most wonderful place to live. They tell you that people in other countries, like South Korea and the United States, live under terrible governments who do not care for them the way the Kim family cares for you. In the end, you have no reason not to believe them. You have never seen the conditions of other countries and any criticism of your regime has been consistently disputed throughout your entire life. The stark reality of your consistent mistreatment exists in a dichotomy with the ideals that you have been brainwashed to believe to be true.

Approximately 20 million rural North Koreans live in this reality…

Songbun

The class system of North Korea is called Songbun. At birth, each North Korean citizen is labeled as core, wavering, or hostile based on their place of birth, status, and the national origin of their ancestors. For example, a person whose ancestors immigrated from South to North Korea will be given a low Songbun and be assumed to have genetically inherited hostility towards the government. One’s Songbun can never be changed, as it determines every aspect of one’s life including how resources will be allocated to your community and how much mobility you will have throughout the state.

The Command Economy

The Workers Party of Korea (WPK), more commonly known as the North Korean Regime, holds tight control over the command economy and uses it to abuse all people of low Songbun, specifically those who live outside the capital, Pyongyang. Instead of ordering the production of valuable goods like food and home maintenance products for their communities, they overproduce menial things, like children’s socks and beach toys. Many do not have the mobility to go to a neighboring town for resources, and as I will expand on later, many believe that they deserve to starve if they are not entirely self-sufficient.

This economic system has the dual effect of limiting opportunities to participate in the job market. People are not allowed to sell products unless they are commanded to do so by the WPK. Because the WPK is not tasked to create job opportunities for rural people, these people have no opportunity to make money, which only exacerbates the problem of reduced resources.

Lots of brightly colored shoes are piled onto shelves and hanging from the walls and ceilings in a Korean store. There are yellow signs with red and black text in Korean — The overproduction of menial things at the expense of food and necessities. Source: Yahoo! Images

The March of Suffering

The culture that encourages the idea of “suffering for the greater good” is called juche. Juche is the Korean term for the culture of self-sufficiency. It is an idea that is pushed hard into the minds of all North Koreans. Asking for help, depending on friends or family, or participating in a small-scale economy of goods with your neighbors makes you an inherently weak person because you are expected to work harder instead of “begging”. This idea is so ingrained in the minds of North Koreans that they will accept immense abuse from higher-ups at the expense of asking for help or demanding rights.

Starting in 1990, a great famine swept the nation under the rule of Kim Il-Sung. He coined the term “The March of Suffering” to refer to the famine. Using this name, he convinced those who took the hardest hit, the rural people of low Songbun, that they were doing the most honorable thing for their country by suffering in this famine. They were dying for it. Kim Il-Sung glorified their suffering by convincing them that not only did they deserve it (juche), but that their suffering was contributing to the greater good of the country. He had such control over the minds of these people that they loyally followed him straight to their graves.

Handled correctly, this famine could have lasted no longer than a year, and would not have become nearly as severe as it has. Instead, estimates from Crossing Borders suggest that between 240,000 and 3.5 million people have died in the DPRK from malnutrition since 1990.* The famine has outlived not only Kim Il-Sung but also his predecessor Kim Jong-Il.

*The reason for such a wide range of statistics is that collecting accurate data in North Korea is virtually impossible. I expand on the use of outside media control in the second part of this series titled, “How the North Korean Regime Uses Cult-Like Tactics to Maintain Power.”

The camera is facing down a building-lined street. The buildings are neutral colors and appear old. There are two trees with no leaves. There is a group of people all wearing the same dark green/blue clothing. One person is dressed in bright blue and standing in the middle of the street. — Even in Pyongyang, vibrant colors are rare. The buildings are drab and dull, the trees are dead, and people dress monochromatically and uniformly. The person in bright blue serves as a traffic director. Source: Flickr

Suppose the topic of North Korea is interesting to you and you want to work towards clearing up the fog surrounding the nation. In that case, I highly recommend Dying for Rights: Putting North Korea’s Human Rights Abuses on the Record by Sandra Fahy. This book is very informative and one of the only easily accessible, comprehensive accounts of North Korean human rights. It is where I learned most of what I know about the DPRK. It set the baseline on which I built my entire comprehensive understanding of the social systems at play.

The cover of Sandra Fahy’s book. The picture on the cover is taken through a fence in North Korea. The camera’s focus is on the background, making the fence of the foreground very blurry. The view of the fence consists of a top white metal bar and five vertical bars that are red and white. In the background, which is in focus, we look over a small body of water to see a few densely packed and desolate-looking houses. The grass and trees out front are dead. There is snow on the ground. The sand is rocky and gray. There is one bright blue structure that looks like a child’s playhouse starkly contrasting its desolate surroundings. Above the fence, text reads, “Dying for Rights: Putting North Korea’s Human Rights Abuses on the Record; Sandra Fahy.” — The cover of the aforementioned book. Source: Fahy, Sandra. *Dying for Rights: Putting North Korea’s Human Rights Abuses on the Record*. Columbia University Press, 2019. Picture taken by A. Price.

As I will expand upon in the rest of this series, it is imperative that people outside of the DPRK “clear the fog” and find ways to look into the state. One of the biggest motivators for activism is awareness. As people on the outside, some of the most valuable things we can do are spread awareness, garner activism, and bring that activism with us into our participation in the government, whether that be running for office or simply voting for people who share our concerns.

If you are not registered to vote, you can do so here: Register to vote in the upcoming midterm election today.

International Day for The Eradication of Poverty

Monday, October 17th is the International Day for the Eradication of Poverty; in 2022 we have a lot to acknowledge and a lot of work to be done. The theme for this day of commemoration is dignity, focused on how every human has the right to live with pride for themselves and respect from others. The first line of the Preamble for the Universal Declaration of Human Rights (UDHR) emphasizes the importance of how the “…recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,” and that is precisely the ideology behind the founding of this human rights holiday. But why, exactly, is poverty an international human rights issue?

History

Global poverty is defined as “lacking enough resources to provide the necessities of life—food, clean water, shelter and clothing. But in today’s world, that can be extended to include access to health care, education and even transportation.”

This international day of recognition was adopted by the United Nations in December of 1992 to recognize the structures that cause poverty, to listen to and amplify the needs and desires of impoverished persons, and to place a specific focus on how the international community and global leaders can work to solve this persistent social problem. October 17th was chosen to observe this topic because on this day in 1987 a crowd of over a hundred thousand protesters gathered in the Trocadero Plaza of Paris, France to honor the victims of extreme hunger and poverty. In commemoration, a stone was placed in the Plaza, now renamed the Plaza for Human Rights and Liberties, engraved with the following message from Father Joseph Wresinski, “Wherever men and women are condemned to live in extreme poverty, human rights are violated. To come together to ensure that these rights be respected is our solemn duty”.

The right to live free of poverty is not listed in the UDHR, but our current understanding of poverty constituting a violation of human rights has been developing since before the UDHR was proclaimed by the United Nations General Assembly in 1948. This is because living in extreme poverty is almost always accompanied with a loss of essential human rights that were explicitly enumerated in the UDHR, like the right to health, safe food and water and the right to adequate housing as illustrated in Articles 25 of the UDHR and the Human Right to Water and Sanitation. Even in developed and wealthy nations, citizens living in poverty experience obstacles in their ability to access the right to education, work, and political participation named in Articles 21, 23, and 16 of the UDHR.

While persons living in poverty are often denied many, if not all of those fundamental human rights listed above, this holiday gets its theme from Article One of the UDHR, from which this holiday gets its theme: “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.” Those in poverty often lose this right as limited access to the essential requirements of a quality life places them in a position where they rely on the aid of others, who often treat the impoverished as less than equals. They are patronized and degraded in their daily lives, and the social response to an impoverished person exercising their agency to decline charity is typically one of rebuke.

The Current State of Poverty

Global poverty rates have increased since the beginning of the Pandemic in 2020, and World Bank estimates that we have been set back 3-4 years on our path to ending extreme poverty as of October 2021. In addition to climbing unemployment and poverty rates is the leap in inflation, which has climbed globally as supply chains stretch thin. The Pew Research Center has found that the global middle class shrank while the global poor increased as the pandemic progressed, disrupting the progress of developed nations around the world, particularly in Asia and the Middle East.

These economic impacts affect more than immediate financial conditions of those involved. One side-effect has been a loss in education; as the United States and other wealthy countries moved online in response to the pandemic, other nations (particularly in the Global South) had to close schools entirely. Human Rights Watch has noted that, for millions of school-aged children, the pandemic effectively ended their formal education as alternative school options were few and the need for work and additional income rose. The International economic recovery will be challenging, and may take years to accomplish, but it is paramount that we keep the most vulnerable, both their dignity and agency, in mind as we navigate our collective path forward.

International Human Rights holidays are often overlooked due to their focus on what are often perceived to be niche categories outside of major religious or cultural practices. However, observing human rights holidays is a practice that allows for shared positivity and encouragement as we mark progress and victories in the field. They also provide days of unity to focus on pervasive issues that still need attention and work. On this holiday, join me in taking the time to think about how poverty affects your community, how your community has responded, and how it can alter that response to alter the quality of life for its impoverished population.

Pakistan’s Floods : A Humanitarian and Climate Crisis

One third of Pakistan is underwater following disaster-level floods that have ravaged the country since mid June of 2022. The flooding is a humanitarian crisis of epic proportions, bringing climate change and environmental justice into the focus of conversations about why the floods are so devastating. The record-breaking monsoon rains have affected 33 million citizens, leaving millions displaced and threatening the economy by washing away the fall harvest and essential farmland. Pakistan’s most vulnerable are struggling to access the scarce aid that is available, including the 19 million children affected by the floods. It is an unprecedented, once in a century crisis event exacerbated by climate change, poor infrastructure, and the damages of the recent economic crisis prior to the flooding.

Direct Impact of the Floods: Hunger, Disease and Displacement.

The monsoon rains have killed over a thousand people, roughly 400 of which are children. However, hunger, thirst, disease, and shortages of essential supplies threaten the lives of even more; millions of Pakistani people have been displaced over the course of the floods since June. The United Nations Refugee Agency has estimated that 6.4 million people are in need of immediate support.

Any discussion of rebuilding has been shelved in submerged regions as the flood waters may not recede for months, leaving the thousands of kilometers of roads, tens of thousands of schools, hundreds of thousands of homes, thousands of essential healthcare facilities destroyed by floodwater, and prior residents stranded or displaced. In addition to the initial death toll from the floods, the Pakistani people are facing immediate dangers of water borne disease, lack of access to food, water and shelter, and risks of violence; especially for women, children, and minority groups.

The country’s health system has faced substantial blows, both from loss of structures and supplies caused by the flood and the overwhelming need of those affected. Dehydration, dysentery, cholera, malaria, and dengue fever are ravaging make-shift camps as the flood waters become stagnant and clean water and sanitary supplies become harder to come by. Sindh Province, the second-most populated province in Pakistan, and one of the hardest-hit by the floods, has seen over 300 deaths from water borne-diseases since July. Early disease surveillance by the WHO has revealed that tens of thousands of cases of flood water-caused diseases are already present amongst those within reach of relief efforts. Countless villages remain stranded as roads and highways are underwater, so the true number of deaths, displaced persons, diseased, and persons otherwise impacted by these crises are expected to climb as more recovery efforts continue to search the flooded regions.

Without international aid and intervention, an epidemic of disease caused by the floods will cause a second wave of deaths in Pakistan, of which the elderly, children, and pregnant women will be the largest groups facing losses. International aid, medical and humanitarian organizations have joined the Pakistani government and are regularly dropping medical supplies, malaria nets, food and provisional shelters, but the need continues to grow as more people find their way to temporary camps and the rate of disease climbs.

Human Rights & The Most Vulnerable

A nation’s most vulnerable populations are often the ones who suffer the worst effects for the longest time after a natural disaster like these floods. For Pakistan, those vulnerable groups are women, children, the Khwaja Sira (transgender) community, those living in extreme poverty, religious minorities, and other marginalized groups. Typically, socially disadvantaged groups are living in regions with lesser infrastructure, facing the initial worst impacts of natural disasters, but marginalized status often leads to upwards battles to access humanitarian aid after the disaster as well. There are estimated to be 650,000 pregnant women displaced in Pakistan right now, in urgent need of maternal health care and safe, sterile facilities to give birth in, with many taking perilous journeys in hopes of reaching a hospital or safe places to give birth.

CARE, an international human rights and social justice organization, spoke on this concern. Pakistan Country Director for CARE, Adil Sheraz said, “With entire villages washed away, families broken up and many people sleeping under the sky, the usual social structures that keep people safe have fallen away, and this can be very dangerous for women and girls.” 

Following the 2010 floods in Pakistan, denial of aid and violence against minorities became a prevalent issue and large protests against law enforcement arose due to their failure to protect vulnerable groups. Preventative measures against recurrence of these issues have been few and far between since 2010, and international human rights communities are on high alert for rising reports of discrimination in relief distribution and crimes against minorities. Reports of sexual violence have already increased following the floods.

In addition to some of the most vulnerable Pakistanis are roughly 800,000 Afghani refugees who have been hosted by Pakistan in Sindh and Balochistan; two provinces faced with the worst of the flooding and submersion. Pakistan has a deep history of offering asylum and refuge for those fleeing across the border from conflict in Afghanistan, and is home to 1.4 million Afghani refugees currently in 2022. Following the August 2021 withdrawal of US troops from Afghanistan, the Islamic Emirate government (also known as the Taliban), Pakistan became an even more essential haven for the influx of refugees fleeing a violent authoritarian regime. In the wake of this natural disaster, the loss of $30 billion dollars worth of infrastructure, homes and supplies, and facing an economic crisis, Afghani people with hopes of finding refuge in Pakistan must now find new routes to safety.

Environmental Justice & Climate Change

Though Pakistan faces annual flooding of the Indus river from heavy rains in monsoon season, record breaking rains preceded by an extended heatwave contributed to an unrivaled degree of flooding this summer. Heatwaves brought temperatures around 50° Celsius (122° Fahrenheit) to India and Pakistan between March and May of this year. Monsoon rains followed the spring heatwaves, and in the regions of Sindh and Balochistan rainfall reached 500% above average. The 2022 floods will leave a significant economic, infrastructural, and humanitarian impact on the country of roughly 220 million people. The reason for the dramatic influx in severity is complex, but simple at its core: climate change.

Pakistan is facing an unfair share of the consequences of climate change; while it was responsible for only .3% of global CO2 emissions in 2020, it is likely that this year’s heatwaves and floods will be on the less severe end of what is to come. The United Nations has deemed Pakistan a “climate change hotspot”, stating that people in South Asia are 15 times more likely to die from climate impacts. As the global temperature rises and geohazards become more extreme, disaster-prone regions like Pakistan will face more and more devastation. The best prognosis for the region comes with prevention efforts like strengthening anti-disaster infrastructures. As the global north is responsible for 92% of excess emissions contributing to global warming and climate change, Pakistan, the United Nations, and other international agencies are calling for countries like the United States to make increased contributions to relief funds and infrastructure development overseas.

United Nations Secretary-General Antonio Guterres, while visiting Pakistan in September 2022, said, “…the fact is that we are already living in a world where climate change is acting in such a devastating way. So, there must be massive support to what usually is called adaptation, which means to build resilient infrastructure and to support resilient communities and to create conditions for those that are in the hotspots of climate change. Pakistan is one of the hotspots of climate change. For those countries to be able to prepare for the next disaster and to be able to resist the next disaster, this needs a huge investment and this investment needs to be provided.”

Relief & Aid

Pakistan has faced an overwhelming series of calamities since the start of this year, and the impacts from these disasters are greatly exacerbated by food shortages and an economic crisis prior to the start of the disasters in March. There are millions of people in need of aid, and every bit of support helps. If you are unable to financially contribute, please consider sharing this or other articles about this crisis to increase international attention on those who need our help.

For donations of money, time, or other resources, we have compiled some reputable aid agencies below:

Pakistan’s Red Crescent Society is providing clean drinking water, medical treatments, temporary housing, and other essential aid across flood-hit regions. Donate or get involved with their flood response efforts here.
The United Nations Refugee Agency has provided millions of dollars in aid to Pakistan, and you can contribute here to support their continued relief efforts.
The International Medical Corps are on the ground in Pakistan, providing medical care and responses to both the floods and gender-based violence across the country. Find out more & how you can donate here.
Muslim Aid has reached over 29,000 people in three affected districts of Pakistan, providing hygiene kits, shelter, and essentials to those in need. Contribute to their fund here.

A Bright Future – Recent Human Rights Victories

In the midst of a pandemic and international unrest, it is vital to stay encouraged and optimistic as we continue our efforts to uphold and protect human rights internationally. That is why we at the Institute for Human Rights at UAB will be using this article to break up the negative news cycle and put a spotlight on a few of the amazing victories and progress the international community has made during the pandemic that you might not have heard about. Though positive human rights news may not always make headlines, it is important to recognize each success, just as it is vital we address each issue.

The UN Declares Access to a Clean Environment is a Universal Human Right – July 2022

Of the 193 states in the United Nations general assembly, 161 voted in favor of a climate resolution that declares that access to a clean, healthy and sustainable environment is a universal human right; one that was not included in the original Universal Declaration of Human Rights in 1948. While the resolution is not legally binding, it is expected that it will hugely impact international human rights law in the future and strengthen international efforts to protect our environment. Climate justice is now synonymous with upholding human rights for the citizens of member-states, and the United Nations goal is that this decision will encourage nations to prioritize environmental programs moving forwards.

Kazakhstan and Papua New Guinea Abolish the Death Penalty- January 2022

Kazakhstan became the 109th country to remove the death penalty for all crimes, a major progress coming less than 20 years after life imprisonment was introduced within the country as an alternative punishment in 2004. In addition to the national abolition, President Kassym-Jomart Tokayev has signed the parliamentary ratification of the Second Optional Protocol to the International Covenant on Civil and Political Rights. Article 6 of the ICCPR declares that “no one shall be arbitrarily deprived of life”, but the Second Optional Protocol takes additional steps to hold countries accountable by banning the death penalty within their nation. Though the ICCPR has been ratified or acceded by 173 states, only 90 have elected to be internationally bound to the Second Optional Protocol (the total abolition of the death penalty), and Kazakhstan is the most recent nation to join the international movement to abolish the death penalty globally.

Papua New Guinea also abolished their capital punishment, attributing the abolishment to the Christian beliefs of their nation and inability to perform executions in a humane way. The 40 people on death row at the time of the abolishment have had their sentences commuted to life in prison without parole. Papua New Guinea is yet to sign or ratify the Second Optional Protocol to the ICCPR, but by eliminating the death penalty nationwide the country has still taken a significant step towards preserving their citizens right to life.

India Repeals Harmful Farm Plan – November 2021

Many of you will remember seeing international headlines of the violent protests following India’s decision to pass three harmful farming laws in 2020. The legislation, passed in the height of the pandemic, left small farmers extremely vulnerable and threatened the entire food chain of India. Among many other protections subject to elimination under the farm laws was the nations Minimum Support Price (MSP), which allowed farmers to sell their crops to government affiliated organizations for what policymakers determined to be the necessary minimum for them to support themselves from the harvest. Without the MSP, a choice few corporations would be able to place purchasing value of these crops at an unreasonably low price that would ruin the already meager profits small farmers glean from the staple crops, and families too far away from wholesalers would be unable to sell their crops at all.

Any threats to small farms in India are a major issue because, according to the Food and Agriculture Organization (FAO) of the United Nations, “Agriculture, with its allied sectors, is the largest source of livelihoods in India”. In addition, the FAO reported 70% of rural households depend on agriculture and 82% of farms in India are considered small; making these laws impact a significant amount of the nation’s population. A year of protests from farmers unions followed that resulted in 600 deaths and international outcries to protect farmers pushed the Indian government to meet with unions and discuss their demands. An enormous human rights victory followed as Prime Minister Narendra Modi announced in November of 2021 that they would rollback the laws, and on November 30 the Indian Parliament passed a bill to cancel the reforms. As the end of 2021 approached, farmers left the capital and returned home for the first time in months, having succeeded at protecting their families and their livelihoods.

Sudan Criminalizes Female Genital Mutilation – May 2020

Making history, Sudan became one of 28 African nations to criminalize female genital mutilation / Circumcision (FGM/C), an extremely dangerous practice that an estimated 200 million woman alive today have undergone. It is a multicultural practice that can be attributed to religion, sexual purity, social acceptance and misinformation about female hygiene that causes an onslaught of complications depending on the type of FGM/C performed and the conditions the operation is performed in. Among the consequences are infections, hemorrhage, chronic and severe pain, complications with childbirth, and immense psychological distress. It also causes many deaths from bleeding out during the operation or severe complications later in life. We have published a detailed article about female genital mutilations, gender inequality and the culture around FGM before, which you can find here.

FGM/C is a prevalent women’s rights issue in Africa, and in Sudan 87% of women between the ages of 14 and 49 have experienced some form of “the cut”. While some Sudanese states have previously passed FGM/C bans, they were ignored by the general population without enforcement from a unified, national legislature. This new ban will target those performing the operations with a punishment of up to three years in jail in the hopes of protecting young women from the health and social risks that come from a cultural norm of genital mutilation and circumcision.

Where do we go from here?

While we have many incredible victories to celebrate today, local and international human rights groups will continue to expose injustices and fight for a safer and more equal future for all people. Our goal at the Institute for Human Rights at UAB is to educate; to inform readers about injustices and how they can get involved, and to celebrate with our incredible community when we have good news to share! While the past year has been marked with incredible hardships, it is always exciting when we have heart-warming international progress to share!

You can find more information about us, including free speaker events and our Social Justice Cafes on our Instagram page @uab_ihr! Share which of these positive stories you found most interesting in our comments, and feel free to DM us with human rights news you would like us to cover!

Afghanistan’s Deteriorating Healthcare System

Afghanistan’s healthcare infrastructure is crumbling after its foreign assets were frozen and donor organizations pulled funding after the Taliban takeover. The Taliban is a Pashtun Islamic extremist group that is known for imposing strict religious and conservative rule over their areas of operation including Afghanistan and Pakistan. The organization previously served as the government for southern Afghanistan in 1996-2001 during which the healthcare system had collapsed. The child mortality rate was 2x as high as it was in 2012 and polio was widespread. Safe drinking water and sanitation were also nonexistent.

Over the past two decades, non-governmental organizations (NGOs) have historically provided 75% of the funding and supplies to support the healthcare systems in 31 out of the 34 provinces of Afghanistan. As a result, the Middle Eastern country has seen enormous improvements in the healthcare system. As of 2018, with over 3,000 medical facilities staffed and supplied, about 87% of the population were able to receive services. Maternal and child mortality rates also plummeted and infectious disease treatment programs helped decrease mortality rates.

International donor support started declining even before the Covid-19 pandemic, and Afghanistan’s Ministry of Health and other public health organizations were barely able to compensate. The economic decline at the onset of the pandemic made medical resources even more scarce. Hospitals began charging payment for supplies such as meals and scalpels previously free to patients, and patients were forced to use their own money to buy surgical equipment. In April 2021, President Biden announced that the United States would withdraw all of their 2,500 troops from the Afghanistan, triggering the entire NATO (North American Treaty Organization) alliance to withdraw a total of 7,000 troops. The process was completed in mid-September. Shortly thereafter, the Taliban rose to power once again in Afghanistan.

A pile of international notes from the United States, Turkey, and Europe. Source: Unsplash

The World Bank then froze $600 million in health care aid funded by the US Agency for International Development, the European Union, and others. The $600 million was part of the Sehatmandi project, a global initiative to increase health facilities in Afghanistan, which was a collaboration with the Afghanistan government. The withdrawal shut down 2000 of the 2800 facilities that the project previously funded, leaving healthcare workers and patients out in the wind. Currently, healthcare workers have not received payment in 6 months and do not know when they will receive payment. Many patients struggle to reach the remaining facilities because the trip there is either unaffordable, geographically dangerous, too far, or the route is lined with Taliban conflict.

If provided now, donors feared that donations and allocations would be misused by the Taliban to generate income for the militant group instead of for healthcare problems. There is speculation that if the funds are released, wages will never reach workers and medical supplies will be bought then sold to the public at astronomical prices. All entities are waiting on instructions or action from other governments to search for a way to transfer donations in order to circumvent the regime’s administration.

Healthcare for Children

A toddler girl biting into her shirt sleeve next to her parent. — A toddler girl biting into her shirt sleeve next to her parent in Afghanistan. Source: Unsplash

Hunger is becoming more widespread as inflation rates climb and supply chains grow unsteady. The Integrated Food Insecurity Phase Classification (IPC) reported that half of Afghans will face acute food insecurity before winter arrives.

Malnutrition and malnutrition-related illnesses are far more dangerous than any other disease for children. Specific types of malnutrition called acute severe malnutrition and child kwashiorkor, a severe protein deficiency, is prevalent in Afghanistan and are caused by eating too little food or not at all. It can be treated by administering Ready To Use Therapeutic Food (RUTF) and oral hydration therapy. Over 2 million children under 5 years old do not have access to this life saving treatment in Afghanistan. At least half of the children in the country are victims of malnutrition and in light of the food scarcity, mothers unable to produce breastmilk have resorted to feeding infants water mixed with sugar.

Staffing shortages are also insurmountable. Nurses and doctors fled the country fearing what the Taliban’s takeover could mean for their lives. In the main children’s hospital in Kabul, nurses previously caring for 4 babies now have to care for 24 babies each while hospital staff try to squeeze 3 infants into 1 incubator due to equipment shortages. Current staff are overworked and still have to take up jobs at other institutions to get by. Medicinal needs are also not being met for children and adults. Drug cabinets and storage closets become emptier every day as the influx of patients has depleted the resources faster than can be transported into the country.

A hand holding a cluster of large, yellow tablets. — A hand holding a cluster of large, yellow tablets that are basic medications that Afghans need. Source: Unsplash

Women’s Health

The aid cuts have also decreased access to essential healthcare resources for women and girls, including contraception and family planning. Many women carry out risky pregnancies and are subjected to unsafe reproductive procedures without modern medical equipment. Prenatal and postnatal care for infants is not provided, and postpartum care for new mothers is nonexistent. Despite the labor shortages, a great deal of responsibilities for maternal health clinics are on the backs of midwives. Midwives continue to perform complicated surgeries, dangerous deliveries, and other reproductive procedures.

Expensive medicines and transportation to clinics for health problems are not feasible for the majority of Afghan women. Beginning in early 2017, extremist groups turned their sights on medical facilities in Afghanistan, which led to increase of attacks on aid workers, doctors, and hospitals. Mounting fear against staying in maternity clinics has also driven many women away from seeking help.

Covid-19 Pandemic

The lack of data and accountability in Afghanistan makes it difficult to comprehend the extent to which the virus has contributed to the death rate. Around the world, Covid cases are increasing, and the Afghan population is largely unvaccinated. According to the latest data from the United Nations, only 2.2 million of 39 million individuals have been vaccinated, while 1.8 million doses are waiting to be distributed.

Public health experts worry that an impending 4th wave of the disease will render the healthcare infrastructure irreparable. Dead bodies line hospital morgues and overflow into the outside corridors as the lack of fuel has stopped ambulances from operating. Many sick patients suffering from Covid don’t bother coming to hospitals, because they know they would not be able to receive medical assistance. Hospitals, private practices, and clinics are resorting to hastily assembling makeshift wards outside hospitals to accommodate Covid patients.

The healthcare situation in Afghanistan has been worsening for years, and in light of the looming public health disaster, much more support from the international community is needed. The snowball effect of international neglect will continue unless major monetary, political, economic, and healthcare interventions are considered. Nonprofit health organizations such as Doctors Without Borders have been tackling both maternal and child healthcare as well as managing Covid cases in 5 provinces, but people can help by donating to Doctors Without Borders, United Nations Children’s Fund (UNICEF), and increasing awareness for the healthcare crisis in Afghanistan.

Improper Sex Education and the Effects on Women’s Health in Alabama

Sex Education in the United States

In the United States sex education has historically been underfunded and often used as a tool to shame people for their sexuality. Currently, only 29 states in the United States mandate sex education; however, this still does not ensure that children are taught medical sex education in school. In fact, 37 states within the United States require abstinence to be taught as the only way to prevent sexually transmitted diseases and unwanted pregnancy. Even worse, up until April 2021, seven states in the South prohibited educators from discussing LGBTQ+ identities and relationships, which further stigmatizes youth and puts them at a higher risk of contracting sexually transmitted diseases. Currently, now that Alabama has passed a new bill which removed homophobic language forbidding schools from teaching LGBTQ+ sex education, teachers are able to create sex education curriculum as they please, as long as parents are sent an overview of the curriculum and agree to let their children learn said material.

How U.S. Sex Education Policies Measure Up to the ICPD

According to the 1994 Cairo International Conference on Population and Development (ICPD), “ the objective to achieve universal access to quality education, underlines that gender-sensitive education about population issues, including reproductive choices and responsibilities and sexually transmitted diseases, must begin in primary school and continue through all levels of formal and non-formal education to be effective.” The ICPD further notes that “full attention should be given to the promotion of mutually respectful and equitable gender relations and particularly to meeting the educational and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality.” When looking at the rights set forth by the ICPD, it becomes clear that the United States is failing their youth populations and exposes them to unnecessary risk by refusing to inform them of the dangers that come with unprotected sex. By not requiring sex education, the United States also fails to inform youth of preventative measures they can take to ensure the utmost safety and consensual enjoyment between parties. This lack of education has not only resulted in a multitude of unwanted pregnancies and an overflooded foster care system; but has led to thousands of people, especially in the South, contracting chronic disease and illness that will impair them for the rest of their lives as well.

Women’s Healthcare in Alabama: The Dangers of Improper Sex Education

While the United States as a whole has failed its constituency by refusing to mandate sexual education to be taught in schools, the state of Alabama stands as a paradigm for just how dangerous a lack of healthy and inclusive sex education can be. According to Human Rights Watch, the lack of sex education in Alabama has led to relatively high mortality rates. These “mortality rates are higher for Black women, poor women, and those who lack access to health insurance.” In fact, according to the CDC, in 2017, Alabama was among the top five states in the country in terms of the highest rate of cervical cancer cases and deaths, and “Black women in Alabama are nearly twice as likely to die of the disease as white women.” While multiple factors are contributing to this alarming statistic, Human Rights Watch found the following issues to be catalysts for these poor outcomes in Alabama: “shortage of gynecologists in rural areas, prohibitive transportation costs often required to travel to see a doctor for follow-up testing and treatment, and Alabama’s failure to expand Medicaid to increase healthcare coverage for poor and low-income individuals in the state”. By refusing to provide access to healthy sex education, Alabama has left thousands of women without the proper knowledge that is necessary to lower the risk of cervical cancer.

A mother and her child during a pediatric check-up — Yahoo Images, a mother and her child photographed during a pediatric check-up

The Current State of Sex Education in Alabama

In Alabama, the current state code claims that abstinence outside of marriage is the “social norm”. By making non-marital sex an abnormality, the legislatures have shown that they have no interest in providing education to youth who may break the “social norm”. Moreover, in the past, Alabama code emphasized that sexual curriculum had to be presented in a “factual manner and from a public health perspective, that homosexuality is not a lifestyle acceptable to the general public and that homosexual conduct is a criminal offense under the laws of the state”. By painting non-heteronormative orientation as “criminal” Alabama consciously stigmatized members of the LGBTQ community for decades, which put them at a higher risk of contracting a chronic disease. In fact, according to SIECUS, Alabama ranked fourth in the nation for reported cases of chlamydia, gonorrhea, and syphilis in youth aged 15-19. Yet, thanks to activists and constituents voicing their concerns, the Alabama legislature has now removed said discriminatory language from their sex education bill. However, there is still a large amount of work that must be done to further advocate for proper, medical sex education to be provided to students.

Yahoo Images, A woman is holding a poster which states “A woman’s place is in the resistance”

Ways to Get Involved

Thanks to the work of activists, legislatures, and constituents alike, Alabama’s laws have been updated so that they no longer criminalize LGBTQ+ individuals within the states schools’ sex education curriculum. Yet, the work is not over, and schools are still able to refuse to educate students on safe sex practices for non-heteronormative relationships, as long as parents of students consent to the curriculum proposed by staff. This continuation of the lack of medical sex education in our school systems is still leaving children vulnerable to ignorance, and exacerbating the current health issues which are prevalent amongst marginalized groups, especially within the South. Certain organizations, such as the Alabama Campaign for Adolescent Sexual Health and Advocates for Youth Sex Education, are currently advocating for proper sex education. If you are interested in getting involved, sign up to be an advocate for proper seed education through AMAZE, or with WISE (Working to Institutionalize Sex Education), to help aid in the fight for proper sexual education for our youth. Furthermore, if you would like to learn more about the rights of LGBTQ+ individuals and current issues within the LGBTQ+ community, then click this link.

A Glimpse at the Battles Women Face in Nicaragua

by April Alvarez

A Human Rights Internship

This 2021 Spring Semester, UAB’s Institute for Human Rights had the privilege of partnering with Clínica Verde in Nicaragua to dive into the human rights issues that women in the country face, especially regarding health care. The internship, directed by Dr. Tine Reuter and Dr. Stacy Moak, has opened doors to important conversations about the importance of voicing and advocating for people who need support. Although the semester just started, those involved with the internship have already been exposed to several educated and experienced scholars that are making a mark on the country and are looking to equip and inspire others to do the same. In just one month, students have learned about the life of women and children have struggled to find economic stability, and access to basic resources. The purpose of this partnership with Clínica Verde is dive deeper into the ways that UAB (University of Alabama at Birmingham) students can serve others even during a global pandemic. Through the development of the course students will develop programs and educational presentations that aim to advocate the same values and goal displayed by the staff at Clínica Verde to reach out to more people in the clinic’s surrounding community but also to those in more rural areas.

Feed My Starving Children (FMSC)

Yolanda Paredes-Gaitan was the first speaker invited to speak to the students. She lived in Nicaragua for twelve years but is now currently living in California and working for the U.S. government. While in Nicaragua, she worked alongside Clínica Verde helping find ways to advocate for human rights issues, now she does that in partnership with the U.S. Valuable information shared through her presentation revealed that 65% of people in Nicaragua live in rural areas that are usually only accessed by walking or horses. Although the country of Nicaragua is rich in resources such as coffee, chocolate, and honey, however the country has been deemed the second poorest country, after Haiti. So why does this matter? It matters because it affects everything, including the quality of life in the country. Every community in the country has what is known as a health post. Each health post is usually the primary place for individuals to go to for basic health care needs, especially since few people have access to a nearby hospital. However, the problem is that most of the posts are rundown and in need of repairs. With the help of Clinica Verde, one post which had a structure that was falling apart, had holes in the roof, had no running water was transformed into a new and improved post that is now a green building that has natural ventilation, lighting and has access to water and the resources needed to provide the community with quality services. The goal of Clínica Verde is not to keep all the knowledge to themselves but instead to spread it with those in the country. Another thing that the clinic has been able to do is to provide posts with the knowledge necessary to run an intensity garden. The reason the clinic does this is because they are not looking to provide the women and children with short term solutions to their problems. They want to equip people with the knowledge to improve their lives long term, so they are more educated on how to live a more healthy and sustainable life.

Who visits the clinic?

People from all around the country visit the country. One lady traveled by bus and walked two hours up a hill just to get back home, but she did it because she loved the care provided by Clínica Verde. However, unlike the traditional view that when patients need care, they must go to the clinic, Clínica Verde travels to rural communities three times a week. Their mission goes beyond what the four walls of their building. They make it a priority to reach those who would otherwise not have time to visit the clinic. Another important thing to note is that the clinic also Nicaragua had no education in optometry until one donor came to the country and changed that. Now the team at Clínica Verde also has a program that helps provide people in the community with free glasses which is centered around the students but also anyone in the student’s lives that may also need glasses. This optometry program has also allowed senior citizens to have surgeries that have saved them from going blind.

Another Battle for Bodily Autonomy in Trans Youth

On February 10, 2021 the Alabama Senate Health Committee voted to criminalize transgender medicaltreatment for minors. With an 11-2 vote, the committee approved Senate Bill 10 (SB-10), a bill that will “outlaw puberty blocking medications and gender-affirming care for minors.” On March 3, the Alabama Senate passed this legislation, and it is currently awaiting Governor Kay Ivey’s approval. SB-10 empowers the legal system to prosecute clinicians and pharmacists with felony charges if they prescribe medication or provide treatment to aid in the transitional processes of minors. Bill sponsor Senator Shay Shellnutt (R-AL) claims that “minors are too young to be making this decision.” The Senator has also admitted that he’s never interacted with a trans teen before submitting the bill. Opponents of the SB-10 refute Shellnutt’s claim by acknowledging this decision is between the medical care provider, the patient, and the patient guardians. As such, SB-10 infringes on the private rights of parents to care for their children with necessary and proper interventions. Shellnut has mentioned that hormonal treatment and other transgender interventions cause long term issues and that a child is not mature enough to be making such a permanent decision. Shellnut’s claims are false; the effects of hormonal drugs that are puberty blockers are reversible. Also, when evaluating long term effects of gender reassignment surgeries, doctors prefer to wait until the patient is at least 18 years old before they perform the surgery.

A person holding a sign with a metaphor describing gender. — Source: www.mindfulword.org

Doctors must take the Hippocratic Oath which defines their ethical conduct and moral reasoning. There are two main tenets of the Oath: “benefitting the ill and protecting patients against personal and social harm and injustice.” Not only does SB-10 force doctors to dishonor the Hippocratic Oath, but it is also medically harmful to the patient pursuing care and prevents them from confiding in their medical care team. Dr. Marsha Raulerson says it will “take away child’s confidence in trusting doctors with their thoughts and to talk candidly.”

Healthcare providers are only one pillar of the support system for patients wishing to transition. So, when healthcare providers are unable to provide care to these young individuals, it can harm their mental and physical wellbeing and contribute to gender dysphoria. Adolescent and young adult years are incredibly formative. It’s in these years that young people thrive and when they are in need of a lot of support and care. When their support systems and adequate healthcare is taken away “adolescents can feel alone, stigmatized, and undervalued”. Rejection, discrimination, and stigma during these formative years can put young adults at a higher risk of mental health disorders such as depression and anxiety. The aforementioned mental health disorders can lead to the usage of addictive substances like drugs and/or alcohol, and suicidal ideation. These factors contribute to significant health disparities within the LBGTQ+ community. It’s vital the care they receive is given without stigma and affirms the patient’s sexuality and gender identity, but this care cannot be given with government intervention that holds traces of transphobia.

Protestors gathering against the transgender military ban legislation. — Source: www.britishherald.com

Gender is a very dynamic concept, and there is no binary. It is up to the individual to choose their identity. Gender reassignment treatments and procedures are one way to reaffirm and respect an individual’s choice. LGBTQ+ youth deserve to know that they are respected and that they deserve quality healthcare and treatment. Healthcare providers should not be prevented from fulfilling their responsibilities. They should be able to provide quality care and treatment for their patients. If they can’t, they should be able to refer the patient to a doctor who can provide adequate healthcare. This is not the first time SB-10 has been passed to the full Alabama Senate. It was passed all the way up to the Governor in 2020 to be signed into action and is only back on the table due to COVID-19 complications. Advocacy is an important aspect of healthcare, and providers should be willing to advocate the most for marginalized communities. It is important to lift barriers to care for these groups, instead of continuing to make healthcare inaccessible.

A separate companion bill (HB-391) is currently in the Alabama House. This bill would restrict transgender students from participating in school athletics with the gender they identify with. Lawmakers that support the bill claim that it protects fairness for female and “keeps them from having to compete against transgender athletes who were born male.” The biggest difference to make right now is to call Alabama Senate representatives and tell them the harms these bills will cause to LGBTQ+ youth and to the healthcare providers that try to help them.