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					 Population Reports
    Coping with Crises: How
Providers Can Meet Reproductive
Health Needs in Crisis Situations




           Prepared by:
        Deepa Ramchandran
          Robert Gardner
          Series J, Number 53
            December 2005
Millions Need Care in Crises
• Every year natural disasters and conflicts kill
  and displace millions of people.
• Conventionally, humanitarian and relief
  workers have focused on providing basic
  emergency services.
• Reproductive health care is a serious public
  health issue in crises that deserves more
  attention.


                                        Population Reports
                      Overview
• Crises Pose Major Challenges for Reproductive Health
  Care
   – Range of reproductive health care needed
   – Providers face unique challenges
   – International Response
• Reproductive Health Care Providers Can Help
   –   Joining the Inter-Agency Working Group
   –   Disaster preparedness
   –   Following guides to crisis care
   –   Building links
   –   Focusing on refugees not in camps
   –   What to do first in a crisis
   –   After the crisis

                                                Population Reports
 Crises Pose Major
  Challenges for
Reproductive Health
        Care



               Population Reports
    Range of Reproductive
     Health Care Needed
• Safe motherhood
• Protection and response to sexual and
  gender-based violence
• Prevention and treatment of STIs including
  HIV/AIDS
• Family planning
• Adolescent reproductive health


                                     Population Reports
          Safe Motherhood
• In crisis situations 15% of pregnant women
  suffer life-threatening complications of
  pregnancy and delivery.
• Maternal complications are riskier for women
  in crisis situations.
• Better care could prevent most maternal
  deaths.
  – Study of Afghan refugees in Pakistan found that, compared
    with women who died of other causes, those who died of
    maternal causes faced greater barriers to health care.



                                                 Population Reports
  Sexual and Gender-based
          Violence
• Armed conflict leads to widespread sexual
  and gender-based violence (SGBV).
  – Occurs during all phases of conflicts
• Most often women and girls, but men and
  boys also affected.
• SGBV increases with loss of security, trauma,
                        • .
  ethnic tensions and breakdown of society.
• Domestic violence also increases.
  – East Timor: Half of women reported abuse by intimate
    partners, both during the crisis and afterwards.

                                                 Population Reports
 Health Care Providers Can
   Help Reduce Violence
• Caring for Survivors:          • Preventing Violence in
   – Ask a client about abuse.     Camps:
   – Providers should be alert      – Work with camp
     to physical injuries,            management.
     health conditions, and         – Work with refugee health
     clients’ behavior that           care providers.
     indicates trauma.              – Advocate leadership by
   – Provide appropriate care.        women.
   – Document the woman’s           – Work with security
     condition.                       forces.
   – Support women’s self-          – Involve the community.
     esteem.

                                                  Population Reports
   HIV/AIDS and Other STIs
• Coupled with crisis situations, HIV and other
  STIs can spread rapidly.
• Poverty, powerlessness, food insecurity, and
  displacement make refugees more
  vulnerable.
  – In Liberia, HIV prevalence was estimate at 8%. STI
    screenings after the war showed 93% of male combatants
    and 83% of female combatants had at least one STI.




                                                Population Reports
         Family Planning
• Family planning is in as much demand during
  a crisis as it was beforehand.
• Refugees have far less access because
  services and supplies are disrupted.
• Results are unintended pregnancies and
  rising abortion rates.
• Women relying on contraceptive methods
  may have to discontinue abruptly.

                                    Population Reports
    Adolescent Reproductive
            Health
• Adolescents, especially girls are at risk of
  forced sex and sexual coercion in exchange
  for food, shelter and protection.
• Unsafe sex and risk-taking among youth
  increase in crisis.
  – In a refugee camp in Kenya, despite availability of free
    condoms 70% of young men and women had unplanned sex
    without condoms.




                                                Population Reports
    Health Care Providers Face
        Unique Challenges

•   Crises disrupt services
•   Crises overwhelm health systems
•   Crises come on top of existing problems
•   Conflicts and natural disasters create
    different problems for providers




                                       Population Reports
      International Response
             Improving
• Reproductive health care for refugees has
  improved, but gaps remain.
• In the last 20 years the international
  community has paid increasing attention to
  the reproductive health needs of refugees.
• Relief agencies and local agencies working
  together can avoid duplication of services and
  wasting resources.


                                      Population Reports
  International Relief Agencies
  Provide Reproductive Health
              Care
• UNHCR
• RHRC Consortium
• The Inter-Agency Working Group on Reproductive
  Health in Refugee Situations (IAWG)
• UNICEF, UNFPA, and UNRWA
• The International Medical Corps (IMC)
• Refugees International (RI)
• US Government Agencies
• ECHO


                                         Population Reports
      Not Enough Funding
• Relief agencies often cannot provide
  complete reproductive health care for
  refugees due to lack of funds.
• United States and European Union, provide
  most of the funding.
• Since 2000, funding for reproductive health
  care has declined as donor priorities have
  shifted.


                                      Population Reports
Reproductive Health
Care Providers Can
       Help
Join the Inter-Agency Working
             Group
• Inter-Agency Working Group on Reproductive Health
  in Refugee Situations (IAWG) seeks to improve
  interagency collaboration and reproductive care for
  those in crisis situations.
• Providers can join IAWG electronic mailing list to
  receive updates on reproductive health care in crisis.
• Providers can join or start a national, district, or local
  interagency working group that can serve as a focal
  point to collaborate with relief agencies.
   – For further information, contact Nadine Cornier at UNHCR
     <CORNIER@unhcr.ch>


                                                   Population Reports
         Develop Emergency
         Preparedness Plans
• If local communities and NGOs are trained
  and prepared for disasters, a quicker
  response can be mounted.
• International organizations offer disaster
  preparedness training courses.
  – Health Emergencies in Large Populations (H.E.L.P.) course
    offered by International Committee of the Red Cross (ICRC).
  – Public Health in Complex Emergencies course offered by
    International Rescue Committee (IRC).
  – In addition, numerous training tools specifically address
    reproductive health in conflict situations.


                                                  Population Reports
  Pay Attention to Logistics
• Crisis situations present special logistical challenges.
• Any reproductive health program can design and use
  a basic logistics management information system.
   – Contraceptive Logistics Guidelines for Refugee
     Settings (DELIVER) outlines basic principles of
     logistics management:
       -calculating contraceptive needs
       -calculating average monthly consumption
       -how to store contraceptives.



                                               Population Reports
       Create a Skills Roster
• Providers need to quickly identify people with
  essential skills.
• Many refugees have training in health care,
  but their skills can be used in a relief effort
  only if they are known.
• Without a skills roster, expertise can go
  unused.
   – In Tanzanian camps after the Rwandan genocide, some
     providers knew how to insert and remove implants, but relief
     workers did not know about provider skills. Women who
     needed these services did not have access.

                                                    Population Reports
 Establish a Relationship with
        the News Media
• Governments and humanitarian agencies
  should have a plan of working with news
  media.
• Media can provide survivors with critical
  information.
• News media are often the first to define an
  event as an emergency and raise public
  awareness and concern.


                                       Population Reports
 Working with the News Media
• Find ways to help the media report the news
  by providing them with accurate facts.
• Respect media deadlines.
• Always be truthful and factual.
• Use language that is clear, concise, and easy
  to understand.




                                      Population Reports
  Follow Guides to Crisis Care
• The Inter-Agency Field Manual is a key tool.
• Use the Minimum Initial Service Package
  (MISP).
  – Applies to both conflict and natural disasters.
  – A series of activities and supplies designed to deal with
    reproductive health issues in crisis situations.
  – Intended for the acute phase of a crisis.
  – Can be implemented immediately without a needs
    assessment.




                                                     Population Reports
              Build Links
• Coordination between relief organizations
  and local health systems can combine the
  experience/expertise of relief workers and
  local health care providers.
• Local providers can take the first step and
  offer their services.
• Local agencies may receive funding,
  supplies, and equipment from UN and other
  international agencies.

                                     Population Reports
    Focus on Refugees Not in
            Camps
• International relief organizations and NGOs
  can work with local reproductive health care
  providers to offer care for refugees who are
  not in camps.
• Refugees living in host communities often
  receive less health care.
• Health care providers who are able to
  continue serving their regular clients may be
  able to incorporate refugees into their
  services.

                                       Population Reports
    What To Do First in a Crisis
•   Approach someone working          •   If there are many displaced
    for a UN organization and ask         people, talk to relief workers
    which organizations and/or            organizing shelter, water,
    individuals are coordinating          latrines and food.
    RH care or the MISP.
•   Offer your services and           •   If you know how to set up
    provide your qualifications.          water pumps and latrines let
•   If your clinic/hospital has the       them know.
    skills or equipment to provide    •   Work with those distributing
    any component of the MISP,            food rations to make sure
    start immediately.                    women are equally
•   Ask for supplies from relief          represented.
    organizations. Also ask that      •   Make sure sanitary supplies
    they include your clinic in
    distribution of supplies.             as well as clean delivery kits
•   Go to reproductive health             are distributed with food
    care coordination meetings            rations.


                                                           Population Reports
After the Crisis: From Disaster
        to Development
• Even after conflicts or natural disasters end,
  suffering often continues.
• People need continued support to help
  rebuild their lives.
• During the transition to post-emergency relief
  and recovery, humanitarian providers can
  cooperate with other local providers and
  coordinate activities that focus on
  sustainability.

                                       Population Reports
                  Photo Credits
•   Slide 1:Sandra Krause, Women’s Commission for Refugee Women and
    Children
•   Slide 3: EC/ECHO, New Delhi/Alam Aftab
•   Slide 15: CCP, Courtesy of Photoshare




                                                      Population Reports
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                                                     Population Reports