Conflict for too many women is synonymous with rape and violence. It also means sexually transmitted infections, unintended pregnancies, unsafe abortion, maternal morbidity or death.
Sexual and reproductive health is never considered to be as important as food or security, yet for many women and girls, accessing these services can mean the difference between life and death. Many refugee women don’t even report rape; not only is the reporting process lengthy, slowing down their journey, but often the violence is perpetrated by police.
An unprecedented number of women and adolescent girls are crossing into the European Union daily, with the numbers only set to rise. As crises intensify the need for SRH services increases exponentially, yet it continues to be neglected by key humanitarian responders. Most countries do not even have an emergency response strategy in place to deal with crises, let alone one that includes SRH.
If you don’t have an enabling environment in a peaceful situation, how can you respond to SRH needs in an emergency?
Effective emergency response strategies require capacity development, multistakeholder coordination, improved availability of resources — including supplies — and most importantly, funding. Budget for SRH services in humanitarian crises falls a long way short of what is needed to save lives, and increased investment, prior to and during an emergency, can effectively mitigate the impact of future crises.
A set of essential SRH services should be provided as soon as a humanitarian situation arises, including effective coordination, prevention of sexual violence, reduction of sexually transmitted infections, prevention of maternal and infant mortality, and the integration of comprehensive SRH services into primary health care. The occasional provision of dignity kits with items such as sanitary pads and soap, although welcome, are in no means sufficient to address the needs of refugee women. Condoms or any other form of contraception are not included.
Priority on partnerships
To tackle these critical issues and assist countries in preparing for a potential crisis, International Planned Parenthood European Network and United Nations Population Fund (Eastern Europe and Central Asia) developed the Minimum Initial Service Package readiness assessment tool. This looks at whether a country is able to effectively respond to SRH in an emergency and what medical structures are already in place. This enables governments, U.N. agencies, and civil society organizations to respond effectively to the needs of refugee women.
Continuous migration means that responses must also be quick and adaptive. Although most of the response is implemented by CSOs on the ground, partnerships are crucial, and priority areas should be developed in conjunction with governments.
Governments have a duty to respond effectively and must be sensitized to the issues refugee women face. The prolific instances of gender-based violence amongst refugee populations should make SRH a top priority when it comes to emergency response strategies, not an afterthought. For this, the MISP readiness assessment tool guides responders on the following key issues: how to implement and prioritize effective SRH to a population constantly on the move; and how to tackle gender-based violence when women are only there for a maximum of 72 hours.
Serving mobile populations
IPPF EN member association HERA, the Health Education and Research Association in Macedonia, is currently able to provide immediate gynecological services to refugee women and counseling on gender-based violence. This is only possible because HERA and partners began to prepare for SRH needs in a crisis as part of a country team in 2012, in conjunction with the Ministry of Health and other key actors.
This has proved to be vital as more than 650,000 refugees have entered Macedonia so far; up to 50 percent of whom are women. Yet the provision of SRH services is still critically low. HERA is the only responder currently providing mobile gynecological services at the transit camps.
Many of the SRH services delivered at these mobile clinics are lifesaving, particularly for pregnant women. Undertaking these types of arduous journeys means safe delivery becomes almost impossible due to a lack of obstetric care. Malnutrition and epidemics only serve to increase the risk of pregnancy complications. In addition, the burden of time restrictions makes it incredibly difficult for women to receive the necessary medical treatment as they are only given 72 hours to transit the country, and typically only stay for four to six hours.
HERA is also establishing standard operational procedures on how to combat gender-based violence in such a short time frame and provide support for them both medically and psychologically. However, coordinated reporting on gender-based violence at transit camps is extremely challenging as most refugees are unregistered.
Scale up efforts
Poor response systems and EU member states’ willingness to send refugees back to an environment where they are at increased risk of death and violence are indicative of collective amnesia on pledges to aid refugees in crisis. Only 12 EU member states have ratified the Istanbul Convention guaranteeing the protection of women, regardless of their status.
A lack of policy cohesion and compliance with international humanitarian laws has resulted in huge implementation gaps. Member states need to scale up efforts in responding to humanitarian emergencies to prevent gender-based violence, improve the provision of essential SRH services to enable the protection and empowerment of vulnerable women and girls. SRH is a human right and in denying these services, we are denying women and girls of their basic human rights.
By Dearbhla Crosse, Communications Advisor, IPPF EN and Nesrine Talbi, Programme Advisor, IPPF EN