MADRE's Sisters Without Borders: Women's Partnerships for Health and Human Rights

February 2003

Open the newspaper on any given day, and you will likely be assaulted by a gruesome display of human suffering that spans the globe. The litany of wars, natural disasters, famines, massacres and violent crime is enough to make many readers retreat into numbness and apathy. Yet, there are others who insist on their connection to the people behind the headlines, who understand that to transform abhorrent conditions is more than a moral imperative: it is an act of survival in this interconnected world. Similarly, among those people for whom the most horrifying headlines are a daily lived reality are some who emerge determined to heal their lives, their families and communities. What separates those who give in to despair from those who recognize their power to act is the understanding that change is truly possible. To sustain this belief and make it a reality, we need mechanisms that enable us to come together to defy the isolation and hopelessness that are the cornerstones of oppression; to share resources, skills and ideas for creating change and to experience the power of joining forces with others to make a difference. This is the mission of Sisters Without Borders, a health and human rights training program of MADRE, an international women's human rights organization.

MADRE's Sisters Without Borders: Partnerships for Change

Founded in 1983, at the height of a US-sponsored war in Nicaragua, MADRE has worked for 20 years to support women and families around the world who are threatened by US military violence, exploitative economic agreements, US-backed political repression and other policies that generate human rights abuses. Through our Sisters Without Borders program, MADRE members help build partnerships with women's community-based groups to meet urgent needs in their communities for health care, food, potable water, trauma counseling and other critical services. And MADRE works with our partners to develop long-term solutions to the crises they face, providing education, leadership development and skills training that strengthen women's capacities to transform abusive conditions. Over the years, MADRE has delivered more than 20 million dollars worth of resources to our partner organizations in Central America, the Caribbean, the Middle East, Africa, the Balkans and the United States. Sisters Without Borders staff and volunteers have traveled to besieged communities to:

Conduct community mental health workshops for children traumatized by war in El Salvador;
Help launch the first Haitian women's clinic, which integrates health and other human rights by training nurses and lab technicians and developing testimonies from survivors of war-time rape;
Paint hospitals and clinics in Nicaragua;
Assist in the development of a food-security project in Rwanda;
Promote HIV/AIDS education in Kenya;
Deliver ten tons of milk and pediatric medicines to clinics and hospitals in Iraq weeks after the 1991 Gulf War and
Conduct reproductive health and labor rights trainings for women who work in Guatemala City sweatshops.

MADRE believes that community-based organizations are best situated to identify and meet the needs of the women and families they serve because they have a first-hand understanding of local conditions and long-term relationships with the women who utilize their services. Unfortunately, small, locally based groups often lack the resources, expertise and organizational support needed to implement and develop effective programs. By working in partnership with MADRE, our sister organizations are able to build programs based on the initiative and perspective of local communities while benefiting from the resources, training and technical support that a leading international women's human rights organization can provide. To be effective, and attract and involve local women, a program—especially one treating such sensitive topics as human rights or sexuality—must be conceptualized and implemented within the community. Partnering with community organizations has enabled MADRE to avoid the mistakes of many international aid organizations, whose efforts to create effective programs are undermined by their use of "top-down" models in which health services or trainings are delivered by anonymous providers from outside the community. By contrast, MADRE's model of sister organizations, which is the foundation of Sisters Without Borders, stresses culturally and linguistically appropriate programs and services delivered by local community-based organizations and other grassroots leaders.

Many Sisters Without Borders volunteers are health professionals from among MADRE's 23,000 US-based members. Others are women from the global South who are part of MADRE's international network. Because many people in the communities where MADRE works have endured human rights violations, MADRE works to provide Sisters Without Borders health and human rights trainers who are themselves survivors of human rights abuses. These women are able to offer program participants a respectful empathy that encourages them to overcome the isolation and shame that often accompanies human rights violations. Indeed, women who have themselves endured abuses have an important perspective to share and serve as critical role models for moving beyond victimization to empowerment. Sisters Without Borders erases the dichotomy between victims of human rights abuses and human rights advocates, recognizing that survivors of abuse are often the most powerful advocates for change.

Linking Women's Health and Human Rights

Sisters Without Borders began as a women's health program, but MADRE soon realized that promoting women's health depends on guaranteeing a range of human rights that extends far beyond the right to health care itself. In the US, we tend to think of health mainly as a function of biology. However, health is not only the absence of disease and infirmity, but also a state of physical, mental and social well-being. How healthy we are depends enormously on our access to nutritious food, clean water and medical care; on minimal violence and stress in our lives, on decent living and working conditions and on our opportunities for love, pleasure and fulfillment. This means that overall health is strongly influenced by social and economic forces. For the world's poor and disenfranchised—70 percent of whom are women—improving health requires addressing the social and economic inequalities that deny people the option of making the best choices for their health.

Inequality, both between men and women and among different groups of women, is the most widespread obstacle to good health for the majority of women. Around the world, women die mainly from preventable causes, due to the combined impacts of gender discrimination, racism and poverty.

Rates of maternal mortality—the number of women's deaths during pregnancy and childbirth per 100,000 live births—provide one of the best measures of the overall health of a society. These numbers also offer a sharp illustration of the way that gender inequality, racism and poverty interact, claiming the lives of more than half a million women each year. Pregnant and childbearing women die because of gender inequity, which denies women the right to make decisions about their lives and denies them basic resources. As a result, women's reproductive rights are violated, their nutrition is compromised and their access to medical care is denied. Women also die because they have been subjected to colonization and racism: in Guatemala, for example, maternal mortality among Indigenous women is 83 percent higher than among non-Indigenous women. And women die because public health systems in the poorest countries have been dismantled by US-driven economic policies, so that today, a full 99 percent of maternal fatalities occur in poor countries.

Poverty, in fact, is the root cause of poor health for the majority of people in the world. It is the main reason that people go hungry, cannot vaccinate their babies and lack clean water and sanitation. And poverty is a major contributor to serious public health problems like violence, mental illness, stress and substance abuse. Around the world, policies that have exacerbated poverty and inequality have also undermined public health. Structural Adjustment Programs (SAPs) are a prime example of macro-economic policies that have a profound impact on the daily lives of women and families around the world. First imposed in the 1980s by the World Bank and International Monetary Fund (IMF), SAPs mandate that poor governments cut public spending, particularly in health and education, and reallocate resources to debt servicing (making interest payments on money owed to rich countries). In sub-Saharan Africa, the world's poorest region, SAPs have slashed national health care budgets by a whopping 50 percent, decimating basic health services such as nutrition classes, immunization programs and prenatal care. Even urgent medical care is now unavailable to more than half the people in the world's poorest countries.

To meet the tremendous needs caused by SAPs and other neo-liberal policies, MADRE's partner organizations work with Sisters Without Borders to build local organizations that provide a range of services in their communities, including health clinics, domestic violence shelters, HIV/AIDS education, literacy programs, income-generating initiatives, nutrition classes and more. These are remarkable achievements that should be supported, but they must also be understood as the result of a serious failure of governments; community-based organizations, no matter how competent, are no substitute for responsible government that guarantees people's basic welfare.

In response to government inadequacies, Sisters Without Borders works to strengthen women's capacities to hold their governments accountable to meeting people's needs. Moving beyond a "band-aid" approach to service provision, Sisters Without Borders provides leadership development, human rights education and skills training that enable women to be effective advocates for themselves and their communities in local institutions, at the national level and at the United Nations and other international human rights arenas.

The MADRE Model of Human Rights in Action

MADRE's Sisters Without Borders programs in Nicaragua, Rwanda and Palestine illustrate the successes of the MADRE model in promoting health and healing and challenging policies that threaten women's human rights and compromise women's health.

Nicaragua: Creating Food Security and Health Services

On Nicaragua's North Atlantic Coast, home to most of the country's Indigenous and African-descent communities, almost three-quarters of the population suffer from malnutrition. Local rainforests are rich in food and fresh water, but much of these lands have been expropriated by logging and mining companies, cutting people off from their traditional sources of food. Meanwhile, aggressive marketing of processed foods like bread and cola has further undermined traditional diets and exacerbated malnutrition. The region has long suffered from geographic isolation and neglect by the government in Managua, the capital. Consequently, public health services rarely reach communities on the North Atlantic Coast of Nicaragua.

Together with our partner organization, the Wangki Tangni Women's Center ("Flower of the River" in the Indigenous Miskitu language), MADRE works to combat malnutrition and increase food security by providing chickens and vegetable seeds, along with training in livestock management, sustainable agriculture and organic gardening techniques, to local families. The Wangki Tangni Women's Center also works to promote the long-term health of the communities it serves. With MADRE's support, they have developed a model for creating a sustainable public health system on Nicaragua's Atlantic Coast and won legislation to guarantee local health services from the regional government.

In Latin America and around the world, the ongoing destruction of Indigenous cultures has meant the loss of traditional healing and health care practices. Racist attitudes and policies effectively deny Indigenous women access to most public services, including medical care. When available, the medical system has often been a site of disrespect and even violence towards Indigenous women. Many professional health providers do not speak Indigenous languages. Indigenous women rarely participate in the design of public health programs, which, consequently, often fail to address their needs. Examination by male doctors is often culturally unacceptable, but may be the only available option. In numerous Latin American countries (as well as in the US), poor and Indigenous women seeking professional health care have been sterilized without their consent. Not surprisingly, many Indigenous women choose not to use public health services, even when their need for health care is great.

In response to these problems, MADRE co-founded CADAMUC, the first women's health clinic on Nicaragua's North Atlantic Coast. CADAMUC specializes in gynecology, obstetrics, dentistry and general medicine, combining Indigenous healing practices with Western medicine. Most of the clinic's health care providers are members of the community. They speak local languages and respect traditional healing practices and cultural beliefs about sensitive issues like sexuality and family violence. In addition to primary care, CADAMUC provides women and teen-aged girls and boys with education about reproductive health and the prevention of sexually transmitted infections and offers counseling on domestic violence and child abuse. In partnership with MADRE's Sisters Without Borders program, CADAMUC supports women's efforts to make their own decisions about their sexuality and fertility and to defend their reproductive rights in the context of their overall human rights.

Rwanda: Women Healing their Lives and Their Country

During the 1994 genocide, nearly one million Rwandans were murdered and another one million uprooted from their homes. Hundreds of thousands of women were raped in a campaign designed to humiliate and annihilate targeted communities. Those who survived emerged homeless, disabled and traumatized. Today, Rwanda shoulders a staggering 11 percent rate of HIV/AIDS infection, a legacy of the mass rapes of 1994. Almost one in five children die before the age of five from easily preventable illnesses, many caused by untreated water.

These appalling indicators and the human suffering that they represent persist largely because international policy makers have prioritized the repayment of Rwanda's national debt over the lives of its people. Even in the wake of genocide, the World Bank and IMF have capped Rwanda's public health budget at barely 10 percent of what the government spends on debt servicing. Providing potable water and basic health care would cost a fraction of Rwanda's yearly debt service payments, yet these critical services are denied to most Rwandans.

MADRE's partner organization in Rwanda, BENIMPUHWE ("From the Heart" in Kinyarwanda), is an association of women working to heal their lives and their country. They have constructed a new village, home to both genocide survivors and those from the community that perpetrated the massacres, on the scorched earth of the genocide. MADRE has helped BENIMPUHWE construct a potable water system for the community, reducing the threat of water-borne diseases like cholera and saving women hours of hard labor each day hauling water from the nearest river. Through Sisters Without Borders, one of MADRE's Nicaraguan partners traveled to Rwanda to conduct human rights trainings with the women of BENIMPUHWE. In a series of workshops, women gathered to learn how international human rights instruments could be used in their struggle to demand basic services from the government, including health care and clean water.

Palestine: Health Care is a Human Right

Daily life for children in the refugee camps of Palestine has long been circumscribed by military violence and grinding poverty. Since the most recent escalation of violence in September 2000, Palestinian neighborhoods and refugee camps have been attacked by US-made helicopter gun ships; homes and health clinics have been fired upon and bulldozed; and children have endured protracted curfews, school closures and worsening poverty and insecurity. Many children are showing signs of trauma, including nightmares, aggressive behavior, spontaneous and seemingly unprovoked hysteria and extreme lethargy bordering on catatonia. Palestine's once functional public health sector has been deeply strained by Israeli army attacks on hospitals, the shelling of the Ministry of Health and the use of live ammunition against ambulances and emergency health workers. Severe restrictions on Palestinian freedom of movement further block people's access to doctors and hospitals, while delays of ambulances at army checkpoints further threaten the health of patients.

The Deheisheh Refugee Camp, just outside of Bethlehem, is home to MADRE's sister organization, the Ibdaa Center. Ibdaa is a cultural exchange and human rights center that offers a range of services for women and young people. Ibdaaï¿½s organizers understand that the psychological harm inflicted on children in times of war can last even longer than the physical wounds. With support from MADRE's Sisters Without Borders, Ibdaa has launched an emergency trauma counseling program to help children, parents and teachers in Deheisheh recognize and address the psychosocial impact of military violence on children. Ibdaa has organized local nurses to provide basic health care to people who have been confined to their homes by military curfew. And Ibdaa offers health education and legal advocacy programs to women and girls that are grounded in an integrated understanding of women's rights, human rights and Palestinian rights to self-determination.

Turning Outrage Into Action

Born of the conviction that people working together can effect positive change, MADRE has always operated at the crossroads of the movements for women's health, human rights and peace. This position offers a critical vantage point for understanding that women's rights are human rights and that all human rights, including the right to health care, are inherently political.

Faced with a world in which inequality poses a serious threat to the health and well-being of millions of women and their families, MADRE's Sisters Without Borders programs reflect the understanding that land reform and resource distribution can be as critical to public health as vaccinations or vitamins. The partnerships created through Sisters Without Borders enable women to join together to meet urgent needs for health education and services, while meeting equally urgent needs for justice and long-term social change.

By Yifat Susskind, Communications Director