Reproductive Health of Refugees Progress and Challenges

Henia Dakkak, MD, MPHInternational Medical Corps

Director of International Relief and Development Programs

UCLA – School of Public Health Nov.6 -2003

Issues to be covered: Definition of refugeesDefinition of conflictInternational Conference on Population and Development (Cairo 1994)Progress (Pre – ICPD and Post ICPD)Challenges

Definition of TermsTerms “ Refugee” and “internally displaced person” have wide implications for people concerned regarding (Rights to Protection and Assistance)Refugees have crossed International BorderInternally 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 refugeesPrevent refugees from being forcibly returnedProvide assistanceProvide protectionSeek lasting solutions to the core problem

StatisticsGlobal 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

75% of most displaced people are women

and children

25% are women of reproductive age (WRA)

20% of WRA are pregnant

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 disturbanceConflict – (Relative stability, Intense fighting, Flight, emergency phase)StabilizationPost 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 WomenStudy 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

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 careIn 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

• 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)NGOsGovernments

IAWG role

Production of manual specific to refugee setting that served as a basic guide to reproductive health services.Setting-up standards and policiesMinimum 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 SpacingSexual Transmitted Infections including HIV/AIDSSexual 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 kits12 kinds of Kits designed to address different aspects of Reproductive HealthClean delivery kits for pregnant womenKits for treatment of STIsKits for Family Planning

Block 1 – Six sub-kits to be used at community and PHC level for 10,000 persons /3 monthsSub-Kit 0 Administration OrangeSub-kit 1 Condom sub-kit (part A+B) RedSub-Kit 2 Clean Delivery sub-kit (individual )

(Part A+B) Dark BlueSub-Kit 3 Post Rape sub-kit PinkSub-Kit 4 Oral and Injectable Contraception

sub-kit WhiteSub-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 BlackSub-kit 8 Management of complications of

abortion sub-kit YellowSub-kit 9 Suture of Tears (cervical and

vaginal) and vaginal examination sub-kitPurple

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 greenSub-kit 12 Blood Transfusion sub-kit

Dark green

Applied Research Conferences

Two conferences were held for researchers to present their findingsDec. 2000 in Washington DCOctober 2003 in Brussels - Belgium

Challenges

Adolescent Reproductive Health Programming among war affected populations Emergency Obstetric Care Logistics and commoditiesHIV/AIDSSexual Exploitation and Gender Based Violence

Contact: www.imcworldwide.orgHelpful websites:

www.reliefweb.orgwww.unfpa.orgwww.rhrc.orgwww.unhcr.orgwww.idpproject.orgwww.globalhealth.org