Day 2: Refugees and Displaced People Must be Involved in Implementing Reproductive Health Programmes, Experts Say. November 04

United Nations Population Fund
Contact: in New York:
Alex Marshall
Fax: (212) 557-6416

The ICPD+5 review process

RENNES, France, 4 November–Refugees and displaced persons must take part in carrying out emergency relief programmes, the Technical Meeting on Reproductive Health Services in Crisis Situations was told today. "We are there not to teach them, but to help them become masters of their own lives," said Serge Malé of the Office of the United Nations High Commissioner for Refugees (UNHCR).

Mr. Malé was one of several experts recounting recent experience in providing reproductive health services to refugees and displaced people. After this overview, three other panels addressed coordination of services; tools to assess refugees' needs and monitor the effectiveness of assistance efforts; and sexually transmitted diseases (STDs) and HIV/AIDS in crises.

The three-day gathering here is organized by the United Nations Population Fund (UNFPA) and hosted by the Ecole Nationale de la Santé Publique. Participants are examining efforts to meet refugees' reproductive health needs, as part of "ICPD+5", a global review of progress in implementing the recommendations of the 1994 International Conference on Population and Development (ICPD) in Cairo.

During his presentation, the UNHCR representative suggested that international agencies and non-governmental organizations (NGOs) involved in aiding refugees should increase collaboration in order to provide comprehensive health services. Local institutions and NGOs should be helped to take over programmes from international organizations when the emergency phase of their operations ends, he added. He pledged that UNHCR would strengthen its reproductive health capacity, despite a recent downsizing in its ranks.

France Donnay of the United Nations Children's Fund (UNICEF) said that, in line with ICPD goals, UNICEF has made a concerted effort to improve the quality of maternal care, prevent and treat sexually transmitted diseases, protect women and children against sexual violence, and promote health education. The agency is also linking HIV/AIDS prevention efforts to opposition to sexual violence and to female genital mutilation (FGM).

UNICEF is providing technical and financial support to Projects, in Angola, Rwanda, Haiti, Nicaragua and Liberia, Ms. Donnay said. Its approach in emergency situations has four elements: advocacy; assessment; care; and protection of vulnerable women and children from intentional harm. It also provides medical and psychosocial support for victims of violence.

International agencies and relief organizations should integrate reproductive health programmes into their normal operations from day one, said Hakan Sandbladh of the International Federation of Red Cross and Red Crescent Societies (IFRC). Communities should be involved in all emergency work being undertaken in their areas, he added. The IFRC is trying to make this happen in the Kigoma refugee camps in Tanzania. He called on relief agencies to make better use of health information systems to improve their operations and provide services more efficiently.

Since the ICPD, UNFPA has helped refugees and displaced people in 33 countries, said Daniel Pierotti, who heads the Fund's Emergency Relief Operations office in Geneva. The Fund has spent more than $6.4 million on 52 projects executed by 24 partner agencies. More funding is needed for such efforts, he noted.

The Fund is working to increase the involvement of its own staff, including Country Support Team reproductive health specialists, in emergency work, Mr. Pierotti added. Towards this end, it organized a Consultative Meeting on UNFPA Assistance to Countries in Conflict, held two weeks ago in New York.

"We are starting to mature at UNFPA," Mr. Pierotti concluded. "We want to be sure, to the farthest extent possible, that in any situation, we know exactly what is to be done. It is absolutely necessary for the reproductive health kit to be available at the right time at the right place, and we are working to make that happen as often as possible."

In a panel on the coordination of reproductive health services in the field, Millicent Obaso of the IFRC said coordination has improved as a result of the ICPD. International agencies and NGOs should cooperate based on common goals, shared information, democratic and open decision-making, and advanced planning, she stated. Each NGO should be allowed to pick a component of services it wants to provide. Purchases should also be coordinated, and made in bulk centrally and in advance; equipment and supplies should be stored in the field in preparation for emergencies, she added.

Many governments are not prepared for emergencies, and refugees often arrive without warning, said Godfrey Mbaruku of Tanzania's Ministry of Health. To complicate matters, he added, NGOs sometimes go to crisis areas with inexperienced or culturally insensitive staff. When relief organizations leave areas of operation, they sometimes leave behind plastic sheets and little else. Like other speakers, he stressed the importance of involving refugees in coordinating and implementing services; otherwise it may seem as if alien practices are being imposed on them.

Speaking on STDs, HIV and AIDS, independent specialist Monica Wernette said a minimum package of measures to prevent HIV/AIDS and provide care and support to those infected is necessary during emergencies. UNFPA, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have produced guidelines to enable governments, United Nations agencies and NGOs to adopt early measures to prevent the spread of HIV due to unprotected sex or blood transfusions.

This intervention is called for on human rights grounds, Ms. Wernette continued: it should be seen as part of meeting people's basic rights to life, health and education. It is necessary to broaden access to user-friendly services and support groups, to challenge prejudices that are deadly in the era of AIDS and to escalate global advocacy on behalf of vulnerable groups.

In an open discussion, Dr. Nicholas Dodd of UNFPA's Technical and Policy Division suggested that a database should be created to help keep track of the wide variety of activities going on in many parts of the world, and of resource materials that have been produced. This would not only aid those active in the field, but would also help raise global awareness of what is being done-and what needs to be done-to meet the reproductive health needs of people caught up in emergencies.

After the morning panel sessions, participants went into six working groups to discuss: minimum reproductive health services in emergencies; sexual violence; adolescent reproductive health; coordination of reproductive health services; information systems--needs assessment, data collection, indicators and monitoring; and STDs and HIV/AIDS. Each group will report and make recommendations to the final plenary on Thursday.

The conclusions of the Technical Meeting on Reproductive Health Services in Crisis Situations, along with those of other round tables and technical meetings in the ICPD+5 process, will serve as inputs to 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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