General presentation

UNFPA in Emergencies

Presented by the Humanitarian Response Unit’s

Dr. Henia Dakkak, Technical Specialist

Why RH services for populations in crisis?

Reproductive health is

• a human right

• a basic health need

• contributes to psychosocial well-being

RH needs continue … in fact, increase during crisis

• Risk of sexual violence may increase during social instability

• STI/HIV transmission can increase

• Lack of FP increases risks associated with unwanted pregnancy

RH needs continue … in fact, increase during crisis

• Malnutrition and epidemics increase risks of pregnancy complications

• Childbirth occurs on the wayside during population movements

• Lack of access to emergency obstetric care increases risk of maternal death

Heightened risk, greater need

• Women and children account for more than 75% of refugees and internally displaced

• 25% of this population at risk are women of reproductive age. 1 in 5 is likely to be pregnant

• More than 37 million people displaced by war

37 million people displaced worldwide

$1 million annual seed money for operations

Safe motherhood and family planning

Emergencies heighten already significant risks:

•Complications of pregnancy and childbirth leading cause of death for women under 50 in most developing countries

•Premature deliveries and miscarriages brought on by trauma

•Fewer than half of all deliveries in developing countries take place with a skilled birth attendant

Continuum of an emergency

Emergency Post-emergency

Exodus of the population

Loss of essential services

Restoration of essential services

Durable Solutions

Relative stability

Return to normality

MISP

Minimum Initial Service

Package

Provision of comprehensive RH services

Destabilizing event Durable solutions

When does UNFPA respond?

0. before emergencies strike1. in acute emergencies2. in refugee and IDP settings3. in post-conflict situations 4. in reconstruction and development

Kosovo pre-deployment of supplies

to Albania

Afghanistan contingency planning in

surrounding countries

Iraq comprehensive

preparedness plan for anticipated refugee movements and cross-border operations

Before emergency strikes

Before emergency strikes

Haiti

Contingency planning for large numbers of displaced

Bangladesh

Contingency planning for natural disaster response

Acute emergencies

Deployment of equipment, supplies and RH kits

Release of funds for local procurement

RH assessments and data collection and analysis for UN-wide targeting and response (CAP)

UNFPA ships pre-packaged supplies directly to field offices, Red Cross, Governments, local partners

Quick response saves lives

Acute crisis

Millions displacedHealth infrastructure

devastatedUNFPA has been

providing training, medicines and supplies through the Red Cross, UNHCR and other agencies, and basic HIV prevention for IDPs and Liberian refugees in four West African countries

UNFPA is the only provider of condoms in Liberia

Acute crisis

Liberia

Examples of UNFPA response in acute emergencies

Natural Disasters:

IndiaEl SalvadorDRC (Goma)KenyaMalawiMexicoIranMongoliaHaitiGrenada

Armed Conflict:

ColombiaSierra LeoneLiberiaIraqCongoIndonesia - MalukuPalestinian TerritoryIvory CoastAfghanistanSudan

For refugees and internally displaced persons, UNFPA:

Assesses RH and gender needs

Distributes RH supplies

Provides RH information

Trains NGO and local staff for delivery of services

Organizes HIV prevention initiatives

Helps to prevent gender Violence

Coordinate and collect data

Refugees and IDPs

Refugees:

Sierra Leone, Tanzania, Uganda, Sudan, Ethiopia, Kenya, Zambia, Guinea, Liberia, Pakistan, Iran, Yemen, Palestine

IDPs:

Eritrea, Liberia, Colombia, Afghanistan, Angola, DRC, ROC, Burundi, Somalia, Tajikistan, PNG, Sudan, CDI

Recent refugee and IDP programmes

Refugees and IDPs

Post-conflict recovery

• Renovation of health facilities

• Counseling

• Training

• Equipment and supplies

• Support to local NGOs

• Demographic data

Not enough beds, Bas Congo

Recovery Democratic Republic of Congo

ReconstructionRecovery

Rehabilitation of Hospital

Baby Ahmed!6.5 pounds

Mother in good shape2nd child, 6th pregnancy

Afghanistan

Angola

Establishment of maternal mortality programs

Rehabilitation of maternity centers

Provision of equipment, supplies

Retraining of health staff

Reestablishment of EmOC

HIV prevention

Safe blood supply

Strengthening of referral systems

Recovery

How does UNFPA respond?

1) Initial authorization up to $50,000-local procurement, transportation, consultants, etc.

2) Estimate the needs for RH kits

3) Emergency shipment of RH kits

3) Provision of technical assistance (advice and training)

4) Monitoring of RH service provision to affected population and kits distribution and data collection of RH indicators (access, coverage, availability of RH commodities and forecasting)

5) Advocacy for funding and inclusion of RH services and commodities within basic needs of affected populations in humanitarian response

What are the RH Kits?

• Pre-packaged sets of medicines, equipment and supplies designed to meet the most basic RH needs in crisis situations

• They are designed so that each kit can be used in contexts where there is little or no health infrastructure

RH kit for emergency situations Block 1

Primary health care/health centre level10,000 people for 3 months

Kit 0 1 2 3 4 5

•Training and administration •Condoms (male & female) •Clean delivery sets (individual)•Post-rape (EC and STI prevention, PEP)•Oral and injectable contraception•STI drugs

Post-Exposure Prophylaxis (PEP)

• Now a part of Kit #3 (“post-rape kit”)

• For accidental/possible exposure to HIV, including sexual violence

• Costs have come down dramatically – now much more affordable

RH kit for emergency situations Block 2

Kit 6 7 8 9 10

•Professional midwifery delivery kit

•IUD insertion

•Management of complications of abortion

•Suture of cervical and vaginal tears

•Vacuum extraction

Health centre level or referral level30 000 people for 3 months

Kit

11A

11B

12

RH kit for emergency situations Block 3

Referral level150 000 people for 3 months

•Surgical (reusable equipment) •Surgical (consumable items and drugs) •Blood transfusion (HIV testing)

Local Logistics Issues• Customs clearance• Observing the cold chain• Observing expiration dates • Transport and Distribution• Warehousing• Coordinating with local partners (MOH,

NGOs, other UN agencies)

Options to think about?

1) Pre-positioning in neighboring countries

2) Stockpiling in central warehouse or neighboring countries

3) Sending in supplies during crisis-airlifting, sea, road, train,etc

4) Air Dropping in areas that is inaccessible

5) Utilizing existing commercial networks for distribution

6) Role of the military/armed forces/peace keepers in regard to logistics and in demanding services and commodities

Challenges/Questions

1) Cost Effectiveness

2) Storage and distribution

3) Expiration dates and shelf time

4) Technical Support

5) Planning for long-term commodity security (once population stabilize)

6) Managing procurement and achieving commodity security in situation of high insecurities? (Iraq as an example)