November 2021 marked one year since the conflict between the Government of Ethiopia and forces in its northern Tigray region started, which has thrown the country into turmoil. That’s one year of a humanitarian crisis aggravated by COVID-19, one year of increased risk of Sexual and Gender Based Violence (SGBV) for millions of women and girls, one year of strain on an already fragile health system and one year of intensified sexual and reproductive healthcare (SRH) needs of many displaced women and girls.
Seven (7) million people in the Northern Ethiopian regions of Tigray, Amhara and Afar are in dire need of humanitarian assistance. More than 2.5 million Ethiopians are displaced from the Tigray, Amhara and Afar regions, as a result of the political upheaval. These are more than just abstract figures to fill the pages. This data represents real people in real need. The unstable situation has heightened the demand for vital sexual reproductive health (SRH) services for the internally displaced and refugee women fleeing these areas for safety and international protection. Many of these women are pregnant and forced to travel for weeks with young, often malnourished children. The blockade of aid, threat to humanitarian workers, and limited banking facilities not only poses a threat to the functionality of many non-government organisations (NGOs) and international organisations (IOs), but also thwarts the ability to respond to the emergency health needs of women and girls, boys and men, and survivors of war and conflict.
Central to this humanitarian responses are the essential life-saving SRH needs of refugee women fleeing the Tigray, Amhara and Afar regions for safety in neighbouring Sudan and Djibouti, where IPPF’s local partners, the Sudan Family Planning Association (SFPA) and the Association Djiboutienne pour l’Equilibre et la Promotion de la Famille (ADEPF) have stationed mobile clinics to provide services to refugee women in camps. Over 30,000 refugees have fled to Djibouti while nearly double that number have arrived in Sudan, since the conflict started. Today, there are an estimated 1.2 million internally displaced people in Tigray, 250,000 in Amhara and 112,000 in Afar region. Our local partner, Family Guidance Association of Ethiopia (FGAE) is currently providing sexual and reproductive healthcare to vulnerable women and girls.
If immediate access to maternity care is not provided, the risk of complications and mortality is high given the fragile humanitarian settings these women are subjected to including fatigue, the psychological effects of war and displacement, weak health systems, and malnutrition.
Experiencing pregnancy and childbirth while enduring displacement can be life-threatening. We know that 500 women in humanitarian and fragile settings die during pregnancy or childbirth every day. With many health centres in northern Ethiopia damaged or lacking basic supplies and medicine, many pregnant women will not be able to deliver their babies in a safe and equipped facility. Additionally, access to contraceptive services and treatment for sexually transmitted infections (STIs) are hindered. Women and girls facing displacement are also more vulnerable to violence and abuse. School buildings are being used as temporary shelters, leaving young girls out of school and subject to sexual and gender-based violence (SGBV).
According to UNHCR, forced displacement likely exceeded 84 million by mid-2021. Following the recent High Level Global Compact on Refugees Meeting, IPPF called for the initial prioritization and expansion of SRH services, with particular attention to the most vulnerable and marginalized communities who often have the highest needs, such as refugees. UNFPA estimated that in 2019, out of nearly 132 million people in need of humanitarian aid and protection worldwide, 35 million women, girls and young people required lifesaving sexual reproductive health and rights (SRHR) services and interventions to prevent SGBV and respond to the needs of survivors. What these figures indicate is that women’s health must be integrated into humanitarian programming to address the disparity in humanitarian services and funding.
In 1994, the Programme of Action of the International Conference for Population and Development (ICPD) acknowledged for the first time the importance of SRH services for persons affected by humanitarian crises, particularly women and girls, and of them being protected from SGBV. Although SRH is now integrated into many state and federal Government humanitarian response strategies and is gaining recognition as a crucial health service, there is still an evidential gap in funding. SRH is a core humanitarian need and its position in humanitarian programming is significant in all phases including mitigation, preparedness, response and recovery. Often, IPPF is the sole humanitarian aid agency providing SRH care to women and girls in an emergency. In order to provide the most impactful services, we must invest at the preparedness stage and understand and integrate SRH and SGBV services in every stage of planning, response and recovery, leaving no one behind.
Sexual and reproductive healthcare in humanitarian settings is multifaceted and cuts across many thematic areas including SGBV prevention and survivor care, HIV and STI related morbidity reduction, contraception, safe abortion, and obstetric and neonatal care – thus the need for sufficient and timely SRH funding in emergencies. Through our member associations, and local civil society organizations, IPPF enables contextually appropriate, timely, high-quality SRH care at the onset of emergencies for the displaced women and girls in Ethiopia and neighbouring Djibouti and Sudan.
There are ways that we as an international community can support the sexual and reproductive needs of the women and girls affected by the conflict in northern Ethiopia.
Three ways we can support the SRHR needs of refugee and internally displaced Ethiopian women:
Provide safe abortion care in humanitarian settings; women living in humanitarian settings frequently have limited access to safe abortion and post abortion care. Abortion is still a taboo in many African states and unsafe abortion is a major cause of maternal death globally. The laws and policies governing abortion vary across Ethiopia, Djibouti and Sudan ranging from less restrictive to more prohibited. When access to safe abortion care is restricted, women often resort to dangerous procedures that may result in severe bleeding, infection, disability and death. IPPF is committed to promoting access to safe abortion care in humanitarian settings as part of our life-saving work for women and girls.
Championing local actors to lead humanitarian response; The design and delivery of humanitarian response must be localized. Enhancing local and national capacity is essential for the effective delivery of sexual and reproductive healthcare services. ‘Globally connected, locally owned’ – a now renowned phrase – reemphasizes that we, the International community must be led by local humanitarian professionals in order to meet the needs of affected populations. Local actors and influencers are better placed to lead the discourse on sexual and reproductive rights, particularly within the cultural terrain of each locale and to reduce stigma associated with survivors of SGBV. Localization facilitates smooth service delivery. Our partners on the ground understand the traditions, cultural and societal values while abiding by the core humanitarian principles. IPPF invests in emergency preparedness like pre-positioning medicines and supplies as well as provides direct funding within 48 hours to our local partners so that they can quickly respond to a crisis.
Recognise and prioritise SGBV response and prevention as life-saving humanitarian activities; refugee and internally displaced women are vulnerable to all forms of SGBV. Young girls who are out of school due to conflict and war are also at high risk, including the 624,000 adolescent girls between the ages of 10-19 currently in the Tigray region. Recent reports detail the gruesome violent attacks and rape of Ethiopian women and girls caught in the conflict. SGBV survivors face further distress as many of the targeted districts do not have access to emergency medical treatment, let alone necessary psychosocial support and referrals and access to other services and providers. Reports suggest that healthcare workers in the Tigray region do not prioritise SGBV as a real threat to women and girls, despite the rise in incidents particularly intimate partner violence. Working with our local teams, IPPF ensures that healthcare for SGBV survivors, including emergency medical care and urgent connections to non-healthcare services, is prioritised in our humanitarian programming.
An estimated 22 million Ethiopians will continue to require humanitarian assistance in 2022 as predicted in the Global Humanitarian Overview 2022. The continued need to empower local actors to meet the SRH needs of women and girls of reproductive age in this conflict continues, and we, as an international community, cannot forget about them.
Taft is humanitarian director, International Planned Parenthood Federation (IPPF).
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