More than 10,000 civilians were killed or wounded in the Afghanistan conflict during 2017, a nine per cent drop over 2016, according to a United Nations report out Thursday which also revealed rising casualties caused by suicide bombings and attacks using improvised explosive devices (IEDs).

“The chilling statistics in this report provide credible data about the war’s impact, but the figures alone cannot capture the appalling human suffering inflicted on ordinary people, especially women and children,” said Tadamichi Yamamoto, the Secretary-General’s Special Representative for Afghanistan.

A total of 10,453 civilian casualties – 3,438 people killed and 7,015 injured – were documented in the 2017 Annual Report released Thursday by the UN Assistance Mission in Afghanistan (UNAMA) and the Office of the UN High Commissioner for Human Rights (OHCHR).

Although this figure represents a decrease of nine per cent compared with 2016, the report highlights the high number of casualties caused by suicide bombings and other attacks using IEDs. 

“I am particularly appalled by the continued indiscriminate and unlawful use of IEDs such as suicide bombs and pressure-plate devices in civilian populated areas. This is shameful,” said Mr. Yamamoto, who also heads UNAMA.

The second leading cause of civilian casualties in 2017 was ground engagements between anti-government elements and pro-government forces, although there was a decrease of 19 per cent from the record levels seen in 2016.

The report attributes close to two-thirds or 65 per cent of all casualties to anti-government elements: 42 per cent to the Taliban, 10 per cent to Da’esh/Islamic State Khorasan Province (ISIL-KP), and 13 per cent to undetermined and other anti-government elements. 

Pro-Government forces caused a fifth of civilian casualties: 16 per cent were attributed to the Afghan national security forces, two per cent to international military forces, one per cent each to pro-Government armed groups and undetermined pro-Government forces.

Unattributed cross-fire during ground engagements between anti-government elements and pro-government forces caused 11 per cent of civilian casualties.

Women and children remained heavily affected by conflict-related violence. UNAMA documented that 359 women were killed, up five per cent, and 865 injured in 2017. Child casualties – 861 killed and 2,318 injured – decreased by 10 per cent compared with 2016.

“Afghan civilians have been killed going about their daily lives – travelling on a bus, praying in a mosque, simply walking past a building that was targeted,” said UN High Commissioner for Human Rights Zeid Ra’ad Al Hussein.

“Such attacks are prohibited under international humanitarian law and are likely, in most cases, to constitute war crimes. The perpetrators must be identified and held accountable,” he added.

The report attributes 1,000 civilian casualties – 399 deaths and 601 injured – and the abduction of 119 civilians to Da’esh/ISIL-KP.

“The group mainly targeted civilians in 2017 but also conducted indiscriminate and disproportionate attacks against security forces in civilian areas,” the report states.

Among its recommendations, the report urges parties to the conflict to take all feasible precautions to protect civilians and civilian installations. It calls on anti-government elements to cease the deliberate targeting of civilians and civilian objects and the indiscriminate and disproportionate use of all IEDs.

The United Nations World Health Organization (WHO) has issued new guidelines on global care standards throughout labour and immediately after childbirth aimed at reducing the use of needless and potentially harmful routine clinical and medical interventions.

“We want women to give birth in a safe environment with skilled birth attendants in well-equipped facilities. However, the increasing medicalization of normal childbirth processes are undermining a woman’s own capability to give birth and negatively impacting her birth experience,” said Princess Nothemba Simelela, the Assistant Director-General at the UN World Health Organization (WHO) for Family, Women, Children and Adolescents.

Worldwide, an estimated 140 million births take place every year and most of these occur without complications for women and their babies.

However, according to WHO, over the past 20 years, health practitioners have increased the use of interventions that were previously only used to avoid risks or treat complications, such as oxytocin infusion to speed up labour or caesarean sections. Studies show that a substantial proportion of healthy pregnant women undergo at least one clinical intervention during labour and birth.

“If labour is progressing normally, and the woman and her baby are in good condition, they do not need to receive additional interventions to accelerate labour,” added Dr. Simelela.

Based on 56 evidence-based recommendations, the new guidelines include having a companion of choice during labour and childbirth; ensuring respectful care and good communication between women and health providers; maintaining privacy and confidentiality; and allowing women to make decisions about their pain management, labour and birth positions and natural urge to push, among others.

If labour is progressing normally, and the woman and her baby are in good condition, they do not need to receive additional interventions to accelerate labour — Dr. Simelela, WHO Assistant Director-General

Every labour is unique and progresses at different rates

Recognizing that every labour and childbirth is unique and that the duration of the active first stage of labour varies from one woman to another, the guidelines state that the previous benchmark for cervical dilation rate at 1 cm/hr during the active first stage of labour (as assessed by a partograph or chart used to document the course of a normal labour) may be “unrealistic” for some women and is inaccurate in identifying women at risk of adverse birth outcomes.

The guidelines emphasize that a slower cervical dilation rate alone should not be a routine indication for intervention to accelerate labour or expedite birth.

Furthermore, while most women want a natural labour and birth, they also acknowledge that birth can be an unpredictable and risky event and that close monitoring and sometimes medical interventions may be necessary.

When a medical intervention is wanted or needed, “the inclusion of women in making decisions about the care they receive is important to ensure that they meet their goal of a positive childbirth experience,” said Ian Askew, the head of WHO Department of Reproductive Health and Research.

High quality and dignified care for all women

The UN agency also noted that with more women give birth in health facilities with skilled health professionals and timely referrals, they deserve better quality of care.

Estimates show that about 830 women die from pregnancy- or childbirth-related complications around the world every day – the majority of which can be prevented with high-quality care.

Additionally, disrespectful and non-dignified care is prevalent in many health facilities, violating human rights and preventing women from accessing care services during childbirth. In many parts of the world, the health provider controls the birthing process, further exposing healthy pregnant women to unnecessary medical interventions that interfere with the natural childbirth process.

“Achieving the best possible physical, emotional, and psychological outcomes for the woman and her baby requires a model of care in which health systems empower all women to access care that focuses on the mother and child,” underscored WHO.

The United Nations will need to focus its efforts on supporting Guinea-Bissau’s national leaders in their efforts to appoint an acceptable Prime Minister, establish an inclusive Government, organize and conduct timely elections, and implement the priority reforms, a UN envoy for the West African country said Wednesday.

“After several years of long-term investment in the stability of Guinea-Bissau, it is time to consolidate and reap the dividends of our concerted efforts. It is vital that we accompany this process to its completion,” Modibo Ibrahim Touré, the Secretary-General’s Special Representative in Guinea-Bissau told the Security Council. 

Mr. Touré stressed the importance for the Council to continue to reaffirm the centrality of the Conakry Agreement, reiterating its support to the Economic Community of West African States (ECOWAS) in its mediation efforts.

The Conakry Agreement of 14 October 2016 provides for, among other things, the appointment of a consensual Prime Minister.

According to the UN Department of Political Affairs (DPA), Guinea-Bissau has been plagued by chronic political instability since gaining independence in 1974. 

The DPA provides support and oversight to the UN Integrated Peacebuilding Office for Guinea-Bissau (UNIOGBIS), a special political mission first established in 1999 following a two-year civil war in the country. Since mid-2016, the Mission is headed by Mr.Touré. 

The main priorities of UNIOGBIS are to support efforts to consolidate constitutional order, further political dialogue and national reconciliation, encourage security sector reform, and promote respect for human rights and the rule of law. 

On political developments, Mr.Touré said President Jose Mario Vaz dismissed former Prime Minister Umaro Sissoco Embaló and replaced him with Artur Silva.

“The absence of a functioning and stable Government for more than three years has limited the ability of UNIOGBIS to effectively and sustainably implement some of its mandated tasks,” said Mr.Touré.

Until the completion of the electoral cycle in 2019, Guinea-Bissau remains a country that requires a dedicated UN presence to prevent a further deterioration in the political and security situation at the national level and to avoid any negative spill-over to its neighbours and creating a fertile environment for trafficking to thrive, he noted.

“It will be important for the United Nations to remain engaged in peacebuilding efforts in the country while supporting ECOWAS intervention to resolve the political crisis for at least one more year,” he said.

Lastly, throughout the past year, the presence of ECOWAS Mission in Guinea Bissau has consistently acted as a deterrent to unauthorized military action and a stabilizing factor in the country, he said, calling on the Council and international donors to support the continued presence of ECOMIB through to the holding of a presidential election in 2019, including by advocating for the renewal of its mandate and the provision of the financial support needed to maintain its deployment.

In this century, child marriage cannot be allowed to happen, and similarly, children should not give birth to children, the United Nations youth envoy told an African forum on reproductive health and rights on Wednesday.

“There are high levels of adolescent pregnancy virtually everywhere in the continent. Africa has the highest levels of teenage pregnancy in the world. The larger part of them occur within marriage,” said Jayathma Wickramanayake, the UN Secretary General’s Special Envoy on Youth, at the opening ceremony of the eighth Africa Conference on Sexual and Reproductive Health and Rights held in Johannesburg, South Africa.

She said that the 2030 Agenda for Sustainable Development, adopted by all UN Member States two-and-a-half years ago, acknowledges that increased attention to the health and well-being of the world’s adolescent girls, including their sexual and reproductive health, is a necessary condition for success.

“A cross-sectoral approach is critical to ensure the holistic development of young women, as well as young men, as we know that negative sexual and reproductive health outcomes impact on so many other issues in a young person’s life,” she stressed.

Ms. Wickramanayake noted that the millions of adolescent girls drop out of school due to child marriage and teenage pregnancy, and millions more still miss out on their education during their menstrual cycle because of the lack of sanitation facilities at their schools.

The lack of employment opportunities impacts those who become mothers while being children themselves, or those who are found to be HIV positive.

With the world today faced with the largest generation of youth in its history, these 1.8 billion people between the ages of 10 to 24 are the torchbearers of the Sustainable Development Goals (SDGs).  Meaningful youth engagement and participation is critical to the achievement of the 2030 Agenda.

“Nowhere is this more critical than right here in the African continent, the only region that will continue to see its youth populations grow in the decades to come,” she said.

Africa continues to be faced with high levels of maternal mortality and morbidity. It is unacceptable that women continue to die while giving life. AIDS is still among the leading causes of death among adolescents in Sub-Saharan Africa.

All of this requires concerted efforts to ensure young people everywhere have access to quality, affordable and accessible sexual and reproductive health services.

She said during her multi-country visit across the continent, which took her to Senegal, the Gambia, Ghana, Nigeria, and South Africa, she witnessed the youthful energy that is driving creativity and new solutions to old problems, through technology and innovation.

It is young people who will drive the development of this region over the next several decades, and investing in young people is the recipe to the realization and achievement of the SDGs and other national and regional development frameworks, in particular the African Union 2063 Agenda.

“It is high time to recognize the power of the young people, and the value they can bring on to the decision-making table as full-fledged partners,” Ms. Wickramanayake said.