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Family Planning in Emergencies: Urgent need for focus on women made vulnerable by humanitarian disasters

 

What are the first things you would grab if you were forced to leave your home tomorrow?
Not many people would answer that question with ‘contraceptives’

 

As tens of thousands of Sudanese refugees continue to move across the border into South Sudan, fleeing from hunger and conflict in Blue Nile State, a great many women and girls find themselves vulnerable to unplanned pregnancies and are at serious risk of death or disability from complications during pregnancy, childbirth and unsafe abortions.

Sexual activity and reproductive health needs do not disappear in the midst of emergency. According to the United Nations, one in five women of childbearing age is likely to be pregnant in a crisis or refugee situation.  When families are forced to flee their homes because of conflict or natural disaster, most do not get to bring their contraception with them. Organisations responding to humanitarian crises must ensure continuity in birth control, and respond to further demand for contraception for women who choose to delay pregnancy because of their increased vulnerability and their uncertainty about the future.

Too often, however, family planning is not highly prioritised among the myriad demands of an emergency response. The United Nations refugee agency, UNHCR has found that, contraceptive use and awareness of family planning methods are generally low amongst refugees, access to information is difficult, contraceptive stocks are insufficient or unpredictable, and that emergency contraception tends to only be used in post-rape care.  At the same time, the risks of unplanned pregnancy only increase with trauma, malnutrition, and disease, while sexual violence, heightened during times of conflict and crisis, can result in large numbers of unwanted pregnancies.  When access to quality medical care during childbirth is restricted, as it often is during emergencies, pregnancy can be fatal.

 

International Medical Corps prioritises access to family planning information and services in our emergency responses, so that women, who have endured highly traumatic experiences, fleeing their homes, facing constant insecurity and often caring for large families already, are able to have some control over whether they want to become pregnant.

As part of International Medical Corps’ current response to the refugee crisis in South Sudan’s Upper Nile State, we are providing family planning services within our primary health care package of services – including a place where refugees, including survivors of sexual assault and all those who are sexually active can come for counseling and contraceptives. Once the initial phase of the emergency is over, we will start community outreach activities in order to increase access to information on family planning services and the benefits of spacing pregnancy.  Our approach recognises that a family in control of its reproductive future is better placed to recover quickly from the effects of a disaster and to remain resilient against future shocks.

 

Julie Taft, International Medical Corps’ Reproductive Health Advisor explains it best:

“We should ensure women are able to make choices about their reproductive life at all times, but in disasters – when they are faced with so many uncertainties – it is one choice we should do our best to give. This is why International Medical Corps have made it an integral component of how we respond in emergencies.”

 

As thousands of refugees arrive each day in South Sudan’s refugee camps, delegates prepare to attend a major Family Planning Summit in London organised by the Department for International Development (DFID) and the Bill and Melinda Gates Foundation.   The summit’s aim is ambitious: to halve the number of women in the world who are unable to access contraceptives.  We know however that many of the women without access to full family planning support live in countries where disasters, including conflict, are a regular reality.   International Medical Corps asks delegates to the London Family Planning Summit to ensure that they are not forgotten and that the initiative being launched addresses the needs of women in emergencies and disaster-affected states.

  

Haiti

Just 22 hours after the devastating 7.0-earthquake hit in January 2010, International Medical Corps’ Emergency Response Team was on the ground in Haiti providing medical care to survivors. Our doctors and nurses were able to mobilise on an unparalleled scale to provide 24-hour emergency care to the acutely injured at the Hôpital de l’Université d’État d’Haiti (HUEH), a 700-bed hospital in Port-au-Prince. HUEH was badly damaged in the earthquake and many local health care professionals were missing. We were able to save thousands of lives through emergency and trauma care in the critical days following the earthquake.

At the height of emergency operations at the hospital, International Medical Corps treated approximately 1,000 patients per day. Our early entry also gave us the foundation to rapidly expand our operations to 15 mobile clinics throughout Haiti to provide critical services. Through the hospital and mobile and fixed clinics, International Medical Corps teams provided more than 110,000 patient consultations during the first year following the emergency.

When reports of acute diarrhoea emerged from the north of Haiti in October 2010, International Medical Corps doctors and nurses immediately deployed to the region providing emergency relief for the growing cholera crisis. Our network of rapidly constructed cholera treatment centres, supported by 820 community health volunteers to educate communities on how to prevent and identify cholera, meant that more than 30,000 cholera patients received life-saving treatment within the first year following the outbreak.

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Libya

Libya ambulanceInternational Medical Corps was among the first organisations to enter Libya once the conflict began in February 2011, providing emergency medical care to casualties from the fighting and support to hospitals with medical staff and supplies. Among the first challenges our Emergency Response Teams encountered was a chronic shortage of nurses, as thousands of foreign nurses had fled the country. In partnership with the Jordan Health Aid Society, International Medical Corps immediately deployed volunteer nurses to health centres across eastern Libya moving them to towns and cities throughout the country as access permitted. Volunteer nurses trained the local counterparts while working alongside them.

At the country’s borders and within Libya, we supplied those displaced by the fighting with essential relief items, including blankets, bottled water and food. Recognising the danger posed by communicable diseases, our sanitation and hygiene specialists constructed latrines and washing stations in transit camps along the Tunisia borders.

Libya 5As the fighting went on International Medical Corps worked as close to the front line as possible, providing emergency treatment to those injured in the conflict, and medicines and supplies to besieged towns and cities. In Misurata, inaccessible by road, we evacuated nearly 500 injured civilians by boat. International Medical Corps’ mobile field hospitals treated the wounded from battles in Tripoli, the Western Mountains, Bani Walid, Sabha, Jufrah and Qaddafi’s hometown of Sirte.

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Mali

Mali - villagerInternational Medical Corps mobilized an emergency response in Mali in January 2013 after rebel armed forces from the north began moving south, triggering French military intervention. In Timbuktu, which had spent months under the control of armed Islamist rebel our team were amongst the first international organisations to arrive and found pillaged clinics, missing medical personnel and damaged health infrastructure.

We immediately began supporting eight strategically targeted health clinics in remote areas around Timbuktu, where the Malian Ministry of Health has been unable to maintain adequate services to local communities. By providing medicines, training staff and recruiting qualified doctors and nurses, we can ensure local people will now have access to basic primary and secondary health care for the first time in months

Mali-Road-to-TimbuktuTrue to our mission to build self reliance, International Medical Corps is also already training community health workers to go out to local markets and spread essential hygiene, reproductive health and nutrition messages. We are also working to rehabilitate clinics damaged during the conflict, by building or repairing latrines, water systems, solar panel systems and other infrastructure repairs, enabling health workers to have stable and well-equipped facilities to help the people of Mali.

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Basanti & Bishal's story

Basanti, a young mother of two in Nepal, returned home from fetching water for her family to find her 8-month old son Bishal had fallen into the open cooking fire. Basanti was in shock, but she wrapped her baby in blankets and ran for help. No one in their village or at the local health post knew what to do so she had to travel more than six hours by bus to seek emergency care at the closest hospital. The district hospital could only stabilize Bishal and wasn’t able to treat his wounds properly. As a result, his little fingers contracted into a fist as the burned skin contracted and “healed” over the coming year, making it impossible for him to use his hand. His cheek, lips and eyelid also contracted and tightened, threatening his vision.

After selling part of their farm to pay for transportation to Kathmandu, Basanti sought further treatment for her baby. However, two hospitals in the nation’s capital could not help either. Adding to Basanti’s struggles, her husband abandoned the family, leaving her alone to care for Bishal and his four-year-old sister.

Thankfully, Basanti heard about the surgical care available through ReSurge International, our trusted partner with a 43-year history of serving burn victims. Dr. Rai, ReSurge’s Outreach Director in Nepal, and his team restored Bishal’s eyelid and his hand will soon be surgically repaired as well.

Even though it took more than a year for him to get appropriate treatment, Bishal is one of the lucky ones. Thousands of children never get the care they need to live a normal life after a disabling burn.

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Our impact through training in 2012

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Our Mother Care Group Approach

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Read more about our community based approach to prevention and treatment of malnutrition

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