Purpose statements for panels and sessions
WHO Conference on the Health Aspects of the Tsunami Disaster in Asia
Panel 2.10: Reproductive, mental and child health
United Nations reports indicate that the impact of crisis situation, given natural disaster and/or conflict, result in a) the destruction of the social fiber and network of families and communities; b) the disruption of education and health systems; c) the decline in economic development leading to exacerbation of poverty; and d) exploitation of adolescents through forced labor, prostitution, slavery, and trafficking. However, according to the United Nations Population Fund (UNFPA), women and children are most vulnerable in such events. Recent estimates reveal that 75% of the affected populations due to conflict and/or natural disasters are women and children; where women and children constitute up to 80% of the world’s refugees and IDPs (The United Nations Refugee Agency). Ensuring the well being of women and children and addressing their health needs, including their reproductive health needs in such settings/environments is a challenge to aid agencies and national authorities. Twenty-five percent of women in crisis situations are of child bearing age, and possibly 1 in 5 is likely to be pregnant. The reproductive needs of these women are often left neglected or delayed in the acute phase of most emergencies.
The Tsunami in Asia clearly demonstrated that addressing maternal and child health needs was a priority. According to the Women’s’ Commission for Refugee Women and Children, approximately 11,350 pregnant women in Indonesia required immediate care to address complications of pregnancy and childbirth. WHO and UNFPA estimate that more than 7300 deliveries occur monthly in Banda Aceh province, of which 820 births take place in refugee camps. Under normal conditions, pregnancy-related complications are estimated to occur in 15% of all pregnancies; however, this figure could rise to 25% in this situation. The WHO January-situation report noted in Maldives, there were 1500 pregnant women scattered across the 200 islands who have been affected by the disaster. It was anticipated that within six months 1000 of these women will deliver in an environment were supplies and equipment are limited and health centers are damaged or destroyed. In addition, the mid February report indicted that drop out rates from family planning programs were high, youngsters were reported to be vulnerable, privacy is compromised due to cramped living conditions, and women were overworked and over burdened.
With respect to child health, a UNICEF rapid assessment conducted in Indonesia of some 600 children found that approximately 13% were acutely malnourished. The malnutrition was strongly associated with a high prevalence of diarrhea (42.6%), coughing (69.7%), fever (55.9%) and vomiting (34.6%). Acute malnutrition combined with these conditions increases the health risks.
Similarly, in Sri Lanka, the Medical Research Council in collaboration with UNICEF and WFP conducted a rapid nutrition survey. Preliminary results from clinic-based data (growth monitoring) illustrate underweight prevalence rates among children in all affected areas higher than the national average prior to the tsunami. Causes of malnutrition are linked to disease, as well as caring and feeding practices. Infants and young children in camps do not have access to appropriate complementary foods. There is concern about a potential rise in micronutrient deficiencies among the affected population, especially children and pregnant women (vitamin A deficiency, anemia).
International and national organizations have accumulated years of experience in providing basic relief services for women and children in disaster settings. The development of the MISP and other inter-agency guidelines and tools is an indication of political commitment/will among partners to work in a coordinated manner, bringing forth lessons learned and best practices from previous disaster settings.
Key issues to be addressed
Coordination/collaboration of all partners to prevent duplication of service and ensure that needs are met and fill gaps:
- Coordinating the work of UN agencies, NGOs, private sector, national authorities, and civil societies
- Application of standards and tools for assessments, monitoring and interventions to be adapted as needed
- Addressing linkages between relief and development (sustainability of efforts)
Provision of services:
- Training of health care providers (doctors, nurse, midwives, etc) to provide essential service to affected populations taking into account country context
- Promotion and use of the MISP in emergency situation to address: Maternal and child, reproductive health including family planning, HIV/AIDs, STIs
- Ensuring the availability of EOC with linkages to existing health services (ie. PHC or hospital)
- Availability of essential supplies and equipment (essential medicines, safe blood, FP contraceptives, diagnostic tools, etc.)
Awareness raising and advocacy:
- Collecting, analyzing, and reporting on vital information about affected populations (% of women, children, dominators, # pregnant, # new-born, etc)
- Application of best practices (ie. Health promotion campaigns to affected populations)
- Promotion of Reproductive health and MCH as a essential component of emergency relief efforts