Reproductive Health in Reproductive Health in EmergenciesEmergencies

2nd International Medical ConferenceAn-Najah National University

Faculty of Medicine

Ali Nashat Shaar, MD. MSc.

Reproductive health in crises Reproductive health in crises situation situation

Natural disasters Man-made disasters

In crises situationIn crises situation

Impact on affected population– Casualties– Displacement– Loss of social integrity and

protection– Loss of income

In crises situationIn crises situation

Impact on institutions•Disrupted or affected social

services •Order of law•Access to services

What has this to do with RH- the What has this to do with RH- the hidden victimshidden 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 and

might 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 of complete 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 into

surgical departments to cope with high number of casualties 23 PHC clinics were directly affected by military attack and

infrastructure was damaged 100.000 were displaced including around 50.000 hosted in 58 UNRWA

shelters Among those, it is expected that 22.000 women reproductive age

lived in shelters Some communities were completely isolated in claves

FindingsFindings

Access to careBased on population size in Gaza and the

fertility rate, 170 deliveries occur every day 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 health

facility due to overload with injured

FindingsFindings

Quality of care

31% increase in miscarriage cases admitted to maternities (data from Awda, shifa and Naser)

50% increase in neonatal death (data from Shifa hospital).

Early discharge after delivery (within 30 minutes)

FindingsFindingsQuality of care

Increased prevalence of complications as reflected by increased C/S proportion to reach 29% in January compared with 15% average prior to crises

Qualitative data from communities inform about severe impact of the crisis on mothers and infants not being able to reach care.

25% Increase in premature deliveries

Reported in-ability of mothers to initiate and/or continue with breast feeding

FindingsFindings

Psychological Impact

- Reported cases of panic disorders attending maternities (27 from Jabalia neighborhood registered in the local health facility)

- Qualitative information report that pregnancy is perceived as a fearful experience due to uncertainty of outcomes and safe access to care

- Severe psychological stress affecting women, who acquired disabilities (women stating they better 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 to

support 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 on

7th February and quoted in the ER conference in Sharm Material support in a value of 1,2 million USD and continues….

Response- medium and long Response- medium and long termterm

Three continua of care need to be taken into consideration:

Women to child continuum: safe pregnancy, delivery and care for the mother and newborn

Community to hospital continuum: ensuring that basic capacity for care is available at all and each of the three levels (community, primary care and referral hospital).

Emergency to development continuum: preserving a high level of integrity of services during 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 to

basic and comprehensive emergency obstetric care and neonatal care

Strengthen the referral system between different care levels Establish or strengthen existing logistic monitoring system to assure

availability at all levels of health facilities and at least 6-9 month stock of reproductive health commodities at central level.

Psychosocial: preserve and support coping capacity of individuals and households

Support community-based organizations staff to cope and provide needed support

Link with the WHO-MOH community mental health program to ensure smooth and reliable referral of cases in need for specialized care

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