Transcript Reproductive Health of Refugees Progress and Challenges

Reproductive Health of Refugees
Progress and Challenges
Henia Dakkak, MD, MPH
International Medical Corps
Director of International Relief and
Development Programs
UCLA – School of Public Health Nov.6 -2003
Issues to be covered:
Definition of refugees
Definition of conflict
International Conference on Population
and Development (Cairo 1994)
Progress (Pre – ICPD and Post ICPD)
Challenges
Definition of Terms
Terms “ Refugee” and “internally displaced
person” have wide implications for people
concerned regarding (Rights to Protection
and Assistance)
Refugees have crossed International Border
Internally displaced persons have not
crossed the border of their own country
United Nations High
Commissioner for Refugees
(UNHCR) was created in 1950
by UN General Assembly
resolution
Convention on the status of Refugees was
drawn up in 1951 and is ratified by at least
120 countries
UNHCR Mandate
Encourage countries to receive refugees
Prevent refugees from being forcibly
returned
Provide assistance
Provide protection
Seek lasting solutions to the core
problem
Statistics
Global refugee population is estimated
to be 11-12 million
“Internally Displaced Persons" (IDPs)
are today estimated to number over 50
million worldwide (of which 25-30
million have lost their homes due to
conflict)
Refugees are Women and Children
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75% of most displaced people are women
and children
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25% are women of reproductive age (WRA)
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20% of WRA are pregnant
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About 30% of refugees are adolescents
Phases of Conflict according to Aid
workers
Four Phases from the point of view of
giving assistance to the displaced
Pre-conflict (deterioration of economic and
social circumstance, civil disturbance
Conflict – (Relative stability, Intense
fighting, Flight, emergency phase)
Stabilization
Post conflict (return – spontaneously or
part of resettlement, reconstruction)
Emergency Assistance in Large
Scale Population Movement
Priority is to meet/provide the most basic
human needs
Food
Shelter
Safe clean water
Sanitation
Medical Care
Refugees waiting to be resettled in
shelters and camps in Albania
Bench Marks highlighting
Reproductive Health among War
Affected populations
Cairo 1994 - International Conference on
Population and Development
Beijing 1995 Fourth World Conference on
Women
Study published in 1994 – New York by
WCRWC
“Refugee Women and Reproductive Health
Care: Reassessing Priorities”
Why Address RH in Refugee
Situations?

RH is a human right
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Significant cause of morbidity and
mortality

Part of the protection mandate
Safe Motherhood
15% of pregnant refugee women will
experience complications of pregnancy or
delivery that will require emergency
obstetric care
In a study conducted among Burundian
refugees in Tanzania found that neonatal
and maternal deaths accounted for 16%
of all deaths
Causes of Increased HIV risk in
Complex Emergencies
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Mass population displacement
Disruption of societal structures and norms
Disruption of family units
Disruption of sexual networks
Sexual interaction with military
Economic vulnerability of women and UAC
Commercial sex work
Sexual violence/coercive sex
Psychological trauma
Disruption of preventive and curative services
Unsafe transfusion practice
Increase intravenous and other drug use
High prevalence of STIs
Factors Affecting Epidemic HIV
Transmission in Emergencies
• Epidemic maturity in host and refugee
population
• HIV seroprevalence rates in host and refugee
population
• Prevalence/type of STIs
• Level and type of sexual interaction
• Context specific factors
• Level and quality of health services
Follow-Up from ICPD Cairo
Meeting
Inter-Agency Working Group on
Refugee Reproductive Health (IAWG)
was formed:
UN agencies (UNHCR, WHO, UNICEF
and UNFPA)
NGOs
Governments
IAWG role
Production of manual specific to refugee
setting that served as a basic guide to
reproductive health services.
Setting-up standards and policies
Minimum Initial Service Package (MISP)
Annual meetings to discuss progress
and identify areas of needs
Minimum Initial Service Package
The MISP is a minimum set of priority
interventions (reproductive health activities)
to be put in place and implemented at the
onset of humanitarian emergency.
The aim of the MISP is to reduce short and
long term reproductive health related
morbidity and mortality
Reproductive Health Care services
that need to be in place:
Safe Motherhood including Emergency
Obstetrical Care (EmOC)
Family planning or Child Spacing
Sexual Transmitted Infections including
HIV/AIDS
Sexual and Gender Based Violence
Cross cutting issues: Adolescent reproductive
health needs, FGC, PAC
UNFPA - Reproductive Health Kits
(commodities) to address the
emergency phase
UNFPA based on IWGA recommendation created
the Reproductive health kits
12 kinds of Kits designed to address different
aspects of Reproductive Health
Clean delivery kits for pregnant women
Kits for treatment of STIs
Kits for Family Planning
Block 1 – Six sub-kits to be used at
community and PHC level for 10,000
persons /3 months
Sub-Kit 0 Administration Orange
Sub-kit 1 Condom sub-kit (part A+B) Red
Sub-Kit 2 Clean Delivery sub-kit (individual ) (Part
A+B)
Dark Blue
Sub-Kit 3 Post Rape sub-kitPink
Sub-Kit 4 Oral and Injectable Contraception sub-kit
White
Sub-Kit 5 STI sub-kit Turquoise
Block 2
Five sub-kits to be used at PHC or referral
hospital level for 30,000 persons /3 months
Sub-kit 6
Delivery sub-kit (Health facility)
Brown
Sub-kit 7 IUD sub-kit
Black
Sub-kit 8 Management of complications of
abortion sub-kit
Yellow
Sub-kit 9 Suture of Tears (cervical and vaginal)
and vaginal examination sub-kit Purple
Sub-kit 10 Vacuum Extraction for Delivery (manual)
sub-kit
Grey
Block 3
Two Sub-Kits to be used at referral hospital
level for 150,000 persons per 3 months
Sub-kit 11
Referral level sub-kit for
Reproductive Health (Part A+B)
Fluorescent green
Sub-kit 12
Blood Transfusion sub-kit Dark
green
Applied Research Conferences
Two conferences were held for
researchers to present their findings
Dec. 2000 in Washington DC
October 2003 in Brussels - Belgium
Challenges
Adolescent Reproductive Health
Programming among war affected
populations
Emergency Obstetric Care
Logistics and commodities
HIV/AIDS
Sexual Exploitation and Gender Based
Violence
Contact: www.imcworldwide.org
Helpful websites:
www.reliefweb.org
www.unfpa.org
www.rhrc.org
www.unhcr.org
www.idpproject.org
www.globalhealth.org