Dear ACD,

With apologies for delay, please find attached Addendum to the RGA focussing on WASH and Protection as well as Shelter of interest to our assessment partners. I have set out each thematic area separately for presentation purposes but there was clearly overlap which I have tried to minimise.

Eid Mubarak!

Colm

Shelter

The updated data highlights that 17% of people now report living in a rented house or apartment while 83% of people are still living in shared, communal or sub-standard accommodation. Regardless, as with a previous CARE survey in 2015, 90% of both IDPs and Host Communities say that there were no separate rooms for female and male IDPs while 70% of all interviewees reported that families had to share a room in their building. This suggests that dignified space for both males and females is still rare and that risk of sexual exploitation and abuse may exist in the absence of private space. Notably, lack of safety and privacy is a significant concern for both IDP and Host Families sharing a home, an arrangement which is usually a product of family or friend networks suggesting that abuses of power could be perpetrated by those known to victims and/or that sexual favours may be anticipated / expected by Host families. Interestingly in this context, IDP families being hosted do not rank problems with their Host families as especially high but this could be a result of understandings or arrangements related to sexual favours or re-enforce stigmatisation around sexual exploitation and abuse and thus under-reporting by interviewees. Of note is that when this issue was explored separately with men and women, substantially more women (36%) than men (21%) reported problems with their landlords.

In the absence of improved shelter conditions in the longer term and evidence that 68% of men compared to 46% of women report overcrowding as an issue, intra household and family tensions including domestic violence may be expected to increase. In addition, inter-household tensions may also be expected to rise including between adult males disempowered in fulfilling their traditional income generation and protective roles for the family unit. Indeed, more men (35%) than women (26%) report security/safety (and perhaps related lack of lighting also) being an issue. Idol young males too, as known in other contexts, may become socially disruptive. Inter-household tensions are certainly being strained with 8% of interviewees already reporting same and 68% of Host Communities indicating their willingness to assist IDPs for only a limited time. Inter-household tensions would seem to threaten most between on the one hand the 53% of households living in unfinished buildings (47%) and informal settlements (6%) who often lack established local family networks, and on the other their Host Communities.

The physical conditions within shelter too are a challenge for everyone with women (81% and 50%) more affected than men (62% and 33%) by poor protection from extremes of temperature and unhygienic conditions respectively. Regardless, there is little disparity between expressed want by all for improved quality and insulation of accommodation and supported by high demand for clothes, bedding and fuel and stoves for heating, as well as want for flexible cash assistance or vouchers.

A particularly worrying trend overall exacerbating all risks is the still increasing number of IDPs in Kirkuk City though this does require further exploration as there appear to be some inconsistencies in results in the MSNA Data.

Protection

Some 27% of IDPs remain to be registered and this has notable protection implications with those not registered likely to be excluded from possible targeted food distributions. A very evident coping strategy of males and females already across both IDP and Host Communities is a reduction in food consumption in terms of portion size, quality of food consumed, frequency of consumption and prioritisation of children and non-working (assuming this means non-paid work) family members. This however is disproportionately affecting women (and presumably too the elderly and disabled) who are reducing their food consumption more than men in terms of quality (81% vs 64%) and frequency (68% vs 49%) who traditionally have low participation in the work force, and who we now know are selling jewellery they received when they married to pay for food. Women too are much more likely than men to spend an entire day without food (35% vs 20%). Particularly vulnerable to reduced food consumption will be pregnant or lactating women and girls and women of all ages who traditionally carry the burden of household work. Opportunities too for those not registered may be missed for access to referral services including maternal health and legal / health services for victims of domestic violence. Children may miss access to education and in a context where child trafficking and al-mutah is not unknown, lack of registration of children makes child disappearances more difficult to identify. Further exploration of the reasons for lack of registration are required. For example, some, especially young adult males, who may be subject to arbitrary arrest or detention may feel that registration allows their whereabouts to be tracked / known. Alternatively, a sex-disaggregated and/or geographic breakdown of those who have not registered may highlight possible weaknesses in communication strategies and means to reach particular groups e.g. certain channels might be used when women are otherwise consumed with domestic chores.

It may also be possible that there is a lack of registration because some 15-18% of IDPs (to be verified as there are some inconsistencies in data presented), especially those living in unfinished buildings and informal settlements, are planning to leave Kirkuk. Female interviewees suggested that this decision is usually taken by their husbands re-enforcing the previous perception that women’s participation in household decision making is limited. There is no evidence to suggest that relocating will reduce or increase exposure to protection risks.

Either way, evidence clearly suggests that those in rented accommodation or with Host Families not only have a higher physical quality of shelter (if not privacy and dignity as highlighted earlier), they have less fear of eviction, are less inclined to incur debt, and also have better access to food, water, clothing, health services including maternal health services, than those in buildings or settlements. Amongst the latter group, this more vulnerable position could lead to elevated risks of negative coping strategies (other than those related to food referenced above) including early or temporary marriage for young girls (also referenced above in the context of unregistered IDPs), transactional sex or sexual favour, or even increased leaning for both males and females but most especially youth towards extremist/fundamental groups offering incentives. The relationship between vulnerability and access to food, shelter and means to survive is reflected in the prioritisation amongst all groups regardless of gender identity for income (cash and vouchers preferred), shelter and food security.

GBV and sexual health were not highlighted in assessments as health issues by either females or males and this is consistent with non-disclosure related to fear of stigmatisation and disclosure of related matters to close confidants or family members.

Amongst males, the high frequency of major injury combined with especially high levels of psychological trauma when compared with females points to their possible role as combatants, or as deliberate targets by combatants, or indeed other protection risks as yet unidentified and may go some way to explaining men’s higher prioritisation of overcrowding and safety/security as shelter issues.

It is notable that the highest levels of injury/trauma for men as well as pregnancy complications (discussed below) for women occur amongst IDPs in larger groupings or settlements. Lack of access to health care regardless of location /status affects males and females and is also a clear priority behind income (cash and vouchers preferred), shelter and food security referenced already.

The most vulnerable groups identified by both males and females were persons with disability, pregnant and lactating women, single/widowed women, and children under 5 yrs. Elders and chronically ill persons were also identified though notably only by half as many males indicating that women may be better positioned in their homemaker/carer roles to identify the most vulnerable members of their Communities.

WASH

Water: Water quantity, quality, frequency of access and storage is a concern for both IDP and Host Communities. While men are most concerned about taste and look of water, it is women in their traditional gender role of homemaker who, as with food, are impacted most being 3 times more likely to reduce consumption when supplies are limited. In some instances, water is available for as little as 5 hours per day which in the absence of adequate water storage facilities highlighted by women at household level, increases the frequency and time consumed in accessing water which only adds to protection risks especially for male adultescents who may be at risk of arbitrary arrest or detention or women, and girls who may be at risk of sexual violence. Reduced consumption by women and increased risk of violence to male and female adultescents in accessing water appear to be greatest amongst small settlements most distant from water sources and least in rented accommodation occupied by single households and thus not sharing water supply. There is clear preference amongst male and females across all Communities for cash and voucher assistance to purchase clean water.

Sanitation: Lack of sex-disaggregated sanitation and bathing facilities is an issue for males and females being marginally higher in buildings and settlements with multiple families than in cohabiting IDP/Host households and least so for IDPs in rented accommodation not shared with others. Diarrhoea is reported to be an issue for between 25%-37% of females and 25%-41% of males and appears to be most prevalent amongst small groupings of IDPs inhabiting building and settlements where there is least garbage collection and highest levels of stagnant water and broken sewage systems.

Hygiene Promotion: Lack of access to hygiene items for all family members including infants regardless of identity or location is a concern. Women in particular have limited access to sanitary pads. While these can be obtained when NFI distributions do actually take place, at least a third of people do not benefit from such distributions, many women may have limited mobility due to child care responsibilities, disabilities, or need for consent from their husbands/families to access distributions, and there is little dignity in accessing ad-hoc distributions at the Mosque, a largely male domain. Furthermore, some women are not of the Muslim faith and would not have access to the Mosque, and while cloths can be used instead of sanitary pads, there is limited washing and bathing facilities available in some accommodation. As a consequence, dignified menstrual hygiene, which many women in the conservative local culture may be reluctant to speak openly about (it was very low – 5% - as a priority for women amongst NFI needs though this could also be related to age profile of interviewees) is a particular concern.

The primary health issues for females are respiratory infections (77%) and skin disease (81%), psychological trauma (44%), fever of origin unknown (40%), diarrhoea (25%-37%), and eye-infection which may or may not be associated with poor water access and quality. Of particular concern is the high number of women (26%) who reported pregnancy related complications in their top 3 health related issues especially given that many women give birth in the absence of a skilled birth attendant. This is highest for IDPs living in buildings or settlements of larger gatherings of IDPs.

The primary health issues for males are respiratory infections (60%), skin disease (52%), psychological trauma (at 62%, almost 50% higher than that of women), fever of unknown origin (50%), diarrhoea (26%-41%), eye infection (32%), and major injuries 28%.

Environmental Health:

Women seem most aware of the causes and consequences of poor waste management with 95% highlighting garbage disposal as an issue compared to 45% of men and twice as many women (66% vs 30%) prioritising the need to repair sewage networks. In addition, 52% of women prioritised garbage collection as a sanitation priority as opposed to 39% of men. This observation of better understanding amongst women may explain why women feel there is less need for hygiene promotion training but a quarter of men did highlight hygiene promotion as a priority.

Summary of additional information required or that requires further exploration

Actual population size and disaggregation of same by age, sex, status (part of a family unity or alone), disability, health, religion.
Status and roles of elderly in the Community
Reasons for non-registration
Understanding of payments or payments in kind that are being made by IDP families to Host families.
Prevalence of transactional sex and its various forms.
Impact of increasing IDP numbers on rental prices.
Activities and perceptions of youth disaggregated by sex.
Livelihood options available within Kirkuk including seasonal variations.
Intended use of cash by households.
Who is responsible for collecting water at the household level correlated against times when piped water supply is cut off.
Actual quantitative food and water consumption disaggregated by age and sex.
Child mortality rates.
Access to maternal health services and services for survivors of violence (male and female).
Services if any that male survivors would want to avail of / actually use.
Nature of trauma and injury to males and influence on decision making.
Options for relocation and related protection risks.
Movements in gender power relations at the household level.

End