It is estimated that one million women worldwide live with untreated fistula, a devastating injury primarily caused by prolonged obstructed labor when women do not have access to timely emergency obstetric care. Women with fistula are incontinent of urine and/or feces and often suffer severe social and psychological consequences, such as profound stigma and depression. Obstetric fistula affects economically vulnerable women and garners little attention on the global health stage. Exact figures on fistula incidence and prevalence are not known. In Kenya, results from a 2014 population-based survey suggest that 1% of reproductive-aged women have experienced fistula-like symptoms. In collaboration with key stakeholders, Fistula Foundation launched the Fistula Treatment Network (initially known as Action on Fistula) in 2014 to increase access to timely, quality fistula treatment and comprehensive post-operative care for women with fistula in Kenya. The integrated model built linkages between the community and the health system to support women through all parts of their treatment journey and to build capacity of healthcare providers and community leaders who care for these women. Fistula Foundation and its donors provided the program’s funding. Seed funding, representing about 30% of the program budget, was provided by Astellas Pharma EMEA.Over the six-year period from 2014 to 2020, the network supported 6,223 surgeries at seven hospitals, established a fistula training center, trained eleven surgeons and 424 Community Health Volunteers, conducted extensive community outreach, and contributed to the National Strategic Framework to End Female Genital Fistula. At 12 months post fistula repair, 96% of women in a community setting reported that they were not experiencing any incontinence and the proportion of women reporting normal functioning increased from 18% at baseline to 85% at twelve-months.The Fistula Treatment Network facilitated collaboration across hospital and community actors to enhance long-term outcomes for women living with fistula. This model improved awareness and reduced stigma, increased access to surgery, strengthened the fistula workforce, and facilitated post-operative follow-up and reintegration support for women. This integrated approach is an effective and replicable model for building capacity to deliver comprehensive fistula care services in other countries where the burden of fistula is high.

This collection brings together brief overviews of the social assistance landscape in eight fragile and conflict-affected settings in sub-Saharan Africa and the Middle East: Iraq, Jordan, Lebanon, Mali, Niger, Nigeria, Somalia and Yemen. These overviews were prepared as part of Better Assistance in Crises (BASIC) Research, a multi-year programme (2020–24) supported by the Foreign, Commonwealth and Development Office (FCDO) of the UK government. BASIC Research aims to inform policy and programming on effective social assistance in situations of crisis, including for those who are experiencing climate-related shocks and stressors, protracted conflict and forced displacement.

This paper examines social protection policy processes in fragile and conflict-affected settings (FCAS). It explores what the policies of donor governments, aid agencies, and crisis-affected governments reveal about the politics of assistance during crises, and how aid agencies are navigating tensions between humanitarian and development approaches to social assistance. It finds that social protection policies are prone to conflict blindness. Commitments to state-building often ignore dilemmas inherent in supporting states that are parties to ongoing conflicts and the political rather than technical challenges involved. Government social protection policies in FCAS often make little mention of the fact that war or conflict are taking place.

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