Interview with UNICEF's regional director

With the world's focus shifting to reconstruction in Iraq, aid agencies in the South and Central Asian region fear renewed donor fatigue, which could have a negative impact on projects established in needy countries. In an interview with IRIN, The United Nations Children's Fund's (UNICEF) Regional Director for South Asia, including Afghanistan, Sadig Rasheed, spelled out his agency's priorities, and said development work with children in the region would be severely affected unless donors responded more positively to urgent needs. QUESTION: As the regional director of UNICEF, what do you see as the main issues in this region that require urgent attention? ANSWER: South Asia has by far the longest distance to go amongst all regions in terms of the wellbeing of children as measured by many indicators. Several priorities cry for urgent attention, but two are key. One is ensuring that in the very first years of life, children survive and thrive. Fourteen million children in South Asia are not immunised against diptheria, that's 41 percent of the world's total; 78 million children are malnourished (more than half's world's underweight children); and the region has the highest number of low-birth-weight infants. The other key area for children in South Asia is to try and get all children to have an education that is worthwhile. Six of the eight countries in this region are being targeted by UNICEF for an acceleration in the enrolment of girls into schools by 2005. There are 43 million children out of school in South Asia, of which 26 million are girls. The highest percentage of the total out of school children globally are in this region. We find that girls are usually the last to be put into schools and the first to be taken out. Every year a girl spends in school pays enormous dividends in terms of better health, family planning and lessening vulnerabilities, and is a sure way of preventing the perpetuation of illiteracy, gender-bias and poverty. These priorities must feature prominently in governments' national plans and budgets. Combating HIV/AIDS and improved protection of children from violence, abuse, exploitation and discrimination, with particular emphasis on the gender dimensions, are two other priorities in the region. Q: With the focus on reconstruction now shifting to Iraq, are you concerned that this will have an effect on resources available for this region? A: Even before the Iraq conflict began, UNICEF globally was warning that donors appeared to be keeping their hands in their pockets in anticipation of the need to find large sums to assist in the rebuilding of the country. We noticed that resources for and, better said, investment in the wellbeing of children as far afield as Colombia and Rwanda were suffering a chronic shortfall in funding. While first and foremost, governments must invest adequately in children and in development efforts, international development cooperation is essential. If assistance remains at the level where the same pot of money is moved around and distributed according to the latest emergency, then there will be problems of sustainability of human development efforts. Q: One of the pressing issues in South/Central Asia today is the spread of HIV/AIDS. How does this deadly virus threaten this region, and in particular Pakistan ? A: The unmistakable signs of an expanding HIV/AIDS epidemic in South Asia are all around us. About 4.2 million people are living with HIV/AIDS in South Asia. While the epidemic is still relatively small compared to the population of the region, it will rapidly and mercilessly grow if left unchecked. Only immediate, comprehensive action will prevent at least 5 million new HIV infections in South Asia this decade, and will begin to successfully turning back the epidemic. So this is a monumental crisis in the making, that is not only destroying lives but could potentially pose a real threat to poverty reduction efforts, human development and economic progress. The number of children living with the condition is still relatively small, but we have to concentrate our minds and efforts on the potential growth. You asked specifically about Pakistan, where UNAIDS estimates that around 78,000 men, women and children are affected. But this really should not be about figures, individual countries or who is most at risk. Because, one way or another, everyone is at risk. One of the major lessons learned in the fight against this condition is that we should not wait, but must move fast to mount effective policies to halt the growth. It can be done, and in Thailand, Cambodia, Uganda, and Brazil they have managed to reverse the climb of the graph. Q: What is UNICEF doing specifically to help curb the spread of AIDS in this region? A: The lack of education for girls, entrenched gender bias, silence and denial, and prejudice against people with AIDS are among the host of factors fuelling the epidemic. UNICEF is forcefully advocating that the wall of silence must come down, and these factors must be countered. Through its country programmes of cooperation, UNICEF is supporting national efforts to expand girls' education and, together with the UNAIDS co-sponsors, is providing the knowledge as to how the people can best keep themselves and their families safe. In this regard, the prevention of HIV/AIDS among young people and mother-to-child transmission are extremely critical elements. Political leadership is a critical element in this fight. In February 2003, UNICEF and UNAIDS hosted a high-level meeting of ministers, parliamentarians, religious leaders, young people and people living with HIV/AIDS from each of the South Asian countries, who recommitted themselves to taking effective action. I am gratified that Pakistan's government and leaders, the Federal Minister of Health who attended Kathmandu conference in particular recognised the threat, have declared a commitment to combat it, and are openly speaking to the public about this threat and how it can be averted. Critically, we also helped organise a forum of young people beforehand to see what they wanted from their leaders. They asserted their rights to be part of the solution. Q: What information do you have on the spread of HIV in Afghanistan, and how will UNICEF educate people on safe sex in this country, given the cultural taboos and levels of illiteracy? A: There are no reliable figures at the moment on this in Afghanistan. But of course, it is there and people need to be informed in an appropriate and relevant way that gives them accessibility to knowledge without causing offence, because that will not solve the problem. The policy makers are committed to confronting the disease, and UNICEF will lend its advocacy skills to the government, and can do a lot to ensure that communities, their leaders and health authorities get good information. As anywhere, what happens in the future is in the hands of leaders. But as I have said before, the important thing for us all is to realise that the growth of this epidemic is not inevitable and upward trends can be reversed. Q: Moving on to child protection, is the situation of children's rights improving in this region? If so, how has it changed? If not, why hasn't it improved, and what measures are being taken to do so? A: There is now much greater awareness of child rights in the region, and governments are making important efforts to improve the situation and also reporting regularly on the status of such efforts to the UN Committee on the Rights of the Child. Also, national civil society organisations, ombudsmen and committees on child rights are raising awareness about the protection of child rights and speaking out against violations. Yet, much is to be achieved. There are millions of children out of school, millions without access to basic social services, millions working in harsh conditions, and being denied an environment where they can play, express themselves and live without beatings, threats and abuse. This is why it is so important that all children have access to schools. The school is a key component of what we call the protective environment. It is a place where children are observed, where they can develop, where a teacher may notice if a child is ill or suddenly goes missing. UNICEF works with governments and many other agencies to expand the network of strands in this protective environment and advocates for change. The encouraging thing is that the list of partners on this issue is growing, that all the governments are 'on side' and are signatories to the Convention on the Rights of the Child. Q: What about the situation of Afghan children, both inside and outside the country. How vulnerable are they and what are UNICEF's priorities for them ? A: Over 20 years of war and internal conflict have reversed most of the gains Afghanistan made for children through the 1960s. Most social indicators reflect the worst levels in the world. Less than one-fifth of the population has access to safe water and sanitary latrines. At 250 per 1,000 live births, under-five mortality is one of the highest in the world. Vaccine preventable diseases, lower respiratory tract infections (including measles) and diarrhoea account for most under-five deaths. At 5 percent, girls' enrolment rates in primary schools are insignificant and there was an overall decline in enrolment rates and quality of education. This situation has started to change for the better with the fall of the Taliban regime. In the last one year UNICEF, with support from the international community, has worked very closely with the interim administration and the transitional authority. As a result, in 2003, over 4 million children enrolled in school (30 percent of whom were girls); over 9 million children received protection against measles, and 6 million were vaccinated against polio. Through UNICEF interventions, over one million people gained access to safe water. Q: Afghanistan also has the highest maternal mortality rate in the region, with Pakistan also featuring high. Why is this? Again, what work is UNICEF doing to prevent the increasing death rate? A: Afghanistan's maternal mortality rate stands at 1,600 per 100,000 live births (including the worst-ever documented ratio in the world, in Badakhshan, where estimates are 6,500 per 100,000 live births). With the exception of Sri Lanka and Maldives, all the countries in South Asia have significant and extremely worrying levels of mothers dying at childbirth. Obstetric complications are the leading causes of death and disability among women of reproductive age in South Asia. Statistically, we know that 40 percent of all births will have complications needing some kind of medical intervention, and 15 percent will need emergency treatment. Yet this statistical certainty is given a low priority, even though two lives are in danger in the birthing room. This lack of priority reflects a general lack of health provision for women, which also impacts on other services. Nurses are not well trained and they do not feel they have the power to make decisions. But there are many underlying causes, such as early marriage and teenage pregnancy. More than 40 percent of girls in the region give birth before the age of 20. Domestic violence against women continues to be a major contributor to maternal death in the region. Malnutrition has not changed in the region over the past decade and anemia levels remain above 70 percent in pregnant women. Poverty, caste, ethnicity and other social and economic disparities compound the vulnerability of women and girls to gender-based discrimination. Q: What is UNICEF doing to help improve the situation? A: We have the Woman's Right to Life and Health project that engages policy makers, works on the planning and budget down to district levels to see if obstetric care can be provided 24 hours a day and whether there is emergency provision. We develop and provide training materials for medical staff. In Afghanistan, the target is to achieve one obstetric facility with emergency capability in each of the districts. Q: Gender issues in this region continue to be a problem. We hear about endless projects and programmes on education for women etc etc. How has the situation of women in this region changed over the past decade, if at all? A: In South Asia more that in other regions of the world, overcoming the extreme gender disparities is a task as challenging as overcoming poverty. They are interrelated. Experience has shown that education of girls and women is critical for overcoming gender-based disparities. Similarly, while it is extremely difficult to try and calculate the cost of not investing in basic education, it has been estimated that in South Asia the cost of not addressing properly education and knowledge about HIV/AIDS adds up to 6 percent of GDP for each country. Gender disparity, the missing females, the baby screening that is aimed at removing future mothers, and policies that favour business as usual has a cost so huge that it retards development. Q: With mass polio vaccination programmes under way in Afghanistan and Pakistan, how far have these countries come in eradicating cases of the crippling disease? A: Afghanistan, Pakistan and India are three South Asian countries of only seven in the world where polio remains endemic. The vaccination drives in Afghanistan and Pakistan are paying good dividends. Afghanistan now stands on the verge of stopping transmission of the virus, and the number of cases in Pakistan has been cut down to 90 cases in 2002 from 119 in 2001.