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SFG1006 REV Rwanda Great Lakes Emergency Sexual and Gender Based Violence and Women’s Health Project Public Disclosure Authorized Environmental and Social Management Approach, including Environmental Management Plan and Medical Waste Management Plan Executive Summary and Conclusions The Environmental and Social Management Approach (ESMA) provides general policies, guidelines, codes of practice and procedures to mainstream environmental and social (E&S) due diligence during the implementation of the World Bank supported Great Lakes Emergency Sexual and Gender Based Violence and Women’s Health Project. The objective of the abbreviated ESMA is to help ensure that activities will be in compliance with the national legislations of Rwanda and the World Bank’s E&S safeguards policies. Public Disclosure Authorized The document is the main due diligence instrument required by the World Bank as financer, and additionally covers and goes beyond the Rwandan national regulatory requirements for project- level environmental assessment and management. The Environmental and Social Management Plan (ESMP) will be the main resource for environmental management and monitoring for the Client and set the standards and practices that will guide environmental and social project performance. It will become part of the tender package and environmental management and compliance will constitute a subsection of line items in the bill of quantities (BoQ). The selected bidders will be required to accept E&S conditions and tasks upon contract signature, and the implementation of the ESMP will be an integral part of the construction contracts. The monitoring of E&S performance will, much as other quality criteria, be tied to contractual penalties and damage restoration requirements via appropriate contractual clauses. Public Disclosure Authorized The project has been designed to cause minimal environmental or social adverse impacts; those which are expected are temporary, minor, confined to locations within already existing structures, compounds and built up areas, and are mitigable with standard, readily available measures. Due to the need to manage the limited, site-specific environmental and social impacts caused by activities supported by the proposed operation, the World Bank’s Safeguards policy on environmental assessment (OP 4.01) was triggered. The following two safeguards instruments are anticipated to fully manage and mitigate the potential adverse social and environmental impacts of activities: (i) an Environmental Management Plan, and (ii) a Medical Waste Management Plan. Project Description The Great Lakes Emergency Sexual and Gender Based Violence and Women’s Health Project Public Disclosure Authorized includes Burundi, the Democratic Republic of Congo, Rwanda and the International Conference on the Great Lakes Region (ICGLR). The Project Development Objectives (PDO) of the regional project are to (i) expand the provision of services to mitigate the short and medium term impact of SGBV, and (ii) to expand utilization of a package of health and nutrition interventions targeted to poor and vulnerable females. The Rwanda project will contribute to the first objective 1 of the regional project. Direct project beneficiaries include male, female and child survivors of SGBV. In addition, the project will provide selected support to families of survivors as well as support at the community level. The project will support the following components: (i) Holistic support to survivors of SGBV and violence prevention, and (ii) Regional and National Knowledge Sharing, Research and Capacity Building. Component 1: Holistic Support to Survivors of Sexual and Gender Based Violence and Violence Prevention This component will support delivering an integrated package of short and medium term assistance to survivors of SGBV at both community and health facility levels through scaling-up the ISANGE OSCs while promoting gender equality, behavioral change and violence prevention in the intervention zones. The holistic approach aims to support survivors’ physical, mental, social and economic well-being, taking into account the multiple needs, causes and consequences of SGBV. A holistic response will contribute to preventing or decreasing different consequences related to SGBV and breaking the cycle of violence. Specifically, this component will support: (i) Integrated Support for Survivors of SGBV and Prevention of Violence at Community Levels; and (ii) Integrated Support for Survivors of SGBV at Health Facility level. Sub-component 1A: Integrated Support for Survivors of SGBV and Prevention of Violence at Community Levels. This sub-component will include activities to support long-term behavioral and social norm changes to promote gender equality and reduce levels of violence, including SGBV through: (i) launching sensitization and advocacy activities to promote gender equality through public awareness campaigns (including radio, theater and television shows) at the national and community level including on existing laws, policies and services as well as the development of educational/informative modules designed to examine a range of issues directly or indirectly related to SGBV; and (ii) promoting behavioral change through the scaling-up of effective models for working with women, men, boys and girls at the community level to change behaviors and reduce violence in cooperation with other development partners. In addition, this sub-component will provide support to (iii) ensuring follow-up at the community level through social services and referrals to existing social protection programs for the economically vulnerable survivors of SGBV to promote their economic empowerment; and (iv) supporting safe houses to help survivors of SGBV to benefit from temporary safe housing before returning to their communities of origin. Sub-component 1B: Integrated Support for Survivors of SGBV at Health Facility level. This sub- component would support needs of survivors through scaling-up the ISANGE OSCs at the district level, using the established Multidisciplinary Investigation and Intervention Team Model (MDIIT). The ISANGE OSCs will be established in 17 existing hospitals which would be rehabilitated and modernized to accommodate the OCSs in line with the National Strategy to ensure multidisciplinary services and protection of survivors, 4 of which will focus on providing services to refugee SGBV survivors.1 In addition, during the fourth year of the project, 6 1 The project selected hospitals to set up and upgrade ISANGE OSC s include: (i) Kigali Province: Kigali district Masaka, Muhima and Kibagabaga hospital; (ii) Western province: Karongi district Kilinda and Mugonero hospital, Nyamasheke district Kibogora hospital, Ngororero district Kabaya hospital, Rutsiro district Murunda hospital; (iii) Southern province: Ruhangodistrict Gitwe hospital, Gisagara district Kibilizihospital, Nyamagabe district Kaduha hospital; (iv) Northern province: Rulindo district Rutongo hospital, Gakenke district Nemba hospital and Ruli 2 additional ISANGE OSCs close to refugee camps and boarder areas currently supported by the Government of the Netherlands will be supported. The services are available free of charge, 24 hours per day, 7 days a week. The support provided under this sub-component will complement the recently signed three-year project to support the scaling-up of the ISANGE OSC model with support from the Government of the Netherlands and One-UN. Specifically, this sub-component will include: (i) setting up the ISANGE OSCs in selected hospitals with the necessary facilities, equipment and medical supplies; (ii) supporting clinical care, case management, rapid initial support, and referral depending on the needs of SGBV survivors and based on an individualized and confidential service-delivery plan addressing these needs; (iii) providing PEP emergency kits, medical care services, surgery equipment and medical consumable; (iv) providing medico- legal support through the collection of forensic evidence and the completion of the standard medico-legal form from the national police with the necessary additional equipment and intervention services; (v) providing mental health and psychological support through specialized psychotherapeutic interventions, family mediation, family mental health support, and psychiatric referral, as needed in coordination with social services; and (vi) providing legal aid through police services, legal advice, free legal counseling and representation in court, transport and judicial follow-up, in coordination with social services. Component 2: Regional and National Knowledge Sharing, Research and Capacity Building. The second component will support: (i) Regional and National Learning and Capacity Building; (ii) Research and Surveys; and (iii) Project Management. Under (i) two pre-identified buildings will be upgraded to function as a Center of Excellence on Sexual and Gender Based Violence. Environmental Baseline Data The environmental baseline of all potential project locations is characterized by a pre-existing use as medical facilities, usually within larger villages or cities, within urbanized areas, compounds designated as hospitals for several years already, and entirely within existing structures. The medical facilities within which the ISANGE OSCs would be established are currently well managed, especially in terms of medical waste generation, which is treated in modern incinerators that are installed in about 90 percent of the 42 current district hospitals.