Introduction

In Asia and the Middle East, the most prevailing issue for many decades has been the internal displacements of populations due to armed conflicts and wars. The plight of the hapless victims of displacements is deplorable. In the Philippines, mainly in the southern Mindanao regions, internal displacements due to acts of violence and armed conflicts between the military forces and Moro’ Front groups have been the most predominant.

In times of local armed conflicts and the ensuing internal displacements, women and children account for the biggest casualties and are the most vulnerable to risks of health, social dislocation, and loss of property or even life. Accounts of women and children affected by armed conflicts and war indicate that they suffer mainly due to displacement and its consequence of poor access to food, safe drinking water, privacy, reproductive health (RH) care, and psychological support (NSO, 2002).

Fr. Eliseo Mercado, OMI (in NDURC, 2004) contends that internal displacement is one of the five urgent issues confronting Mindanao. In Central Mindanao, in particular, the armed conflict between the Philippine military and the Moro Fronts since the early 1960s has caused displacements in many communities. The affected families usually live as internally displaced persons (IDPs) for extended periods away from their homes and sources of livelihood. Separated from kin and community support systems, they are rendered most vulnerable to health risks and hazards.

Every time war erupts and civilians have to evacuate, media reports document the number of people affected, cost of damaged property and infrastructures, and figures for morbidity and mortality. There are scarce data, however, on the quality of life and the difficulties encountered by the victims of conflict, particularly on their health issues.

This study examines the reproductive health concerns of women who had experienced life in Pikit evacuation centers in 2000 and 2003. It also explores how they coped with reproductive health concerns in order to hopefully provide information for policy makers and other stakeholders on the impact of war and displacements on the lives of women caught in conflict situations.

The Research Sites

This study was undertaken in the municipality of Pikit in the province of North Cotabato, Central Mindanao.

Central Mindanao or Region XII has a population of 3,222,169 (NSO, 2000, cited in NDURC, 2001). Created in 1996 through Executive Order No. 36, the region has a total land area of 20,566.26 square kilometers covering the provinces of North Cotabato, Sultan Kudarat, Sarangani, and South Cotabato and the cities of Cotabato, Kidapawan, Koronadal, General Santos, and Tacurong. The Lumad,’ such as the Tbolis, Blaans, Kalagans, Terurays, Manobos, Iranons, Ubos, and Tagakaolos inhabit the mountainous and hilly parts of the region. The Moro, such as the Maguindanaons, Maranaos, and Iranuns share space in the municipalities along with the settler Christians, mostly composed of Ilonggos, Cebuanos, and Ilocanos.

North Cotabato, with its 6,657 square kilometers, sits on about forty-five percent of the land area in Central Mindanao. Its seventeen towns host 544 barangays within which reside 658,643 Ilonggos, Cebuanos, Ilocanos, Maguindanaons, and Manobos (Cotabato Province Annual Report, 2003). The province is bounded on the north by the provinces of Lanao del Sur and Bukidnon, on the east by Davao City, on the south by Davao del Sur Province, on the west by Maguindanao Province, and on the southwest by Sultan Kudarat Province.

[Refer to the Original Copy]

The highly conflicted town of Pikit in North Cotabato has a total land area of 604.61 square kilometers. Within its jurisdiction are forty-two barangays, in which reside Maguindanaons (69 percent), Cebuanos (18 percent), and Ilocanos (9 percent). Pikit is bounded on the north by Aleosan, on the east by Pagalungan, on the south by Sultan sa Barongis, and on the west by Midsayap. Datu Piang lies on the southwest.

Since the late 1990s, Pikit has been the site of armed struggles between government forces and the Moro liberation groups. Among the communities most adversely affected by firefights are the largely agricultural barangays of Takepan, Inug-ug, and Rajahmuda, which are the study sites.

Barangay Takepan

Situated on the south-central part of Pikit, Barangay Takepan has seven sitios inhabited by 457 households with a total population of 2,749. Predominantly Christian in composition, Takepan has two sitios with a Christian—Muslim mix and one that is mainly Maguindanaon. About seven kilometers away from the Pikit poblacion. Takepan has been tagged a “Space for Peace,” along with six other barangays (Canuday, 2004).

Barangay Inug-ug

Located along the National Highway, Barangay Inug-ug has three sitios and 200 households. About sixty percent of these households are Maguindanaon. This barangay suffered losses during the conflict episodes in 1997, 2000, and 2003, with a number of houses damaged or destroyed.

Barangay Rajahmuda

Barangay Rajahmuda is an all-Maguindanaon community about five kilometers from the National Highway. The barangay is bounded by the Pulangi River and the municipality of Pagalungan on the east. In 2000 and 2003, armed conflict forced all families in its five sitios to evacuate to the poblacion of Pikit. More than fifty families opted not to return to Rajahmuda after the 2003 conflict. As of 2005, Rajahmuda was home to around 528 families.

Data Sources

In-depth interviews were conducted to surface women IDPs’ experiences in conflict situations, the living conditions they found in evacuation centers, and the coping strategies they applied. Key informant interviews of barangay leaders, local health workers, school officials, and representatives of nongovernment organizations (NGOs) and people’s organizations (POs) provide data on institutional responses to the needs of women in conflict situations, as well as the provision of support mechanisms for IDPs.

Information on armed conflicts and displacements and on health and related issues were also retrieved from reports of the municipal offices of the Department of Interior and Local Government (DILG), Department of Social Welfare and Development (DSWD), Department of Health (DOH), and the Mayor’s Office, among others.

The Context of the Armed Conflicts in Central Mindanao

Despite the signing of the Peace Accord between the government and the Moro National Liberation Front (MNLF) in 1996, trouble still hounds Central Mindanao and the Autonomous Region in Muslim Mindanao (ARMM), where for over thirty years now different Islamized ethnic groups struggle for either autonomy or independence.

The Moro struggle of independence was initiated with the organization of the Muslim Independent Movement (later known as the Mindanao Independence Movement or MIM) by Cotabato Governor Udtog Matalam in 1968. At this time, some members of the MIM were undergoing guerrilla training in Sabah. Sometime in 1972, the year when Martial Law was declared by President Ferdinand Marcos, the Muslim movement took an armed revolutionary approach to the struggle.

The movement for secession was a response to the Jabidah massacre, land grabbing, and the Moro disappointment with the government’s inadequacy in dealing with the socioeconomic problems of the Muslim communities. Although the Islam religion was the common bond for membership in the Moro Front movement, its members Came from varied backgrounds. There were members who may have been disgruntled politicians who saw involvement in the movement as a means to forward their own political ambitions. There were also displaced farmers, victims of military abuse or police brutality, religious leaders who would like to construct an Islamic theoretic state, idealistic intellectuals and students moved by a sense of social duty, adventurous young men who would like to test their fighting prowess, and still others who joined because they had friends and relatives in the movement.

The demand for an independent Bangsa Moro Republic by the MNLF included Mindanao, Sulu archipelago, and Palawan. However, the Tripoli Agreement that was signed in 1976 defined the regional autonomy only for thirteen provinces and nine cities. In these areas, the Muslims comprise about twenty percent of the population.

In 1984, the Moro Islamic Liberation Front (MILF), under Hashim Salamat, was formed. The front reasserted for a separatist movement in Mindanao parallel to the autonomy movement being pursued by the MNLF.

With the approval of Republic Act (RA) 6734 or the Organic Act for the Autonomous Region in Muslim Mindanao in 1989 by President Corazon Aquino, a plebiscite was conducted to identify the provinces that wanted to be part of the ARMM. The results of the plebiscite identified only five out of the thirteen provinces: Tawi-Tawi, Basilan, Sulu, Lanao del Sur, and Maguindanao. Despite the signing of the Organic Act of 1989, fighting and armed encounters between the military and the Moro Fronts continued in Central Mindanao and in the ARMM.

In September 1996, the Peace Accord was signed between the Government of the Republic of tile Philippines (GRP) and the MNLF, defining the implementation of two phases of action (Aguirre, 1999). The first action was the proclamation of a Special Zone for Peace and Development (SZOPAD), the establishment of the Southern Philippine Council for Peace and Development .(SPCPD), and the creation of a Consultative Assembly (CA). They were formed to serve as transitory mechanisms to coordinate peace and development efforts in the SZOPAD within a three-year period. One of the additional stipulations in the Accord provided for the integration of MNLF elements into the Philippine National Police (PNP) and the Armed Forces of the Philippines (AFP).

The second action was. the establishment of a new era of autonomy, which required the Congress to amend or repeal RA 6734 at the end of the three-year transition period. The government permitted the holding of a plebiscite in 1999 to determine the prospects for expanded autonomy for Muslim Mindanao.

In 1996, there was- yet optimism that the military activities of the Islamic groups would end. The MILF, however, asserted its own representation in the: Mindanao crisis. It engaged in armed conflict with the governnwnt to assert its identity as separate from the MNLF. Eventually, in 1997, it signed an agreement with the government on the general cessation of hostilities. However, this was to be repeatedly violated.

In the meantime, the goverment outlined a four-point program for national security to address the Mindanao crisis: a) to restore or maintain peace; b) to promote socio-economic development; c) to pursue peace talks with the MILF; and d) to fully implement the GRP-MNLF Peace Agreement. To date, achieving this peace agenda is still gaining ground.

In 2000, the hope for peace considerably diminished. The Estrada government initiated an all-out military offensive in March 2000. Renewed clashes between the military and the MILF prompted massive displacements once again. Military offensives waged in Central Mindanao areas aimed to dismantle the various MILF camps. Camp Abubakar in Matanog, Maguindanao, the largest camp of the MILF, was a prime target. Fighting ensued and spilled over to many other areas in North Cotabato, Lanao del Sur, South Cotabato, and the cities of Cotabato and General Santos. In Central Mindanao alone, thousands of people fled their homes, and evacuation centers were set up. Even today, there are still families that remain displaced because of this war.

The 2004 report on the social assessment of conflict-affected areas in Mindanao (NDURC, 2004) noted that the Moro land issue is a conflict that can be understood in part by attributing it to opposing systems of land use practiced by the indigenous Moro groups and the non-Moro migrant settlers who have come to occupy territories traditionally owned or controlled by the Moros. The tensions over the land rights are both a cause and an outcome of conflict.

Varied reasons are raised as contributing to the cause of the Mindanao conflict. Among them are the resentment from minority deprivations, economic and social marginalization, local and foreign political crisis, and government inefficiency. The Mindanao conflict is also attributed by some quarters to the general underdevelopment of the region, an unequal redistribution of wealth, and limited efforts by the government to integrate the Muslim population in Mindanao into the political and institutional fabric of the country. And while it may appear that religion is an element in the conflict, it is not and has never been among the contentious issues under negotiation. Some analysts observe that the rich reserves of untapped natural resources and raw materials of Mindanao, particularly in the Moro area, may also be a strong incentive for the government to fight the Muslim secessionist movements since the 1970s (NDURC, 2004).

The Armed Conflict Experiences of the Pikit IDPs

The 2000 All-Out War saw major military offensives launched to take the various MILF camps in Central Mindanao and the Lanao provinces. Most targeted was the heavily fortified Camp Abubakar, the main MILF camp that stretched across the Maguindanao towns of Buldon, Barira, and Matanog. All over Central Mindanao, the military offensives caused massive displacement.

Pikit was one of the most affected municipalities in 2000 because the Buliok complex, a major MILF camp, is located at the border of Pikit and Pagalungan, Maguindanao. About 45,205 persons from the twenty-three Pikit barangays fled their homes; 16,245 persons were distributed in twenty-nine evacuation centers while 28,960 persons opted to live with their relatives in the poblacion of Pikit and other neighboring barangays.

Buliok was finally captured in February 2003, after the military offensives had affected twenty barangays in Pikit. Around 6,460 families with 38,760 persons were displaced. About 2,594 families with 15,564 persons stayed at the evacuation centers in Pikit while 3,866 (23,196 persons) stayed with their relatives somewhere else. Sixteen evacuation sites were put up in Pikit during this period.

The evacuation centers used by the local government to temporarily house the IDPs were the agricultural warehouses, day care centers, schools, a chapel, a gymnasium, and makeshift tents. At these evacuation centers, the displaced families had to endure the congested sleeping quarters, lack of privacy, and scarcity of food and potable water. The families endured severe heat during the day and cold during the night. Deprived of their livelihood source, they depended heavily on the relief

[Refer to the Original Copy]

assistance extended by government and various NGOs, which began to dwindle a few weeks after the height of the conflict.

Among the barangays affected by the 2000 and 2003 conflict episodes were Takepan, Inug-ug, and Rajahmuda. Both times, these barangays were used as the exit points of both the military and the MILF armed groups.

In May 2000, Muslim residents from barangays Saranay/Gantong, Brotherhood I, and Brotherhood II in Barangay Takepan evacuated to Batulawan for at least three months, while their Christian neighbors stayed for a month in the Pikit Parish Gymnasium and Pikit Pilot Elementary School. The offensives spilled over to Inug-ug, prompting people to move out, especially when an intense firefight occurred there on 16 June 2000. At this time also, Barangay Rajahmuda residents believed that the government troops suspected the barangay to be an MILF camp. All of them fled to some parts of Pagalungan in Maguindanao and to evacuation centers in Batulawan and the Pikit Mahad School.

On Eid’l Adha in 2003, the Rajahmuda residents would again flee the barangay as government troops bombed the Islamic Center of Buliok Complex. Lower Inug-ug, on the other hand, saw people moving out as early as February to stay at an evacuation center set up for them at Mahad in Fort Pikit or among relatives. Meanwhile, residents in Takepan experienced at least two violent episodes that caused them to leave their homes that year. On 11 February, soldiers and MILF rebels clashed in neighboring Barangay Dalengaoen, such that the Muslim residents from Sitio Saranay/Gantong rushed for refuge at the makeshift evacuation center along the National Highway fronting the Takepan Elementary School. Three months later, unidentified armed men fired at Barangay Nalapaan, an adjacent barangay. Fearing further harassments, the Muslim families went to Batulawan. Most of them eventually ended up at an evacuation site near the Church of Christ.

In May 2000,16,245 Pikit residents were in twenty-nine evacuation centers located in the Poblacion, Fort Pikit, Takepan, Nunungan, Paidu Pulangi Elementary School, and Manaulaan Mahad. In 2003, the DOH recorded that most of the 15,564 Pikit IDPs were staying in the evacuation centers in the Buisan Dryer, National Food Authority Warehouse, and Pikit Mahad School.

The evacuation centers were mostly located in schools or day care centers, mosques and warehouses, multipurpose structures, and

[Refer to the Original Copy]

makeshift tents at the town plaza or on small patches of idle lands along the highway. These evacuation centers were very crowded and lacked the necessary facilities to address the daily needs of the refugees. In most instances, families camped in the evacuation centers for extended periods. Some even stayed for years, enduring deplorable conditions there, because they feared that war would break out in their barangays again.

The DOH also reported the prevalence of fever, flu, cough, typhoid fever, and pneumonia in the evacuation centers in Central Mindanao. Skin diseases, acute respiratory infections, gastroenteritis and diarrhea, mostly among children, were also reported. A number of adults succumbed to cardiac arrest due to the severe heat. Skin diseases afflicted many women and children. There were also deaths.

Reproductive Health Concerns in the Evacuation Centers

Close to fifty percent of IDPs were female (Cotabato Province Annual Report 2003) — young girls, middle-aged women, elderly widows, or single mothers. Interviews in Takepan, Inug-ug, and Rajahmuda revealed the health hazards of life in the evacuation centers. These included problems related to: personal hygiene,
particularly during menstruation, due to the lack of water supply or non-access to appropriate services; birth planning and gynecological services; sexual health education; medical assistance during labor and delivery; special needs of nursing mothers; health of newborns and young children; nutrition and healthy food sources; prevention and control of infections of the reproductive tract and urinary tract and other diseases; and pregnancy and abortion.

Following are some accounts of the IDPs’ experiences about life in the Pikit evacuation centers:

Death, trauma, and health problems

Baikong, 40, is a Maguindanaon widow with three children. She shared that,

Ito nangyari noong 2002 conflict. Ang Auntie ko na 60 years old ay namatay sa sakit sa puso, sobrang nerbiyos; hindi na nadala sa doctor. Ang Uncle ko naman na 70 years old, may asawa ay na-shock at nabuang. Hanggang ngayon, buang pa rin siya. Pag makarinig na may sundalong parating, magbitbit na ng kahit anonggamit sa bahay at pupunta sa labas, at gusto magbakwit. Magdala din ng baril. Mag-alis din siya dahil sa takot, kung minsan hindi na magdamit, hubad talaga. Kawawa nga ang asawa niya kasi kung magbawas siya kahit saan na lang, kahit nakapantalon pa sya. (My 60-year-old aunt died of heart failure because of extreme nervousness. She was not brought to a doctor. My married uncle who is 70 suffered shock and eventually became mentally ill. He is still unstable. When he hears that soldiers are coming, he would grab anything he could find in the house, rush out, and say they have to run. He would get his gun, too. Afraid, he would leave the house naked. We pity his wife because he would defecate anywhere, even with his pants on.)

Yung asawa ng Kuya ko na 32 years old, sa Sitio Diruyuden, nanganak sa evacuation center. After one month, namatay ang baby niya. Hindi ko alam ang dahilan. (My brother’s 32-year-old wife from Sitio Diruyuden gave birth at the evacuation center. After a month, her baby died. I don’t know what caused the baby’s death.)

Dahil sa sobrang init sa evacuation center, palagi man katning mainitan, naging masakit sa akin ang pag-ihi. Bumili lang ako ng garnot, di kaya ay tnanghingi ng gamot sa Health Office ng Pikit sa Poblacion. (Because of the extreme heat in the evacuation center, I found urination painful. I just bought medication or asked for medicine from the Municipal Health Office of Pikit).

Lower abdominal pain, cause unspecified

Miriam, 26, a Maguindanaon mother of three, had two years of college education. She had a history of urinary tract infection (UTI) prior to the 2003 evacuation. She said her health condition might have been aggravated in the evacuation center because she would hold her bladder, afraid to go out and relieve herself. She experienced intermittent lower abdominal pain.

Nagpahilot lang ako para mawala ang sakit. (I just requested a traditional healer to massage my abdomen to alleviate the pain.)

She also had vaginal itchiness. She said it was due to allergy sa tubig (water-borne allergy).

Nagpakonsulta din ako sa health center sa Poblacion, Pikit. Niresetahan ako at bumili ako ng ointment panghaplas. Yong sakit sa may puson, hindi ko alam bakit yon, basta pinahilot ko lang. (I went to the Health Center in Poblacion, Pikit. I was given a prescription for an ointment, which I bought and applied. The pain was in lower belly, I don’t know why [it was painful], but I just had my abdomen massaged.

Baby contracts skin disease and dies

This was recounted by an 18-year-old Maguindanaon mother of two:

Ang anak ng kapatid ko ay nanganak sa tent lang. Pagkatapos ng dalawang buwan ay nag-kaluli. ‘Yon ang dahilan bakit namatay ang bata. Wala silang mabili na gamot. Inasikaso din ng mga lider at nagbigay ng gamot pero `di na nakayanan. (My sister’s daughter gave birth in a tent [in the evacuation center). After two months, the baby contracted kaluli [a type of skin disease]. That is the reason for the baby’s death. They could not buy medicine. The leaders gave some assistance and medicine, but it was too late).

Ang pinsan ko rin, 22 years old, ay natamaan ng baril. Naglalakad Lang papuntang evacuation center nang natamaan ng baril. Sundalo daw ang nagpaputok. (My 22-year-old cousin was hit by a stray bullet on his way to the evacuation center. They say it was a soldier who fired the shot.)

Auntie ko, 40 years old, sumakit ang tiyan at ulo; nagtae-tae, mainit kasi masyado sa evacuation center. Binigyan ng gamot pero hindi na nakayanan, namatay na. (My 40-year-old aunt complained of a headache; then she had diarrhea, maybe because it was just too hot in the evacuation center. She was given medication, but she was too weak, she died.)

A very public birthing

Bai, 28, is an Iranun/Maguindanaon mother of three. She was unemployed and pregnant with her fourth child at the time of the interview. She said she was pregnant when armed encounters reached their barangay, forcing her to hike all the way to the evacuation center in Pagalungan where she gave birth. She said,

Mahirap manganak sa evacuation center kasi sa trapal lang, malamig masyado. Nahihiya ako dahil maraming tao. Tinitingnan ako ng maraming tao ha bang nanganganak ako. Wala naman akong magawa. (It’s hard to give birth in an evacuation center. We had only a tarpaulin sheet, it was very cold. I was also embarrassed because a lot of people were looking while I was giving birth. I couldn’t do anything about it).

Marumi kasi ang paligid. Humingi lang ako ng gamot sa Pikit Health Center para sa sakit ng pag-ihi. Bago lang kasi ako nanganak noon. (The surroundings were dirty. I just asked for medication for painful urination from the Pikit Health Center. I had just given birth then.)

Reproductive tract infection symptoms

Bai, 29, is a Maguindanaon farmer and mother of seven. In 2000, Bai had the following physical symptoms — frequent and painful urination and lower abdominal pain. She explains that,

Dahil siguro sa dumi ng paligid… Mom lang ng tubig ng niyog. Lyon lang ang ginamot ko. (Maybe because of the dirty surroundings. I just drank coconut water. That’s my only remedy.)

Sa sobrang pagod, akala ko malaglagan na ako noon. Pinagamot ko sa manghihilot, nilagyan nya ng herbal oil. Pero paulit-ulit ko man naramdaman ito, nagpahilot lang din ako. (I thought I would lose my baby because I was extremely exhausted. I went to a traditional healer who applied herbal oil. I had it massaged every time the pain recurred.)

Before the conflict, she also experienced painful urination, which she thought was due to her pregnancy. She remembered that,

Pag-umiinom ako ng tnainit na tubig, mawala na (Every time I drink warm water, the pain would go away.)
Bai shared that she started active prevention of future pregnancy:

Nagsimula na akong gumamit ng pills noon pang 2003. Marami na kasi akong anak. Gusto ko matulungan ang asawa ko kaya dalawa kaming nagdesisyon nito. (I started on the pill back in 2003. I have so many children already. I want to help my husband, so both of us decided on this).

Dire consequences of dirty water

Monera, 21, is Maguindanaon mother of one. She recounted that,

Ang anak ng kapatid ko, mga dalawang taong gulang ay narnatay dahil sa diarrhea. Ang tubig na inumin sa evacuation center ay galing sa kalot. Ito marahil ang dahilan ng pagtatae niya. Dinala sa ospital ang bata pero hindi na makaya. (My sister’s 2-year-old died of diarrhea. The drinking water at the evacuation center was drawn from a well. Maybe this caused her frequent and watery discharge. The baby was brought to the hospital to no avail.)

Monera herself also experienced problems with the water:

Nakaranas rin ako ng vaginal itchiness. Dahil din sa tubig na curling ginagamit. Niligo ko lang at naglinis ng katawan. (I had vaginal itchiness. It was also because of the water. I just bathed and cleaned my body.)

Unexpected, unwanted pregnancy

Baikong, 27, is a Maguindanaon farmer and mother of six. She was pregnant in 2000 when her family had to evacuate. She narrated that,

Marami akong karanasan sa gitna ng kaguluhan sa among barangay. Una, ang Tsang anak ko nagka-diarrhea sa evacuation center. Dahil din sa sobrang lamig sa sentro, ayaw niyang magdede. Malapit na sana mamatay. Dinala namin sa Pagalungan Health Center at na-dextrose pa siya. (I had many experiences in the midst of the conflict in our barangay. First, my child had diarrhea at the evacuation center. Because of the extreme cold, the baby did not want to suckle. She nearly died. We brought the baby to the Pagalungan Health Center, where she was fed intravenously.)

Baikong said she had given birth in an evacuation center:

…sa Pagalungan Municipality kami kasi nagbakwit. Noong nanganak ako, walang mga gamic. Kulang ang pagkain, sobrang lamig pa sa tent. (… in an evacuation center in Pagalungan Municipality, where we  evacuated. When I gave birth, we had no things [for the baby]. We lacked food, and it was very cold in the tent.) She also experienced frequent urination which she did not mind so much in the belief that it was all part of being pregnant. She did not know why she sometimes had painful urination, abdominal pain, and vaginal itchiness. She disclosed that,

Ang ihi ko yellow kasi. Magpakulo lang ng tanglad, yong tubig inumin ko. Palaging masakit and tiyan ko. Ewan ko, baka sa pagbubuntis ko. Nagpahilot lang ako. (My urine was yellow. I made lemongrass tea to drink. I had constant abdominal pain. I don’t know why—maybe because I was pregnant. I tried to have it massaged.)

She said she got pregnant before war escalated and that she had not been happy about it:

Nalungkot ako, dahil marami na ang anak ko. Pagod na akong mag-alaga ng bata. Gusto ko sana mag-abroad, hindi payag ang Tatay ko dahil marami na akong anak, kawawa kung iwanan. Tinuloy ko ang pagbubuntis kaysa ipalaglag ko. Pero palaging rnagsakit ang ulo ko. Sabi ng asawa ko, magpunta ako sa health center, magpa-BP kasi anemic ako-80/60—at hindi maganda ang paningin ko. (I was despondent, because I had many children already. I was tired of looking after babies. I wanted to go abroad, [but] my father didn’t approve of it because my children would suffer if I leave them. I chose to keep my baby instead of going for an abortion. But, I have recurring headaches. My husband told me to go to the health center and have my blood pressure checked because I am anemic —[my BP is just] 80/60 — and my eyesight is not too good).

She had experienced delayed menstruation before the conflict episode in 2000 when she had profuse vaginal discharges.

Nagpahilot ako, pagkatapos nagdugo na ako. Hindi ko alam ang dahilan. Nagbaba ang matres ko. Sumasakit ang tagiliran ng tiyan ko, pinahilot ko. Humingi ako ng tulong sa midwife. Magbili na lang ng gamot, sabi niya. Wala akong pera kaya pinabayaan ko na lang. Pero uminom ako ng tanglad, pinakuluan, at nawala naman. (I had my lower belly massaged, after a while I started bleeding. I didn’t understand why. My uterus was [displaced and] too low. Then I had pain here on one side, so I had that massaged also. I asked a midwife for help. She told me to buy medicine. I had no money so 1 just ignored it [the pain]. But I drank a concoction of lemongrass tea, and it disappeared).

Postpartum mother flees the fighting

A 29-year-old Maguindanaon mother of two who was a resident of Sitio Saranay/Gantong of Barangay Takepan had this to tell:

Noong nagkagulo sa 2003, limang araw pa lang akong nakapanga n ak, nakaranas ako na umabot ang bola sa tabi ng bahay namin. Kaya kahit nakakaranas pa ako ng pagdurugo napilitan akong sumamang tumatakbo palayo sa aming tirahan. (It was just five days after I gave birth when violence broke out in 2003. Bullets hit the house next door. So even though I was still bleeding, I was forced to flee along with others.)

She had just a year to go in college but had to stop schooling.

Hindi na ako nakapag-enrol dahil nasa bakwitan pa. Pagkagaling sa bakwitan, nag-asawa na ako.” (I couldn’t enrol because we were still in the evacuation center. After that, I got married.)

Pregnant and contemplating abortion

Fatima, 27, is a Maguindanaon farmer with three children. She did not complete elementary education. She claimed to suffer from ulcers. She disclosed that she got pregnant while staying at the evacuation center during the conflict in 2003.

Malaki na ang tiyan ko pagbalik namin gating sa evacuation center. Noong nalaman kong buntis ako, Tsang buwan pa Yon, nagplano akong ipalaglag siya kasi nagkasakit ako. Naglagnat ako, nanginig ang buong katawan ko. Naisip ko rin na baka maapektuhan ang bata. Sinabihan ko ang midwife tungkol dito. Sinabihan niya ako na hindi ituloy, matakot ako dahil dalawang buwan pa lang ang pagbubuntis ko. Gumaling naman ako noong dalawa at kalahating buwan na. Hindi ko na pinalaglag. Nasa akin na lang daw ang desisyon sabi ng asawa ko. Hindi ko na rin tinuloy ang pagpalaglag. (My tummy was already big when we came home from the evacuation center. When I learned that I was a month pregnant, I wanted to have it aborted because I got sick. I had fever and chills. I thought the baby might be adversely affected. I told the midwife about my plan. She advised against it, [fearing complications] because I was already two months pregnant. Anyway, I felt better at around two-and-a-half months so I did not have my pregnancy terminated. My husband let me decide.

Lack of proper toilet facilities

Vina, 42, is an Ilocano mother of one. She teaches high school in Barangay Takepan. During the conflict episode in 2003, Vina shared that,

Pirmi lang ako maka-ihi. Walay tarong nga maihian. Nag-inom lang ko ug tubig sa niyog para mawala. Dili ako makaihi sa bakwitan kay makahadlok man maggawas ug layo para mag-ihi lang. (I needed to urinate often. There was no proper toilet. I drank coconut juice to make it go away. I couldn’t go to the bathroom as often as I needed because I was afraid to go farther off where I could relieve myself).

Mother considers abortion

Sahara, 30, is a Maguindanaon mother of seven. She is an elementary school graduate. She said that before the 2003 hostilities, she had hoped to have some rest from childbearing and was even contemplating the use of family planning methods:

Dili nako gusto mabuntis Ey! Huna-huna nako pwerteng krisis na gyud. Mga bata gahi ug ulo. Magsakit ang akong ulo sa pagbuyag sa ila. Usahay makasulti ko, pwerteng daghana na nila. Ipahilot unta nako para ipakuha. Nag-ingon man ang manghihilot nga makagaba daw. Wala na lang nako gidayon ug palaglag. OK man pud unta sa akong asawa nga ipakuha nako. (I didn’t want to get pregnant any more. I realize we were in a major crisis. My kids are hardheaded. I get headaches minding them. At times, I tell myself, there’s just too many of them. I thought of having it [the baby] aborted by a traditional midwife. But, she warned me that it’s bad luck. That’s why I did not go through with it. It would have been fine with my husband if I had it aborted.)

About family planning, she said:

Mahadlok ko kay ang uban musulti madaot ang tiyan. Naa man daw namatay ana — labi na ang nagpa-Depo. Naa daw namatay ana. Gusto sa akong bana, mag-pills ko sa una. Ako lang ang dili kay mahadlok ko. Pero gusto na nako karon, kay daghan naman gud akong anak. Kining akong kamanghuran gani (pointing at her baby) ipakuha unta gani nako ni, pero dill lang musugot ang manghihilot. (I’m afraid because some said it can damage the insides. They say there have been deaths — especially from using Depo [Provera]. Some have reportedly died because of it. My husband wanted me to take pills then. But I didn’t because I was afraid. But now, I want to because I have so many children. I even planned on having this youngest [child] aborted, but the traditional midwife was unwilling [to do it].)

A long drawn out war trauma

Rahima, 22, is a housewife. She is married to Junaid, a farmer. She has lived in Barangay Rajahmuda since birth. She remembered when the Islamic Center in Barangay Buliok was bombed. She reported what she witnessed of the attack.

Pinasok at binomba ng mga sundalo ang Islamic Center. Habang nagsamba ang mga Muslim, bigla lang nila pinaputukan ang mga ito. At dahil madaanan ang Barangay Rajahmuda papuntang Buliok, damay din sa putukan ang Barangay namin. May putukan ang Barangay namin. May papuntang Poblacion ng Pikit. Naglakad at nagtakbo para makalayo sa putukan. Ang iba nagkawatak-watak ang pamilya (The soldiers attacked and bombed the Islamic Center. While the Muslims were at prayer, they [the soldiers] fired at them without warning. Since Barangay Rajahmuda is on the road to Buliok, our barangay was exposed to the hostilities. There was gunfire in Rajahmuda that scared us so we immediately headed to Pikit poblacion. We walked and ran away from the firefight. Some families lost each other in the haste).

She got sick at the evacuation center and eventually manifested some serious stress reactions. According to Rahima,

Nag-trangkaso ako at ang mga kapatid ko dahil sa ibabaw lang kami ng lupa natutulog. Naglagay lang kami ng banig sa lupa para tulugan, trapal lang ang atip namin. Talagang mainit doon sa araw. Mga dalawang linggo ‘yon kasi natakot ako sa putukan. Naglagnat ako tapos wala na ako maisip. Mga tatlong buwan ‘yon na wala akong matandaan. Grabe ‘yon kasi natakot ako sa putukan. Sabi ng Nanay ko dahil daw sa takot ko, nag-lagnat ako at nagka-trauma ako. Minsan tulala ako. Umiiyak lang ako palagi. Umiiyak ako dahil matakot ako matamaan ng putukan. Sa bazooka, di ako makatulog. Minsan naglalakad lang ako, tulala, di nagsasalita, parang wala ako sa isip ko. Minsan nagahubad ako sa bahay (evacuation center). Nakapantalon lang wala t-shirt. Wala nga sa sarili. Ang ginawa ng Nanay ko, binabantayan ako para ‘di makalabas sa evacuation center. Minsan ang mga kapatid ko na kambal ang nagbabantay sa akin. Pinagamot ako ng nanay ko sa albularyo (I got sick with the flu, along with my siblings, because we were sleeping on the ground. We rolled out a mat to sleep on and hung a tarpaulin for roof. It was unbearly hot during the day. It was about two weeks after the start of the hostilities. i developed a fever, and then I could not think any more. For about three months, I had no memory of what happened. It was terrible, I was terrified of firefights. My mother said it must have been because of extreme fear that I had fever and suffered trauma. At times I would be dazed. I would weep uncontrollably. I would cry because I was afraid of being hit by a bullet. I couldn’t sleep when they fired the bazooka. Sometimes, I would just walk about, dazed, not speaking, seemingly not myself. At times, I would not have my clothes on in the house [evacuation center]. [I would have] my pants on, but [I had] no shirt. I was really not myself. What my mother did was keep a cloase watch so I would not be able to get out of the evacuation center. Sometimes, my twin brothers would help take care of me. My mother brought me to an herbalist for treatment.)

Living with a husband’s pain

Samra and Alimudin are residents of Barangay Inug-ug. They claim to have experienced three conflict episodes since they got married in 2000. While in the evacuation center, the couple quarelled several times because of Alimudin’s problem. The poor man had difficulty urinating. Samra said,

Tuwing sumasakit ang ari ng asawa ko, nag aaway kami. Magalit siya sa akin. Ang dahilan noon, ang takot niya sa putukan. Ganito ‘yon, isang linggong nakalipas pagbakwit namin, nilagnat siya doon sa evacuation center. Ang epekto noon ay natakot siya sa putukan ay nilagnat siya. Pagtapos niyang mag-lagnat,  may lumabas na nana sa ari nya, at masakit daw kung mag ihi sya. Tuwing may putukan o kung may marinig syang putukan, natatakot siya. Pagkatapos mag-andar naman ang sakit ng ari niya, at inaaway niya ako. Minsan nga kung may putukan, sinisisi niya sa akon ang gulo at ang sakit ng ari niya. Sabi niya, kaya daw siya nagkakasakit dahil sa akin. Minsan nga parang wala siya sa sarili niya dahil pati ang gulo at putukan binibintang niya sa akin. Grabe na galit niya sa ‘kin. Kung inaaway niya ako, hinahayaan ko lang dahil nawawala lang man ang galit niya sa akin ‘pag nawala na ang sakit. (Every time my husband’s penis would cause him pain, he would readily pick a fight with me. He would be angry with me. The real cause was his fear of gunfire. This is what happened- a week after we evacuated, he developed a fever in the evacuation center. His fear of gunfire resulted in a fever, When the fever subsided, pus oozed out of his penis, and he compalined of pain when urinating. Every time there was gunfire, he would be greatly agitated, after which his penis would be painful, and he would quarrel with me. Sometimes, when there was gunfire, he would blame me for the trouble and the pain in his penis. He said he was sick because of me. At times, he would not be himself, attributing the trouble and the firefight to me. He believed I was the cause of it all. He would be very furios with me. When he was angry with me, I just let him be because his anger would pass when the pain subsided.)

Samra sent her husband to the Pikit Health Center for Checkup, but there were no finsings.

Pinainom lang nila ng Cotrimoxazole. (They gave him Cotrimoxazole.)

The couple stayed in a small tent in an evacuation center for one year. Samira reported to experience abdominal pain while in the evacuation center. She said that was because.

Kasi ang inot sa evacuation center. Tapos sa lupa lang kami nakahiga. Maglagay lang kami ng banig, minsan karton lang. (It was hot in the evacuation center. We slept on the ground. We laid a mat, or sometimes just a [flattened] cardboard box.

Maybe the water

Mariam Ali, 45, is a resident of Sitio Lower Inug-ug. She has six children. Her community experiences many armed conflicts, but she considers the 2000 episode to have been the most intense. She said

May mga sundalong nag-operation doon- mga rebelde at sundalo. (Soldiers conducted operations there- both the rebels and the soldiers).

The were forced to evacuate to the Pikit Town Plaza. After a few weeks, they were transferred to the Amanah dryer where they pitched their tents. It was there that she got pregnant. After she had given birth, she experienced some problems with postpartum recovery:

Pagkatapos ko nanganak, umihi ako sa baba namin. Tapos ilang araw ang lumipas, sumasakit ang pag-ihi ko, siguro dahil sa singaw ng tubig na hinugas ko. Pero isang buwan lang ang pananakit, nawala din. Uminom ako ng antibiotic at butong. (After I had given birth, I urinated downstairs. A few days later, I experienced painful urination, perhaps because of the water I used to wash myself. After a month, the pains subsided. I took antibiotics and drank coconut juice).

Marital relations in the evacuation center

Noria, 28, is a resident of Sitio Palestine, Barangay Rajahmuda. She is married to a barangay councilman and they have four children. Their main source of income is farming.

Noria and her family had experienced many armed conflicts in their community, but the most intense was in 2003 when the Islamic Center was bombed. Many people died. Noria and her family had to stay in an evacuation center. She shared that,

Kahit nasa evacuation, nangyayaya ang asawa ko na makipagtalik. Kasi lalaki, hindi ‘yan sila makatiis. Tatlong araw lang ang pinakamatagal na hindi makipagtalik. Ang lalaki kasi para din nagpa-fasting ‘yan, kung hindi magalaw ang babae, nauuhaw sila. Meron man din dibisyon ang aming tinutulugan bawat pamilya sa loob ng evacuation center kaya, okey lang. Kapag hindi mo kasi pagbibigyan, mag-init ang ulo niya. (Although we were at the evacuation center, my husband would like to have sex. Men are really like that, they can’t stand not having sex for more than three days. It’s like they are fasting. If they can’t touch the woman, they get thirsty. The sleeping quarters in the evacuation center had dividers, so it was all right. If I didn’t give in to the advances [of my husband], he would surely be bad-tempered.)

Access to RH Services and Assistance Extended to IDP’s

Many displaced families were relucant to return to their communities of origin, mainly because of the destruction of their houses, some of which had been burned during the conflict episodes. Others who had been away too long knew that their neglected houses would not be habitable anymore. Thus, they would have nowhere to stay if they did go back to their communties. Some women cited risk factors, claiming that the presence of combatants- either of the AFP or the MILF- presented the possibility of harm or damage to life and limb were they to return to their communities immediately after a firefight. Caught in this quandary, they had to endure the difficult life conditions at evacuation centers.

In the first few months of their displacement, they received relief goods in the form of food, canned goods, used clothing, and medicines. They got aid and support from various government agencies, particularly the DSWD, DOH, DILG, Regional Disaster Coordinating Council (RDCC), Office of Civil Defense (OCD), and the municipal government. There were also NGOs that extended relief and rehabilitation assistance to the displaced families (MSWDO Pikit, 2003).

During the massive displacements of 2000 and 2003, national line agencies and local government units were supported by many civil society organizations, local NGOs, and church organizations that provided food and health services. Both the DOH and the Municipal Health Office (MHO) served the health needs of the evacuees. However, most of those interviewed said they resorted to herbal medication or sought the help of the midwife in healing themselves or their sick family members. Their immediate source of medicines for colds, fever, diarrhea, skin disease, and other illnesses was the Poblacion Health Center and the Barangay Health Stations. Their supply of medicines however, was limited to over-the-counter drugs that generally provided temporary relief. Emergency cases had to be referred to the nearer hospitals. Because this required transportation and money that most evacuees did not have, the cases resulted in death in some instances.

The United Nations Multi-Donor Program (UNMDP) also supported the DSWD through food-for-work programs and the health and medical needs of the evacuees. Government organizations, such as DSWD, DOH, DILG, National Disaster Coordinating Council (NDCC), and Local Government Units (LGUs), and NGOs, such as Oxford Foundation Against Famine (OXFAM), Community and Family Services International (CFSI), Medicines Sans Frontier (MSF), Movimondo, Accion Contra El Hambre (ACH), and others provided assistance, such as food and medicines, shelter, and latrines and water system (Cotabato Province Annual Report 2003). They also extended livelihood assistance and conducted psychosocial and trauma management sessions, and capability-building trainings and interventions. The municipal government also conducted disaster preparedness and response training for the internally displaced families.

[Refer to the Original Copy]

Coping Mechanisms of Women Evacuees

Women affected by armed conflict demonstrated to be very resourceful and resilient in the face of such insurmountable difficulties. In the case of those displaced by armed conflict in the early 2000s, the support of the government organizations such as the DSWD, DOH, OCD, POs, and NGOs was crucial for their survival while they were at the evacuation centers (Daylusan-Fiesta, 2005). The relief assistance provided to them helped lighten the burden and miseries inflicted by displacements.

Despite the suffering and inconvenience at the evacuation centers, they obviously lived through these. When asked how they coped, they said they (a) prayed together with the family, (b) encouraged and advised each other, (c) shared their feelings and experiences with each other, (d) simply ignored or convinced themselves that the deplorable conditions at the evacuation center were just temporary (e) unloaded their pain to their relatives and neighbors.

They tried to be productive by helping their husbands earn a livelihood for the family. Others engaged in backyard gardening and raising livestock. There were some NGOs who provided the displaced persons with livestock, garden tools, and seedlings for this purpose. Those who were unable to find work had to attend to the family members and maintain the health and sanitation at the evacuation centers.

Other factors that helped the women cope with the situation included the support given by their relatives who also extend provisions for them at the evacuation centers. Psychosocial interventions provided by the DSWD and some NGOs, such as play centers for children and trauma healing sessions with children and women, helped relieve some of the tension that the IDPs felt.

Conclusions and Policy Implications

Congestion and crowding in Pikit evacuation centers deprived women of privacy, adversely affecting their personal hygiene and their marital sexual needs. There were women who had to give birth at the evacuation centers under conditions that did not allow them privacy and dignity. Moreover, such experience exposed both the mother and the newborn to health hazards, some of which resulted in loss of lives. The displaced women were predisposed to illnesses, such as frequent and painful urination and vaginal itchiness, which they attributed primarily to too much heat and the lack of clean water for drinking and washing.

Access to health services was limited to the services provided by the midwife stationed at the barangay. Mostly, women resorted to self-help and traditional practices and used herbal medicine when there was sickness in the family.

Relief assistance given to displaced persons was generally limited, short-term, and temporary. Moreover, these basically addressed survival needs for food and shelter. Health and reproductive health conditions were the least addressed, even though the displaced families lived in evacuation centers for extended periods of time. Program interventions on reproductive health and rights were seldom part of the assistance provided during the conflict situation.

The coping mechanisms employed by women were mainly about accessing kin and community support system. While they also engaged government offices, these efforts only allowed them to access limited help. They had little influence in determining for support agencies the kind of emergency relief that they were to receive.

Interviews with displaced women who suffered and lived a miserable life at the evacuation centers due to armed conflict have presented some policy implications that need to be addressed by the Philippine Government to protect them and their children. Disaster preparedness management systems of municipal and barangay units that host IDPs must be strengthened. Broad reproductive health programs that shall effectively reach displaced women and children need to be implemented. Most critical in the resolution of these displacement problems in Central Mindanao is the urgent need for the national government to prioritize addressing the peace issues involving the Bangsamoro people.