PRESS
RELEASE
The ICPD+5 review
process
Relief Agencies Must
Help Survivors of Sexual Violence, Meeting on Refugee Reproductive
Health Told
Rennes, France, 3 November 1998–An
international meeting on providing reproductive health services to
crisis victims opened with presentations on sexual violence,
emergency contraception and adolescents’ needs. Experts from relief
organizations are sharing experiences in meeting the reproductive
health needs of people displaced by war and disaster, including
pregnant women and victims of rape, throughout the world.
The
three-day gathering here is being organized by the United Nations
Population Fund (UNFPA) and hosted by the Ecole Nationale de la
Santé Publique (ENSP). The school’s Director, Dr. Pascal Chevit,
opened the meeting. He welcomed participants and pointed out that
ENSP has collaborated with several of the agencies represented
here--including the Office of the United Nations High Commissioner
for Refugees, UNFPA and the International Planned Parenthood
Federation--in reproductive health service training, research and
communications activities.
Alphonse MacDonald, Director of UNFPA’s office in
Geneva, spoke on behalf of the Fund’s Director, Dr. Nafis Sadik.
Women and girls suffer the most in crisis situations because of
social inequity, he said. The breakdown of communities’ social
structures often leads to widespread sexual violence, and in several
recent conflicts, rape has been used as an instrument of terror.
UNFPA is cooperating with a number of other agencies
represented at this meeting to provide reproductive health services
to refugees, he noted. Providing services requires equipment and
supplies, properly trained staff and adequate funding.
In
response to sexual violence, he added, service providers need to
help refugees psychologically and socially as well as medically.
"Especially valuable is post-coital contraception, which should be
made available to women who wish to prevent an unwanted pregnancy.
It is both our duty and our responsibility to ensure that
individuals in crisis situations have the same rights and choices as
people everywhere."
Mr. MacDonald also noted that UNFPA’s
long-term goal is to link relief operations to post-crisis
development.
Today’s plenary session included three panel
discussions, on reproductive health minimum services in emergencies,
sexual violence and adolescent reproductive health needs.
In
the first panel, Dr. Michael Tailhades of the International
Federation of Red Cross and Red Crescent Societies (IFRC) described
his organization’s efforts to provide a comprehensive package of
reproductive health education and services to refugees in western
Tanzania, starting in 1996. "A vital part of the strategy was to
offer care, including care for adolescents and post-coital
contraception, for victims of rape and counselling for rape
victims," he said. Another aspect of the programme, organized in
cooperation with UNFPA and United Nations High Commissioner for
Refugees (UNHCR), was the provision of a clean delivery kit to every
pregnant woman returning home from the camps.
One lesson
learned from this experience, he noted, is that reproductive health
problems are most acute during the initial phase of organizing
refugee camps, and must be addressed as soon as shelter, food, water
and sanitation have been provided. Health workers from all
organizations involved in relief efforts need to be trained to
address reproductive health needs, and coordination among agencies
is critical, he added.
Batya Elul of the Population Council
and Dr. Ali Kubba of Lambeth Healthcare Trust in London spoke about
emergency contraception. Ms. Elul discussed three available methods
of "contraceptive first-aid": two different regimens of
pills--either pre-packaged or put together using the contents of
oral contraceptive packets--and the emergency insertion of a
copper-T intrauterine device. The first two methods have been used
for some time in the United Kingdom, Scandinavia and China, and
their use is increasing in a number of other countries; these
methods can be offered anywhere oral contraceptives are available,
and are effective up to 72 hours after unprotected sex. The third
method can be used after 72 hours, but there is a risk of infection,
so a trained provider must perform it.
"For the record, she
stressed, emergency contraception is not abortion. It will not
interrupt an established pregnancy."
Dr. Kubba elaborated on
the clinical guidelines for post-coital contraception, which he
called safe, simple, inexpensive and economical.
To respond
to widespread sexual violence against refugees--including rape,
domestic violence and forced marriage--Kate Burns of UNHCR
emphasized the need for prevention, community action and survivor
support.
Sexual violence is the ultimate act of humiliation,
said Philippe Lecorps of ENSP. This has policy implications: refugee
camps should be organized to serve victims. The role of security
forces should be to help refugees, not control them. Efforts need to
be made to help rape survivors become whole again. And camps should
serve as a collective memory, so the international community will
recognize the magnitude of the problem of sexual
violence.
Dr. Gill Mezey, a forensic psychiatrist at St.
George’s Hospital Medical School in London, said that reproductive
health providers need to be concerned with women’s mental health.
Women who have been raped are subject to depression, anxiety,
substance abuse and post-traumatic stress disorder. Early
intervention--getting women to talk about their experience--can help
to restore their sense of power, dignity and control and to
alleviate long-term trauma, she said.
But "until a woman
feels safe, you can’t really think about treatment", she added.
On the topic of adolescent reproductive health, Dr. Adepoju
Olukoya of the World Health Organization noted that crisis
situations expose adolescents to sexual violence, but there are
still very few reproductive health services aimed at young people.
Cynthia Waszak of Family Health International spoke about the
UNFPA-funded HARP project. Working in Zambia, Uganda and Egypt in
collaboration with the Association of Girl Guides and Girl Scouts,
the project teaches young girls about their bodies and nutrition,
and older girls about reproductive health, including family planning
and sexually transmitted diseases (STDs).
"It is important to
think of adolescence not as a problem to be solved, but as a
resource to be developed and empowered," she stated.
Ms.
Joyce Ringu of the National Council of Churches of Kenya talked
about conditions in the Kakuma refugee camp in north-west Kenya.
Most of the refugees are Sudanese, but the camp also houses Somalis
and seven other nationalities. One third are young people, who are
at risk of drug addiction unwanted pregnancy, abortion, forced
marriage, prostitution and STDs including HIV/AIDS. Her organization
has worked to educate adolescents through cultural activities and
sports, and also provides peer counselling.
The Technical
Meeting on Reproductive Health Services in Crisis Situations is part
of "ICPD+5", a series of conferences and workshops to review
progress towards the goals of the 1994 International Conference on
Population and Development (ICPD) in Cairo. The ICPD called for
comprehensive reproductive health care for all, including displaced
persons. The review will culminate in an international forum in The
Hague from 8-12 February 1999, and a 30 June-2 July 1999 special
session of the United Nations General Assembly.
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