Reproductive Health inEmergenciesReproductive Health inEmergencies
2nd International Medical Conference
An-Najah National University
Faculty of Medicine
Ali Nashat Shaar, MD. MSc.
Reproductive health in crisessituationReproductive health in crisessituation
Natural disasters
Man-made disasters
In crises situationIn crises situation
Impact on affected population
–Casualties
–Displacement
–Loss of social integrity andprotection
–Loss of income
In crises situationIn crises situation
Impact on institutions
•Disrupted or affected socialservices
•Order of law
•Access to services
What has this to do with RH- thehidden victimsWhat has this to do with RH- thehidden victims
RH issues usually fall behind the scene in times of crises
Women in reproductive age constitute 22% of the population
15% of all pregnancies are accompanied with complications andmight require surgical interventions
Low status of women increase their vulnerability
•Ability to move and access care
•Displacement and loss of protection
•Psychological impact
•Increase exposure to violence
Gaza Crisis
December 2008
Context
Crises came on top of 9 years of prolonged crises and 2 years ofcomplete closure
High number of casualties 1400/ injured 5000
Attention was given to direct victims of strikes (protection,transportation, care)
Hospitals and maternities in large hospitals were transformed intosurgical departments to cope with high number of casualties
23 PHC clinics were directly affected by military attack andinfrastructure was damaged
100.000 were displaced including around 50.000 hosted in 58 UNRWAshelters
Among those, it is expected that 22.000 women reproductive agelived in shelters
Some communities were completely isolated in claves
FindingsFindings
Access to care
Based on population size in Gaza and thefertility rate, 170 deliveries occur everyday form which 30 could require C/S.
In the time of crises:
Denied access to health facility
- transportation
- insecure travel
- priority in transportation was given to injured
Delays of receiving assistance in healthfacility due to overload with injured
FindingsFindings
Quality of care
31% increase in miscarriage cases admittedto maternities (data from Awda, shifa andNaser)
50% increase in neonatal death (data fromShifa hospital).
Early discharge after delivery (within 30minutes)
FindingsFindings
Quality of care
Increased prevalence of complications as reflected byincreased C/S proportion to reach 29% in Januarycompared with 15% average prior to crises
Qualitative data from communities inform about severeimpact of the crisis on mothers and infants not being ableto reach care.
25% Increase in premature deliveries
Reported in-ability of mothers to initiate and/or continuewith breast feeding
FindingsFindings
Psychological Impact
-Reported cases of panic disorders attendingmaternities (27 from Jabalia neighborhoodregistered in the local health facility)
-Qualitative information report that pregnancy isperceived as a fearful experience due touncertainty of outcomes and safe access to care
-Severe psychological stress affecting women,who acquired disabilities (women stating theybetter die than be disabled)
Immediate ResponseImmediate Response
Due to triggers prior to the crises, a level of preparedness was built(available medical items in the local Gaza market and immediate delivery)
Immediate mobilization of resources (human and material) at the HQ level
Coordination with operations room and provision of a consultant tosupport in collecting field data
Political Briefings and advocacy fact sheet publications at the highest level(UNFPA, UN)
Coordination within the cluster approach to respond to crises (health,psychosocial, logistics, ER)
Needs assessment of damage in PHC was made public on 23rd January(used by MOP to guide response plan)
Comprehensive assessment of RH and psychosocial impact published on7th February and quoted in the ER conference in Sharm
Material support in a value of 1,2 million USD and continues….
Response- medium and longtermResponse- medium and longterm
Three continua of care need to be taken intoconsideration:
Women to child continuum: safe pregnancy,delivery and care for the mother and newborn
Community to hospital continuum: ensuring thatbasic capacity for care is available at all and eachof the three levels (community, primary care andreferral hospital).
Emergency to development continuum:preserving a high level of integrity of servicesduring crisis, but also beyond
ResponseResponse
Programmatic areas of intervention:
Rehabilitation of damaged infrastructure to preserve the critical life-saving functions.
Supply equipment and medical supplies including essential drugs
Capacity building of staff along the continuum in areas pertaining tobasic and comprehensive emergency obstetric care and neonatalcare
Strengthen the referral system between different care levels
Establish or strengthen existing logistic monitoring system to assureavailability at all levels of health facilities and at least 6-9 monthstock of reproductive health commodities at central level.
Psychosocial: preserve and support coping capacity of individuals andhouseholds
Support community-based organizations staff to cope and provideneeded support
Link with the WHO-MOH community mental health program toensure smooth and reliable referral of cases in need for specializedcare
THANK YOU