h_13_2.txt

 This support often is vertical and often doesn't take the full IDP situation into account.  In fact, over 50% of African countries did not mention their IDPs in their HIV National Strategic Plans and Global Fund proposals  indicating a lack of awareness of the need to build capacity for this portion of the population within their borders.  This goes largely back to the issue of location.  IDPs are often in inaccessible areas where governments don't have health programs and don't have the funds to initiate them.  In addition, countries have a basic responsibility to care for refugees, based on the 1951 refugee convention but no such mandate exists for IDPs.  As an anecdotal example, the WHO cited one of the failings with the Kenya emergency response in 2007 to be that the emergency response plan was only 28% funded.
	In response to some of these issues, the World Bank has issued grants for a number of projects that include micro-financing for healthcare services in IDP situations.  Generally these grants pay to rehabilitate the physical structures, often in conjunction with schools and other buildings that offer similar services.  However, these sorts of grants generally are post-conflict.  Effective financing mechanisms during conflict to ensure access for the most vulnerable is largely done through grants and donations to NGOs or UN services where the country's health infrastructure is insufficient.	


	In many conflict zones, NGOs “pick up the slack” in providing healthcare services to citizens and IDPs.  This is reliant on government cooperation and funding, whether via grants or private funding.  In these frequent situations, coordination between agencies is of the utmost importance, as is earning the trust and commitment of country leadership.  When collaboration with the government does not exist, NGOs can find it impossible to work.  In March 2009, in response to President Omar Al-Bashir's indictment by the International Criminal Court, 13 major aid organizations were kicked out of the country, including Medecines Sans Frontiers, OXFAM, CARE, Save The Children, and the IRC.  This expulsion left 1.5 million people without access to healthcare, according to the UN.  Most of these organizations were never allowed back into the Sudan, leaving much smaller NGOs to take over programming for health and education services, which they were not equipped for.  Similarly, in 2009 Ethiopia suspended the operations of around 40 NGOs, (mostly smaller organizations) for operations “outside of their mandate”.  While these sorts of situations occur infrequently, it does point to one of the real issues with the reliance on NGOs in conflict situations.  If the government does not support their mission, they can be kicked out, leaving vulnerable populations without access to basic health care.
	One area that is of particular concern is that of providing reproductive health in IDP and refugee situations.  Due to the ever-changing US government stance on the “Mexico City Policy,” also known as the “Global Gag Rule,”  which is the refusal to fund organizations involved in any sort of abortion programming, reproductive health can be a difficult area for many NGOs reliant on USAID funding to work in.