The priority given to reproductive health in times of armed conflict or natural disaster is much higher now than it was when the ICPD was held 10 years ago. Supplies for safe delivery and emergency obstetric care, once rarely included in emergency assistance, are now part of the immediate humanitarian response. Awareness is widespread about the heightened risks of unwanted pregnancy, STIs and sexual violence in crisis situations and refugee camps.
In 2004, UNFPA provided assistance in crisis situations and to reconstruction and emergency preparedness programmes in more than 40 countries. UNFPA mobilized funds for urgent action, participating actively in the UN Consolidated Appeal Process. In the last four years, the largest responses to UNFPA requests for emergencies came from Belgium, Italy, Japan, Luxembourg, the Netherlands, Norway, the United Nations Foundation and the European Commission.
EQUIPMENT AND SUPPLIES
UNFPA dispatched emergency reproductive health kits valued at nearly $2.7 million in 2004. The readyto- ship kits are packed with supplies to meet specific needs, such as clean and safe delivery, prevention of HIV/AIDS and other STIs, family planning, rape management and emergency obstetric care for complications.
- In the Darfur region of western Sudan, UNFPA provided supplies and equipment for safe childbirth, blood transfusions, prevention of STIs, and other reproductive health needs. Supplies were distributed to camps and health facilities inside Sudan through the International Rescue Committee, Save the Children UK and the Irish organization GOAL. UNFPA also shipped supplies to Sudanese refugees in neighbouring Chad.
- An airlift of emergency medical supplies from UNFPA arrived in the Haitian capital of Port-au- Prince in March to meet urgent needs after civil conflict led to the destruction and looting of much of Haiti's health care system and heightened levels of sexual violence.
- Deteriorating conditions in Bam, the Iranian city devastated by an earthquake in late 2003, demanded a continued UNFPA response in 2004. UNFPA worked with the Centre for Women's Participation and the Literacy Movement Organization to assist women and families that lost their primary breadwinners.
- In Monrovia, Liberia, UNFPA and community partners distributed personal hygiene kits with toothbrushes, toothpaste, soap, towels, combs and sanitary napkins to 2,000 displaced women and girls. The simple kits helped restore some sense of dignity and provided an opportunity to assess general reproductive health.
After the acute phase of a crisis, UNFPA continues to assist communities as they rebuild facilities and restore services - a contribution to longer-term development.
- When conflicts subside, migration and travel increase exposure to sexually transmitted infections. An influx of truck drivers, uniformed personnel and ex-combatants has fueled a new sex industry in the border towns of Sierra Leone and Liberia. With UNFPA support, education projects in the towns have taught women and girls how to prevent HIV infection and have provided vocational training to help them avoid the sex trade.
- UNFPA donated obstetric care equipment and materials to hospitals looted during a 2002 rebellion in the north-west of the Central African Republic, where conditions are slowly returning to normal. Supplies included mattresses, basins, scales, stethoscopes, speculums, tape measures, clinical thermometers and gloves.
DATA AND ANALYSIS
Accurate data helps determine what action should be taken next. UNFPA's growing expertise in data collection and analysis contributes to the planning, monitoring and evaluation of humanitarian responses.
- UNFPA participated in the first-ever global evaluation to identify gains and gaps in reproductive health for refugees worldwide. The evaluation, published in mid-2004 by the Inter-Agency Working Group on Reproductive Health in Refugee Situations, found improved access to family planning services but limited STI and HIV prevention, with immediate reproductive health services severely lacking.
- UNFPA joined UN partners in a humanitarian assessment mission to Sudan in April, focusing on action to avoid maternal and infant deaths. In July, a UNFPA assessment confirmed that women in Darfur are being targeted with sexual violence during armed attacks on their villages and at refugee settlements when they collect fodder and firewood.
- In Liberia in November, UNFPA participated in a UN mission to assess the situation of host communities and recently arrived refugees from Côte d'Ivoire, finding hugely unmet reproductive health needs requiring immediate response.
- UNFPA provided technical support to the International Organization for Migration for a fivemonth participatory research project on HIV/AIDS among internally displaced persons in northern Uganda.
TRAINING AND EDUCATION
Protecting reproductive health under crisis conditions requires special knowledge, skills and attitudes. UNFPA supports programmes for staff, health workers and partners in UN organizations, NGOs and governments, as well as for populations made vulnerable by conflict or natural disaster.
- The UNFPA-supported photo exhibition Positive Lives toured three refugee camps in Kenya in July and August 2004. Ten refugees at each camp received training to facilitate community discussions inspired by the photos of people living with HIV/AIDS and to assist with peer education, condom promotion, street theatre and sports activities.
- In Swaziland, members of relief committees that distribute food aid received additional training from UNFPA and the World Food Programme to act as community counsellors. The trainees, mostly women, were to share their messages about HIV prevention and other health and safety issues on food distribution days, when people have time to listen and talk while waiting in line.
- Training for doctors, nurses and counsellors in Darfur prepared them to recognize and treat the effects of sexual violence. UNFPA also provided drugs and medical supplies and, working with partners, helped communities organize women's groups to support victims of sexual violence and their families.
- Since April 2004, UNFPA has been actively involved in the development of policies, guidelines and procedures with the UN Inter-Agency Initiative on Disarmament, Demobilization and Reintegration, particularly in HIV prevention.
ADVOCACY AND AWARENESS-RAISING
UNFPA works to make reproductive health a higher priority in national policies and laws and in humanitarian assistance programmes. UNFPA also raises awareness of women's needs and roles. Risks from pregnancy, childbirth, rape and HIV/AIDS are intensified by crisis; at the same time, women are the source of strength and care for children, the injured and other survivors.
- Dozens of Afghan women from NGOs, civil society groups and government benefited from a five-day media and leadership training session in May organized by UNFPA for women leaders in post-conflict situations. The initiative was later expanded outside Kabul to raise gender awareness and empower women in rural areas.
- UNFPA and Marie Stopes International co-edited the January 2004 special issue of the journal Forced Migration Review: Reproductive Health for Displaced People, with funding from UNFPA and the Office of the United Nations High Commissioner for Refugees (UNHCR). Articles noted progress in providing reproductive health care in humanitarian settings, yet warned of gender-based violence, risks to adolescents and youth and other challenges.
An Indonesian woman receiving a kit with personal hygiene supplies soon after the tsunami devastated her home and village.
TSUNAMI: UNFPA RESPONSE
UNFPA is committed to ensuring the reproductive health and wellbeing of those who survived the tsunami of 26 December 2004 and supporting their efforts to recover. Many pregnant women face the danger of giving birth alone because of the deaths of midwives and damage to health facilities. UNFPA is working with national authorities, UN agencies and other partners to: restore health services; help ensure the security, hygiene and dignity of displaced women and girls; and provide counselling for people traumatized by the disaster.
In the countries hit hardest, UNFPA moved rapidly to meet immediate needs for reproductive health commodities, including supplies for clean and safe childbirth, equipment for emergency obstetric care, and contraceptives and condoms for dual protection against unwanted pregnancy and HIV/AIDS.
In Indonesia , after the tsunami, UNFPA set up an office in Aceh and provided hygiene kits, medicines, medical equipment and supplies for distribution by NGOs - 18 tons were shipped in the first two months and the effort is ongoing. A key priority is to assist the thousands of pregnant women living in temporary settlements; an estimated 800 will give birth per month. Working with WHO, the Ministry of Health and provincial and district health offices, UNFPA will focus on re-establishing basic reproductive health services, providing training and equipment, restoring infrastructure at hospitals and health posts, and creating referral systems for obstetric emergencies.
The Fund is also working to improve access to health services for displaced and remote populations. It has provided support to re-establish the Aceh provincial office of the National Family Planning Coordinating Board.
Counsellors are being trained at two community health centres in Banda Aceh to run UNFPA-supported psychosocial counselling programmes at eight community health centres in the worst-hit parts of Aceh.
In Sri Lanka , UNFPA helped set up temporary sites for reproductive health and family planning services where clinics were destroyed. It sent supplies to facilities to safeguard maternal health and meet other reproductive health needs, addressed gender violence in temporary shelters, and provided psychosocial counselling to help survivors cope and rebuild their lives.
To restore dignity and meet simple human needs, the Fund worked with the National Youth Services Council to assemble and distribute hundreds of thousands of hygiene supplies to women and girls.
In the Maldives , UNFPA has supported the travel of counselling teams to work with communities most affected by the disaster, and trained health workers in psychosocial support. UNFPA has supported safe shelters for women, monitored the distribution of relief supplies to prevent exploitation, and trained counsellors and health workers.
In Thailand , UNFPA is collaborating with partners to ensure high-quality maternal and child health and family planning services at health centres and mobile clinics in communities constructed for those displaced by the tsunami, including migrant workers from Myanmar.