Reproductive Health of Refugees: Progress and Challenges
1. 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
2. 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
3. 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
4.
5. 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
6. UNHCR Mandate
Encourage countries to receive
refugees
Prevent refugees from being forcibly
returned
Provide assistance
Provide protection
Seek lasting solutions to the core
problem
7. 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)
8. 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
9. 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)
10. 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
12. 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”
13. Why Address RH in Refugee
Situations?
RH is a human right
Significant cause of morbidity and
mortality
Part of the protection mandate
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. 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
21. 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
22. 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-kit Pink
Sub-Kit 4 Oral and Injectable Contraception sub-kit
White
Sub-Kit 5 STI sub-kit Turquoise
23. 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
24. 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
25. Applied Research Conferences
Two conferences were held for
researchers to present their findings
Dec. 2000 in Washington DC
October 2003 in Brussels - Belgium
