CanWaCH Conference session on fragile contexts

Susan Johnson, Vice President and Director General International Operations and Movement Relations, Canadian Red Cross – CanWaCH AGM Presentation – Nov 2016

First, before I start into the remarks I have prepared, I want to make two points, based on the discussions we’ve had over the course of the last two days:

First I want to quote our current Prime Minister – from the video clip on polio which we saw yesterday – when he said “poverty is sexist”. Entirely agree, and would add: both poverty and sexism are political constructs, as much as they are also economic, social, and cultural constructs. And these are at play in every community and in every context, and we need to be aware and take this into account when we think about and plan effective action to address needs and interests of women and children.

Second – as I will be saying more about fragile contexts which a number of people have mentioned and particularly Rachel from MSF in her remarks just now with which I also fully agree – I want to remind us that Even Wars Have Limits.

Out of great pain we do have great gain: after the Second World War global governance did come to several additional accords, enhancing the original Geneva Conventions. Norms were affirmed about conducting hostilities. Norms that apply to governments and any other arms carriers. And affirming that even in war civilians have rights.

But today, we live in a dark time. Where some of these same governments – and other parties to conflicts – seem to have concluded they can violate these rules of war with impunity. This includes several major powers including our neighbours to the south.

In relation to addressing the health needs of women and children this matters deeply – we will not achieve the SDGs nor the EWEC strategy if the basic rules of IHL are not respected.

Now, to my prepared remarks…

  1. What do we mean by fragile contexts & why is this important?
  • Fragile contexts are where people are living in precarious circumstances, often because of full-on war or various levels of social violence. Can also include people caught up in sudden onset disasters. Key is to understand that these are not the same…
  • Some people might be in areas controlled by and serviced by government but many are not
  • Access to normal social services are not available for various reasons but including that state health facilities don’t exist, or are under-staffed/under resourced, or even under attack (which I will come back to later)
  • This is not a marginal issue.
  • Today, in the Red Cross world, we are engaged in providing humanitarian services to civilians at risk, obviously including women and children, in more than 90 countries around the world. For the international committee of the Red Cross approx. 2/3rds of the global budget (of some 2 b CAD) is spent in fragile countries, and the top 10 operations are in countries where in protracted conflicts where the wars have lasted an average of 36 years
  • Huge number of women and children live in these at-risk areas:
    • 1.5 b people currently living in countries affected by conflict, fragility or pervasive violence.
    • Women and children account for approximately 75% of those displaced by conflict and about 20% of those displaced are women of reproductive age. Among these women, one in five will be pregnant.[1]
    • 60% of preventable maternal deaths, 53% of deaths among children younger than five years and 45% of neonatal deaths take place in fragile settings of conflict, displacement, and natural disasters.[2]
  • We will not meet the targets of the SDGs nor deliver on EWECEW if we don’t successfully reach women and children in these communities.


  1. What are some of the challenges of reaching women and children in these places?
  • Access – reaching communities isn’t straightforward at all. And when I say access, I mean many things:
    • Security – communities can be cut off by front lines of conflict, or under siege by warring forces, or simply under the control of forces other than the official government
    • Negotiations – access and security means needing to dialogue with and negotiate with ALL parties to the conflict. And when I say ALL parties, let’s remember that in today’s wars there are very seldom two neatly organised opposing parties to the conflict. Instead it is an ever-evolving soup of actors, with changing alliances and interets. You need a sophisticated set of skills and a well-developed network to secure permission to be where you need to be and to do what you need to do. And if you don’t have that capacity you should definitely think twice about trying to venture into these areas because you will be putting yourself and others at risk.
    • Logistics of reaching remote communities – you need a lot of resources just to get to these communities; its more expensive and more difficult
    • Resources – both human resources and material resources are in short supply
  • And to make matters worse, as I have already noted, we are going backwards re the conduct of hostilities:
    • The targeting of civilians – and of health facilities – has become deliberate: intentional, deadly and pervasive. In the past 3 years 2,400 targeted attacks have been carried out against patients and health-care workers, transport and health centres in 11 countries. The loss of these health facilities and personnel affects the health of hundreds of thousands of people, and threatens to reverse progress we had seen in reducing child mortality. [3]
    • in Syria alone, more than 700 health workers have been killed in the conflict, further decimating a health infrastructure that has experienced more than 300 attacks on health facilities.


  1. What does this mean for framing effective policy that can inform effective action?

Let me address this at 2 levels – for organizations like those of us gathered here today and for national governments, specifically the Canadian Government

  • For international humanitarian and development organizations, and academics who want to be part of addressing women and children’s health issues =
    • First and foremost I call on ALL of us to recall we need to preserve the neutrality and independence of humanitarian actors and ensure that perceived or actual affiliation with political or religious entities does not endanger health workers or the people whom they serve.
    • Humanitarian organizations have to take a long view – understand that crises (and humanitarian response) takes place within a context, and complex web of social, economic and political and cultural relationships, and do a better job of contextualizing their action, and understanding the relationship to development
    • Humanitarian organizations should develop better capacity to work on two tracks, sustaining or preserving development gains while delivering additional humanitarian assistance
    • Development organizations should be cautious about placing themselves in the middle of the most unstable and difficult circumstances; take time to understand what it takes to deliver neutral, impartial, humanitarian action, and tool up to do a good job
    • Essentially my message to both, and to the academic community, would be: open your eyes, understand where you are, be careful with the assumptions you make. If you can’t take the time to do this, and to tool-up to be a responsible actor in these contexts, then please do go.
  • For governments, in particular Canada =
    • A reminder – All civilians – including women, adolescents and children – have a right not to be targeted during armed conflict, but also have the affirmative, internationally recognized right to be protected – and to have their access to humanitarian assistance and health facilities assured. And this needs to be re-affirmed and asserted constantly.
    • On a positive note: in May 2016, the Government of Canada co-sponsored UN Resolution 2286, which reaffirms the global obligation to protect civilians and condemns attacks against health facilities and personnel in conflicts. Canada must affirm this commitment through our domestic and global action, in our peacekeeping, diplomacy and as parties – no matter how limited – to armed conflicts.
    • We must continue to call on all armed actors to respect International Humanitarian Law, and end impunity for violations of IHL.
    • Note the campaigns NOT A TARGET and Health Care in Danger
    • Secondly, on the Global Financing Facility: We welcome the CanGov commitment to the GFF and particularly Canada’s recognition that international funding cannot only flow through national governments. We’ve long argued that if we want to reach Every Woman, Every Child, Every Where we have to find a way to support people outside of government systems.
    • Let’s remember what I mentioned at the beginning of my remarks – poverty is sexist, and political, and that in many parts of the world – governments may not even have an interest in providing health care services to all. Discrimination in real..
    • So, to reach everyone we need a complementary financing mechanism to be available to credible humanitarian and civil society actors who can reach communities at risk and deliver.
    • I look forward to seeing how the Cdn Govt lives up to that commitment, working with other governments to create a funding facility for humanitarian actors – global and local – who CAN reach women and children, and deliver on EWECEW.

Thank you.

Additional points:

Specific impact of conflict on women and girls:

Women, adolescent girls and children experience different threats to their health than do men, particularly in conflict affected settings. A lack of access to sexual and reproductive health care services, including ante-natal care and emergency obstetric care, can lead to fatal consequences.

Sexual and gender-based violence and other forms of violence against women and children increase during disasters and conflict, requiring specialized medical and psycho-social services.

We encourage women to give birth in facilities – or at least to have a skilled attendant at birth. This is best practice, it is a global standard of care we all know. Even in the most desperate circumstances, a woman should feel that she and her newborn will fare better at a health centre than without the care of skilled attendants during labour and childbirth. In a conflict she should at least be able to feel safer, protected by the global prohibition against targeting health facilities and health workers during conflict.

We must recognize and respond to the very specific needs of women, adolescents and children in conflict contexts and think and act innovatively and creatively to save lives in humanitarian space that is protected and supplied with life-saving commodities.


Changing nature of conflict and trends:

Increased number and types of humanitarian actors and other stakeholders. There is a plethora of humanitarian actors and other stakeholders involved in responding to crises: humanitarian agencies and NGOs, faith-based organizations, state emergency ministries and armed forces. This has meant that the humanitarian sector is often misperceived, that roles and intent of stakeholders are often blurred, with the potential of endangering both humanitarian actors and the people they serve.

The world is witnessing a growing number or conflicts which have regional implications. The impact is frequently beyond the coping capacities of neighbouring national governments, threatening to destabilize the often tentative peace of these neighbours. Lebanon and Turkey exemplify these concerns.

Increasing ranks among extremist armed groups: Increasing numbers of impoverished and desperate young people have been either forced or lured to the extremism of armed groups such as Boko Haram, ISIL, AQIM and others, with civilians paying the highest price in the face of sectarian violence.

New forms of warfare and weapons are being used in total disregard of IHL, with heavy consequences for civilians: Mass kidnappings of girls and women, deliberate attacks on health facilities, cluster bombs, chemical weapons, and other weapons are used which are no longer restricted to military targets. Nigeria, Syria and Yemen, among other countries, have all experienced these tactics and trends.


[1] Reproductive health during conflict: The Obstetrician and Gynecologist: Volume 16, Issue 3 July 2014 Pages 153–160

[2] Zied, S., Bustreo, F., Barakat, M., Maurer, P., and Gilmore, K. (2015). For every women, every child, everywhere: a universal agenda for the health of women, children and adolescents. The Lancet, May 2015, Col. 385, No. 9981. Retrieved from:

[3] Peter Maurer, address to the UN on Resolution 2286 (2016)


November 22, 2016


Susan Johnson