By Nick Palombo
Health considerations in DDR incorporate human security, analyze key health concerns, and respond to the needs of the most vulnerable groups of ex-combatants. Major health concerns in DDR, among others, are chronic communicable diseases, HIV/AIDS, violence and injury prevention, and psycho-social support for mental health and substance abuse. However, health concerns vary greatly according to the geographical area of caseload and conflict dynamics. Types of interventions appropriate in DDR will be dependent on the number of combatants in the caseload, their relatives, the median gender and age, specific needs, and local capacities for the provision of health services.
The objective of integrating health care in DDR is to reduce the percentage of avoidable illnesses and deaths in a caseload, through basic healthcare and preventative epidemiological interventions. These include both reproductive-health and psycho-social care considerations. In all cases, there must be a minimum guaranteed basic medical screening, which should be conducted in the interim at first point of contact (disarmament and demobilization stage). However, ongoing access to healthcare and voluntary counseling and treatments must also remain available during long-term reintegration processes. Satisfying these conditions requires creating partnerships with local public health stakeholders to generate sustainable health services and long-term medical records. Health interventions in DDR are best facilitated through comprehensive partnerships with local health actors. These may include NGOs and international humanitarian agencies, like the World Health Organization (WHO), the United Nations Population Fund (UNFPA), the Joint United Nations Program on Aids (UNAIDS), and the International Committee of the Red Cross (ICRC).
A primary strategy for intervention should be treating ex-combatants in the interim. This means treating acute sicknesses and infectious diseases over chronic and non-infectious diseases. This strategy can decrease the rate of transmitted infections, and minimize the chances of co-infection in already infected individuals. Basic medical screening can permit monitoring of potential epidemiological and nutritional issues, and can build capacity for early detection as well as rapid response. Linking health interventions to DDR can take the form of many types of programming. Therefore, the choice of programs should be based off an analysis of the political and legal arrangements of peace agreements and the specific nature of the conditions on the ground. Including and utilizing local healthcare providers can ensure that local public health concerns are taken into account. Therefore, local health sectors should be represented in all established programs to oversee the health intervention from the earliest possible stage.
When speaking to health interventions in DDR programs, it is essential to discuss HIV/AIDS infection. DDR programs frequently operate in locations with high HIV/AIDS prevalence. Ex-combatants are considered high-risk groups for infection given their age range, degree of mobility, and risk-taking behavior. Women associated with armed forces are also part of this high-risk group, given the widespread instances of sexual violence and abuse. Even child-soldiers are part of this high-risk group, given that they are often sexually active much earlier than their non-combatant peers. Furthermore, in some conflicts, drugs are also highly prevalent. This further increases vulnerabilities by increasing risky-behavior and furthering transmissions of HIV infection. DDR providers should additionally take into account the movement of individuals across borders, and the heightened risk of epidemiological disease transmission from emigration. The best strategy for intervening on this is early detection and containment of disease in foreign ex-combatants, to intercede any potential outbreaks from the movement of these populations.
HIV/AIDS poses a grave impeding risk to the stabilization of peace operations. Integrating testing and treatment for HIV/AIDS in DDR programs is important for maintaining the well-being of male and female ex-combatants, women and girls associated with armed groups, and the greater public health of the civilian community. DDR programs can offer a unique opportunity to reach out to vulnerable groups and intervene in the spread of epidemiological diseases. Practitioners of DDR must co-opt this opportunity and incorporate health programming in their DDR programming.
As with many other diseases, HIV/AIDS prevention can be embedded in DDR through a variety of different outlets. Risk Mapping, based on prevalence, attitudes, vulnerabilities and knowledge, can be facilitated to define the needs of the geo-spatial community. Also, identifying and training HIV/AIDS focal points and developing awareness material and training for target groups can play a role in this type of intervention. Voluntary counselling, testing and treatment must be available throughout the entire trajectory of the DDR program. Also, ensuring the availability of testing, condoms and post-exposure prophylaxis for ex-combatants is critically important. These types of interventions must be facilitated with existing national HIV prevention and treatment infrastructure, in order to develop and ensure their sustainability.
DDR interventions involving HIV/AIDS have been conducted already in many national initiatives. In Colombia, joint UN efforts supported the Colombian government in training male and female ex-combatants in sexual and reproductive rights, gender equity, and HIV prevention. DDR practitioners conducted surveys to determine HIV prevalence and sexual behaviors to tailor HIV-DDR programs to the Colombian caseload. Furthermore, the facilitators provided voluntary counselling and treatment alongside a string of other HIV/AIDS-oriented initiatives. DDR in Côte d’Ivoire also incorporated a notable HIV/AIDS intervention program. The UN supported the DDR Commission in creating three voluntary counselling and treatment centers, as well as STI treatment infrastructure at all of these sites. These centers were focal points for screening and treatment, and ensured that medical aid would be widely available to all in need. Additionally, through partnerships with the United Nations Operation in Côte d’Ivoire, the commission also trained uniformed personnel on HIV, human rights, gender equity, and technical support on HIV-DDR. They also trained peer educators to provide local training and support for diagnosis of HIV/AIDS and HIV prevention.
Colombia and Côte d’Ivoire are just two successful examples, among many others, of HIV/DDR treatment integration in DDR. However, many challenges exist in the integration of greater medical processes. Lack of human capacity and will is a major component of deficient health resources in DDR programs. Medical diseases such as HIV/AIDS are simply not a priority for DDR practitioners. Especially since the extensive resources needed to prevent and treat epidemiological diseases such as Malaria and HIV may simply not be available in the budget for DDR programs. Additionally, linking DDR health intervention objectives to community health infrastructure may not be possible, as no health infrastructure may exist to begin with in the country of operation. In this case, building the foundations for future health services may be too large of an operation for DDR. Therefore, because of these reasons, health initiatives become secondary and/or far too rudimentary to achieve their primary objective. While implementing health action in DDR programs can be an extensive endeavor, it is undoubtedly necessary to safeguard the most basic aspects of human security in DDR programs.