Stigma = Death: LGBTI Groups in Lebanon Stand in Protest Against Discrimination

Before COVID19 shuttered the streets of Beirut popular protests advocated for an end to corruption, chanted slogans against the ruling class and added a new voice to expanding space in the street- demanding an end to homophobia.  In Lebanon and the broader Middle East and North Africa (MENA) region, LGBTI people are criminalized ranging from imprisonment to death sentences.  Discrimination and resulting fear and stigma is a barrier to health care access for the LGBTI community. 

While Lebanon is considered a more tolerant country, LGBTI opposition remains – from political leadership to different religious organizations. In addition to popular protest movements new ways to come out aim to tell the LGBTI story in Lebanon and the Middle East:

No Longer Alone | Human Rights Watch

Watch the video series as activists tell their stories and describe how they are

Lebanon’s history of LGBTI criminalization dates to the French Mandate and establishment of Article 534 in 1942 that criminalizes sex that “contradict(s) the laws of nature”. Seventy eight years later, Lebanon’s increasingly visible LGBTI community and health sector allies among others support the annulment of Article 534.

Helem is the first LGBTQ organization in the MENA based in Beirut. With allied organizations including Meem, the Lebanese Medical Association for Sexual Health (LebMASH) and SIDC efforts to support annulment of Article 534 have made slow but steady progress. This includes landmark cases over the past decade. The 2009  Batroun court decision refused to apply Article 534 and later, the 2017 el-Metn court decision refused to apply Article 534 via a rights-based approach.  Today Article 534 remains while Lebanese society changes in the face of protest and pride- marking a tipping point for the LGBTI community to realize their rights.

Join our fight for rights and health for all by demanding an end to discriminatory laws like Article 534. With Eid this month, offer charity to your local LGBTI organization. With Pride month ahead join the fight: report LGBTIQ+ Violations, donate, support emergency housing, legal and domestic violence response, local food banks and refer anyone who needs mental health support. To participate visit Beirut Pride and Global Pride in June 2020.

STOP DISCRIMINATION

Ensuring Medicine Security in Nigeria; building her internal pharmaceutical pipline

In 1989, Nigeria ratified its National Drug Formulary and Essential Drugs List Act, providing guidance on the certain types of medication to be prescribed for use on certain ailments. This was soon followed by the National Drug Policy of 2005, mandating that 60% of all drugs for use in Nigeria should be manufactured internally, with only 40% to be obtained through imports.  

In spite of this, the reality on ground remains contrary. As of 2018, Nigeria spent approximately $606 million on imports of essential medicines, an estimate of 4% of its overall GDP spend on healthcare in 2018. Although, 4% of the overall GDP does not sound extreme, when the fact that the Nigerian healthcare is privately funded is considered, a new picture comes to light. In 2014, an article from USAID found that approximately, spending from all “tiers of government” amounted to 6% of total government expenditure on health. Assuming that everything remains the same in 2018, the $606 million becomes an astounding 60%, thus more than half of available public funds are utilized for the provision of drug imports.

^{Nigeria’s 2018 spend on pharmaceutical imports}
_{Source: https://tradingeconomics.com/nigeria/imports/pharmaceutical-products}

Additionally, it has been widely reported, that 70% of all medicines used in Nigeria are imported, whilst its pharmaceutical manufacturers, churn out the remainder 30%, thus they’re consistently kept under capacity. In light of the above, it is easy to understand why and how access to medication becomes a difficult act to maintain for the Nigerian government. Such difficulties have further ramifications by encouraging the manufacture of counterfeit and look alike drugs. The use of which can result in adverse reactions as well as efforts to block avenues of such production, placing additional burdens upon an already overwhelmed and fragile health infrastructure.

To tackle the above issue, I would recommend a policy providing assistance to the development of robust internal pharmaceutical supply chains within Nigeria. To bolster such development, it would be beneficial for the following bodies to a create a coalition for the maximization of authority and presence.

A coalition comprising of The Nigerian Natural Medicine Development Agency (NNMDR), Pharmaceutical Manufacturing Group-Manufacturing Association of Nigeria (PMG-MAN) and the Raw Materials Research and Development Council (RMRDC), would ensure that the most significant aspects of Nigeria’s production are taken into management by capable hands. The NNMDR and the RMRDC can work together to ensure that the raw materials being utilized for production by the PMG are fit for purpose. Meanwhile, the PMG benefits from strong partners who are able to lobby the government on policy issues directly impacting their members.   

This development will allow Nigeria to achieve several goals at once. 1) Nigeria will meet both its Alma Ata and Sustainable Development Goals by ensuring equitable access to medication for all its citizens. 2) Nigeria will resolve its over-dependency on imported drugs, as a result the funds being used for imports of drugs can be repurposed for other health care needs. Without the above solutions or other similar ideas, medicinal security and access to medicine may prove to be an elusive goal not just for the Nigerian government but also her citizens.

HPV VACCINES INITIATIVE GHANA

Cervical Cancer is mainly acquired sexually through infection with some subtypes of Human Papillomavirus (HPV), mainly HPV 16 and 18. Low and Middle Income countries have over the years struggled with cases of Cervical Cancer primarily due to lack of preventive and control measures. Ghana has been unsuccessful in its efforts to battle the disease with major contributory factors being late detection and most importantly lack of affordable and routinely administered vaccines.

In 2019, WHO outlined some goals that are to be achieved by African countries in the effort to eliminate Cervical Cancer. Among these goals or strategies include ensuring 90% coverage of HPV Vaccines among girls up to 15 years of age. Currently there are two popular vaccines on the market: Cervarix and Gardasil.

To ensure that the above stated goal by WHO is achievable, collaborative efforts by International Bodies, Non Governmental Organizations (both international and local), Health professionals as well pharmaceutical companies that manufacture these Vaccines, will be required. The GAVI Alliance previously conducted a pilot project in about two regions of the country to promote the vaccination of girls between age 9 and 11 years against the HPV. However, these vaccines are considered expensive and mostly found in private health facilities and outlets.

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A system can be put in place whereby, MERCK & CO Pharmaceuticals and Glaxosmithkline, which are the two main vaccine producing companies, can make donations by way of free products. They can also sell the vaccines at highly discounted prices to the low income countries. This can be done collectively with the WHO and the GAVI Alliance. The Ghana association of obstetrics and Gynecologists can take advantage of the patient time to educate several adolescents and women in their reproductive age on the importance of the vaccines and also administer them routinely at their facilities. CERVIVA Foundation Ghana is well known NGO that has over years spearheaded campaigns on awareness and prevention of cervical Cancer and will be useful in this project since they have already gained recognition among most of Ghanaian women via their social media platforms and seminars. Promoting free or highly subsidized HPV vaccines in Ghana will be a huge step in the fight against this preventable cancer.

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photo credit: CERVIVA FOUNDATION GHANA (https://cerviva.org/gallery/talk-on-cervical-cancer-at-makola-market/)

Adequate Funding and Implementation of Nigeria’s National Policy on Infant and Young Child Feeding

While Nigeria has been diligent in recognizing the importance of optimal exclusive breastfeeding (initiation of exclusive breastfeeding within an hour of birth up to 6 months, and continuum of breastfeeding up to 2 years or beyond)  and amended its National Policy on Infant and Young Child Feeding (IYCF) to reflect the World Health Organization’s Global Strategy for IYCF, the nation continues to face grievous challenges with implementation. Nigeria has an exclusive breastfeeding prevalence of 17% in children under six months and has the highest under-five mortality rates in Africa.

Multiple studies have shown that the community’s misconceptions of the quality of breast milk and breastfeeding continues to have a significant impact on compliance with optimal exclusive breastfeeding guidelines. One of the most harmful misconception (promoted by some family members and Islamic Religious Leaders) is colostrum being considered spoilt, and the need for mothers to feed their infants with unsuitable supplements while awaiting the clean, unspoilt milk. Another is the belief that the milk is inadequate. What the community perceives as protective measures are counterproductive to the health and survival of the newborn.

In order for Nigeria to experience the full potential health and economic gains from breastfeeding, they must implement, monitor and fund their IYCF policy strategy with fidelity. Nigeria has already employed efforts to making these changes. Wellbeing Foundation Africa (WBFA) has already collaborated with Kaduna State Government, Alive & Thrive FHI360, Save the Children International, and other nutrition stakeholders to lunch the first multimedia campaign to improve IYCF practices Kaduna and Lagos State.

Alive & Thrive’s Start strong for a better future TV spots

However, more needs to be done at the community level. The government should leverage its partnership with WHO, the World Bank, United Nation’s Children’s Fund, and other donor agencies to employ the recommended annual breastfeeding funding of at least $4.70 per newborn. The nation should also train and deploy Community Health Workers to provide community level, family-based education on the benefits of breastfeeding, consequences of not breastfeeding, changes in breast milk as the baby grows, the importance of the first milk produced shortly after birth (colostrum), and support for initiation and continuum of optimal breastfeeding practices.

Access to Rehabilitation Services in Haiti for People with Disabilities

The devastating earthquake in 2010 resulted in an overwhelming number of people with disabilities and occurred at a time in the country when there were only 10-12 physical therapists. Not only was access to rehabilitation limited,  people with disabilities were marginalized, did not have access to public places, experienced discrimination for employment and were isolated from society. Access to rehabilitation is still limited due to lack of trained physical, occupational, and speech therapists, lack of awareness of the benefits of rehabilitation, education on causes and prevention of disabilities. NGOs have overwhelmingly supported the training of rehabilitation technicians to provide rehabilitation and although this has undoubtably helped many people, the need for skilled rehabilitation therapists to bring evidence based therapy services to Haiti, is still critical. Haitian Law on the Integration of Persons with Disability passed in 2012. Highlighted by highlighted by the Humanitarian Practice Network, the First Haitian Conference on Disability Rights and Political Participation was held in 2014 . These have increased awareness and promote better access and better care for people with disabilities.

http://crudem.org/the-challenges-of-physiotherapy-in-haiti/

What can funding the training of skilled physical therapists in Haiti do for the people with disabilities in Haiti?

• Improve acceptance of people with disabilities
• Advocate for equal rights and opportunities, including advocacy for making roads and sidewalks accessible for people requiring wheelchairs and prosthetic limbs like the Haitians in the photos above
• Ability to create sustainable education by Haitian physical therapists to train more physical to support the country’s needs and improve the quality of life of people

Gender Based Violence for Rohingya Refugees in Bangladesh

Gender Based Violence for Rohingya Refugees in Bangladesh  

Terrible violence in the Rakhine State in Myanmar has driven an estimated 700,000 people from the Rohingya community across the border into Bangladesh since August 2017. Cox’s Bazar, in Bangladesh is hosting one of the largest displaced populations in the world, with over
865,0001 people from this region, most of whom are living in overcrowded makeshift camps and adjacent settlements. This mass exodus of Forcibly Displaced Myanmar Nationals (FDMN) is one of the fastest developing crises in the world.

Deeply embedded in cultural and socio-economic practices, violence against women is sanctioned by both society and the state, in the name of culture, tradition and Islamic religion. According to the VAW Survey 2015, jointly conducted by UNFPA and the Bangladesh Bureau of Statistics (BBS), 73% of ever married women in Bangladesh have experienced some kind of violence by their current husband, 55% have reported some type of violence in the past 12 months, and 50% reported physical violence in their lifetime.

Violence against women and girls within relationships seems to be normalized within the Rohingya community in Cox’s Bazar, and women rarely seek support unless they need medical treatment. Because of this most women stay in their shelters due to social norms that limit their roles in the public sphere, as well as to avoid sexual assault and trafficking that occurs in the camps.

Only gross violence such as rape and murder are paid attention to. Violence at the domestic level, within the home of the family, is often overlooked and ignored, leading to limited intervention and resources available for these women. However, changing our mentality regarding the issue and starting to recognize violence against women as a violation of Human Rights is a significant turning-point in the struggle to end violence against women globally.

In response to this issue, UNFPA Bangladesh and the Local Government and Engineering Department (LGED) have since put a policy in place agreeing upon the implementation of a Gender-Based Violence component of the World Bank Funded Emergency Multi-sector Rohingya Crisis Response Project project.

In addition to this there has been a large response from several of the humanitarian players; all working together to help reduce the incidences of GBV within the refugee camps. UNICEF in partnership with 5 international and national NGO’s will establish Safe Spaces for Women and Girls. CARE will provide sexual and reproductive health services and undertake prevention and response to gender-based violence activities. United Nations High Commissioner for Refugees interventions will focus on increasing meaningful participation and community engagement. Oxfam in partnership with Action against Hunger and Save the Children, CARE, UNHCR, the Inter Sector Coordination Group (ISCG) and
UN Women have conducted a gender analysis, aiming to identify the different needs, concerns, risks and vulnerabilities of persons Rohingya refugee communities and host communities in the Cox’s Bazar district of Bangladesh. There is no easy way to end the suffering that is occurring within these camps, however the increase in support from various organizations and policies being made at the governmental level are certainly steps in the right direction.

Access to Care- Expand Healthcare Coverage in North Carolina.

By: DianaVCraft

Healthcare Coverage continues to be a barrier for many working families in North Carolina. Currently, North Carolina has over 1 million citizens that have no insurance coverage and most of these uninsured individuals aged 19-64 are employed, but either not employed full time, or do not make enough money to afford healthcare coverage. This barrier effects the opportunity for citizens in North Carolina to receive quality and affordable health care and causes a surge in hospitalizations. Though the Affordable Care Act has helped some citizens, many still can not afford the premiums and fall into the healthcare coverage gap. So what can North Carolina do to help address the health insurance coverage gap?

In April 2019, the General Assembly introduced House Bill 655- NC Working Families Act, that will develop a healthcare program that addresses the needs of citizens who are ineligible for Medicaid due to income levels, but do not qualify or afford health insurance. This program will look at working with current healthcare partners (i.e. Blue Cross Blue Shield) on developing plans that would be affordable for families as well as look at expanding Medicaid coverage.

Despite opposition from organizations who support the freedom movement and businesses/corporations, this bill is instrumental in making sure that all North Carolinians can receive quality and affordable health care. The Care4Carolina coalition, is comprised of National organizations such as but not limited to: AARP, National Cancer Society, American Heart/Stroke Association, as well as state organizations such as but not limited to: local health systems, health foundations. This coalition has been crucial in mobilizing support to help move this Bill forward through the General Assembly. By supporting House Bill 655, North Carolina will be able to develop a health program that can close the insurance gap and help North Carolinians gain access to the care they need which will help improve health outcomes.

Shifting Disability Culture in Southern Africa

Botswana: Progressing down the path of advocacy for policy implementation and integration.

In the early 1970s, Botswana, a dualist state, acknowledged the needs of people with disabilities (PWD’s) and upon further findings service development began starting with the Ministry of Health. In May of 1996, the National Policy on Care for People with Disability was established and adopted by the national government. Disabilities are caused by various factors, but inevitably present challenges from individual loss of independence to disintegrated family structure and increased care demand for the state. As a cornerstone for change, this policy presented 9 principles for various actors to implement to elevate the quality of life for PWD’s along with their rights (National Policy).

In accordance with the 2011 Population and Housing Census 2.9 percent of the population were PWD’s with male incidence greater than female. The Central Statistics Office as well as health care district surveys aid in compiling pivotal data to reveal growth and challenges in Botswana with PWD’s (Disability-Statistics). The United Nations created an opportunity to sharpen this vision through the CRPD (Disability Rights), however the government’s acknowledgement of the convention has not yet resulted in its ratification. The spectrum of present disparity for PWD’s range from transportation accessibility to justice, education to employment thus the fight is far from finished (Yearbook). Surveying dynamics across multiple sectors progress from the benchmark of the National Policy presents at varied involvement.

Government coordination, including the Office for PWD’s serve to create and coordinate protection measures in policies like the Employment Act and Inclusive Education Policy (Yearbook). Regarding the latter, the Ministry of Education has evolved on paper in its provisions to PWD’s with quality education however these children remain isolated and ostracized from equal opportunity (MythofInclusion). Meanwhile, the Council for the Disabled, at a national level, works with vigor to coordinate all NGOs and mediate as a lobbyist toward increased human rights for PWD’s (Yearbofrok). Transforming the environment of disability is a daunting task however through a co-ordinated national response and re-calibrated community participation PWDs will realize health and wellness beyond the present shadows they live within.

Strategy

• Strengthening gov’t engagement/communication for legislative action
• Multi-sectoral co-ordination and collaboration
• Partnership in capacity building related to weak infrastructure

Tobacco Control in South Africa- Policies, Power, and Political Implications

https://www.assaf.org.za/images/AfricaTobaccoControlReportFinal1.pdf

“There is a fundamental and irreconcilable conflict between tobacco industry interests and public health policy interests.“

-World Health Organization

The tobacco industry remains a seemingly insurmountable adversary in the fight for tobacco control globally.  With an operation of billions of dollars annually, the industry is able to wield power and influence, and leverage its connections in the political sphere.  In acutely affected countries like South Africa, this influence seeks to dampened efforts against tobacco control, despite evidence-based and informed efforts to address what is identified as the leading cause of mortality and morbidity in lower and middle income countries.  This dichotomous struggle between research, policy, and practice can be seen in the decades long fight in addressing the issue of tobacco control in South Africa. 

In 2018, the Control Tobacco Products and Electronic Delivery Systems bill was introduced, proposing to make changes in 5 key areas: removal of public vending machines for cigarettes, regulation of the e-cigarette industry, target marketing of cigarettes at local points of sale, create a smoke fee policy for public areas, and implement standardized cigarette packaging in an effort to further address and curtail the rates of tobacco use in the country. Backed by international and multi-disciplinary support groups, this recent proposed legislation to expand tobacco control within South Africa is still pending.  

Moving forward with this bill despite opposition, will be instrumental in furthering improvements in tobacco control thru established national policy. In addition, stakeholder and community engagement will prove to be essential in the implementation, regulation, and sustainability needed to decrease tobacco use within communities. As such, efforts should continue to be targeted and aligned thru changes in both policy and practice. With sustained support from National and International partners, Academia, and the Ministry Of Health, it is hopeful that this bill will be enacted; thereby providing stricter regulations guiding the tobacco industry, and building local support mechanisms to facilitate and ultimately reduce the prevalence of tobacco use in South Africa.

Menstrual Hygiene Health of Women in Refugee camps in Ethiopia

The lack of attention in policy towards the menstrual hygiene health of women living in refugee camps is of great concern. In addition, there is also a a general lack of knowledge among girls and women on the risks of reproductive tract infections that can occur due to neglect of personal hygiene during menstruation. As women living in refugee camps do not have access to sanitary products in the rural areas due to accessibility, or are unable to afford them due to high costs, they rely on reusable cloth pads, and wash them before reusing.

Photo credits: File:Jeunes Afars.jpg-Wikimedia Commons

Even when they are given such menstrual products, inadequate education and follow up have been done to teach and inculcate proper and sustainable use of the re-useable products . A lack of infrastructure planned targeting to set up suitable places for woman to have exclusive access to sanitation, latrines and water points for washing these menstrual products in safe and private places. It is important them to garner support and funding from stakeholders to factor in Women’s menstrual hygiene health as a part of WASH planning. This move will indeed begin the process…

…of bringing together all societal and personal influences to raise awareness of and demand for health care, assist in the delivery of resources and services, and cultivate sustainable individual and community involvement.’

WHO, Social Mobilization

As a humanitarian worker , social worker and a woman, I am personally concerned about the many challenges facing women on menstrual hygiene health. 

1. The Challenges of implementing hygiene management:

• Weak infrastructure, large differences in the level of WASH services over rural areas and limited access to them, lack of social mobilization     

2.      The Challenges of implementing social mobilisation

• Required collaboration and support from multiple large stakeholders, such as the government, civil society, media, organisations of the UN system, community leaders, research and academic institutions, as well as access to the rural population which may not be easily achieved
• Extensive manpower needed, especially health workers Therefore, my aim is to rally different key organizations to rethink how menstrual hygiene health can be incorporate into camp planning and into public health education in camps.

The term menstrual hygiene management (MHM) originated in the WASH sector. After decades of use, there is broad understanding and acknowledgement of this term. Importantly, there is also a definition and emerging attempts at measurement in the context of schools, through the WHO/UNICEF Joint Monitoring Programme for Drinking Water, Sanitation, and Hygiene (JMP). 
In 2012, the JMP defined MHM as: “Women and adolescent girls are using a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and having access to facilities to dispose of used menstrual management materials.” 
Menstrual health builds on this concept and encompasses the broader impacts of the psychological, socio-political and environmental factors that accompany menstruation on mental, physical, and emotional health. By using the term menstrual health and hygiene in this guidance, we include both the factors included in the JMP definition of MHM together with the broader systemic factors that link menstruation with UNICEF’s goals in health, well-being, education, equality and rights. These systematic factors have been summarised by UNESCO as: accurate and timely knowledge; available, safe, and affordable materials; informed and comfortable professionals; referral and access to health services; sanitation and washing facilities; positive social norms; safe and hygienic disposal; and advocacy and policy.

https://www.unicef.org/wash/files/UNICEF-Guidance-menstrual-health-hygiene-2019.pdf

Possible actions by stakeholders

1 African Development and Emergency Organization	High Interest: https://orgs.tigweb.org/african-development-emergency-organization-adeoADEO aims to improve the quality of life of the poor and vulnerable in Africa, through the promotion of community empowerment and equity in Africa. It has done work promoting women’s welfare in disadvantaged situations.  Moderate involvement: Likely to be involved has high visibility and nationally. As an indigenous NGO, ADEO is aware of the challenges faced by women in Africa and is able to empathize and advocate for the needs of women.
2 African Humanitarian Action – Sudan	High interest: http://africahumanitarian.org/active_countries/south_sudan/AFHA has been involved in providing integrated and comprehensive primary healthcare (CPHC) in emergency cases.  It partners with UNHCR in curative services esp in the area of reproductive health healthcare in refugee camps High Involvement: has represented the needs of women and able to garner much support due to its proven records. AFHA has been a strong lead in healthcare in Africa, thus it would make a great partner on the ground providing quality healthcare advices to girls and women on menstrual hygiene health.  The close proximity in culture to the refugees represented in Tigray (mostly Eritrea) would make AHA a suitable organization to run targeted programmes.  Its past projects in other parts of Africa would be great networking opportunities to bring in community health workers and builders to value add to the designs of the refuges camps.
3 Blumont	High interest:https://blumont.org/Bulmont is committed to reach communities that require strategic infrastructure to meet specific needs. High involvement: Has been involved in provision of infrastructure to meet specific needs.
4. Sudan Health Association	High interest:https://www.devex.com/organizations/south-sudan-health-association-ssuha-104510 SHA’s mission aims to meet the health and social needs of the refugees and IDPs.  Its current work includes work in the refugee camps for IDPs.  It’s registration with the Ministry of Legal Affairs and Constitutional Development, and also with the South Sudan Relief and Rehabilitation Commission (SSRRC) lends credibility in its advocacy and implementation work. Moderate involvement : Able to link up with strategic partners for networking.
5 .  U.S. Committee for Refugees and Immigrants	https://refugees.org/ High interest: the USCRI has proven records in helping the uprooted to obtain quality healthcare and respect the dignity of individuals – men and women.   High involvement: in partnership with Ethiopia government in the Tigray regions for many years. The organization is involved in projects pertaining to children and women health.  Thus, would likely be very supportive towards menstrual hygiene health.UCRI would be instrumental to coalitions with many stakeholders and political stakeholders due to its long history with work in Ethiopia.

When refugee women left their hometown in a rush, one of the last things that they remember, in their rushed moments, would be their menstrual cloth.  Coming into the refugee camp and starting life with a roof over their heads whilst having to mind their brood of children, menstrual hygiene care is often neglected.  When they begin menstruating and there is a lack of cloths, they might have to sacrifice one of the few precious clothes that they have brought with them.  Worse still, it could be rags that they managed to salvage to use as menstrual cloth.  There is often a lack of washing agents to wash the cloth clean, lack of drying area to hang the cloth to dry completely, lack of cloth to change to.  Infection sets in when damp or dirty cloths are used. 

If organisations such as the African Development and Emergency Organisation, African Humanitarian Action Sudan,  Blumont, Sudan Health Association, U.S. Committee for Refugees and Immigrants , UN Women could collaborate and pilot a Menstrual Hygiene Health programm to provide menstrual kit (menstrual cloths/ reusable sanitation pads) to all women upon arrival at the refugee camps and provide material and  menstrual health training to women health workers who can in turn teach other women in the community, and women teachers to teach the girls in their schools, then this area of Menstrual Health Hygiene of women will not be overlooked, an area that has been ignored for far too long.  It is time to address the issue and ensure equality for women as beneficiaries possessing EQUAL rights to receive humanitarian action )UN Women Humanitarian Strategy 2014–2017).