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“No Control, No Choice” Lack of Access to Reproductive Healthcare in Sudan’s Rebel-Held Southern Kordofan

Sudan
Reproductive Health Lead Agency
NA
Skye Wheeler
wheeles@hrw.org

“No Control, No Choice” Lack of Access to Reproductive Healthcare in Sudan’s Rebel-Held Southern Kordofan

The report by Human Rights Watch, “No Control, No Choice: Lack of Access to Reproductive Healthcare in Rebel-Held Southern Kordofan,” documents how women and girls cannot get contraception and have little access to health care if they face complications during pregnancy and childbirth. The parties to the six-year-long conflict, the Sudanese government and the rebel Sudan People’s Liberation Army-North (SPLA/M-North), have both obstructed impartial humanitarian aid.

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Armed groups in Ukraine

Ukraine
Reproductive Health Lead Agency
UNFPA
Bohdan Pidverbetskyy
pidverbetskyy@unfpa.org

Armed groups in Ukraine

Fighting between the government’s forces in Eastern Ukraine and armed groups has been ongoing since 2014. The turmoil has forced many to flee their homes, with over 1.35 million registered internally displaced persons.40 Women are disproportionately affected by a severe reduction in health services. Pregnant and lactating women continue to face compromised access to reproductive health and referral services, antenatal and post-natal care, and safe birthing options. This exposes pregnant women to a high risk of pregnancy-related morbidity and mortality. In 2013, the reported maternal mortality ratio was 23 deaths per 100,000 live births. In 2012, 68.0% of married/in-union women of reproductive age had their need for family planning satisfied with modern contraceptive methods. In 2012,  87.2% of women aged 15-49 who experienced a live birth received antenatal care four or more times.41 These numbers are expected to decline as a result of the conflict and displacement. NGOs working with women living in highly militarized areas are especially concerned as these women are exposed to sexual violence, transactional sex, and unhealthy and unsafe sexual practices.42

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Internal conflict in Nigeria

Nigeria
Reproductive Health Lead Agency
UNFPA
Ratidazi Ndhlovu
ndhlovu@unfpa.org

Internal conflict in Nigeria

As a result of the continuous violence in Northeast Nigeria, 192,000 people have fled to Chad, Cameroon, and Niger. Although the Nigerian government is working to address the crisis, the conflict with Boko Haram continues. Nigeria is the most populous country in Africa and 92% of the population lives on less than two dollars a day. In Northeastern Nigeria, an estimated 24.5 million people live under continuous attack by Boko Haram. As of June 2015, over 1.2 million people were displaced within the country; 13% of internally displaced persons live in government run camps, official or unofficial camps, or transit centers, as they cannot return to their host communities.38 These dynamics impede access to reproductive health services. In 2013, the total fertility rate was 6.0 children per woman and the maternal mortality ratio was 560 deaths per 100,000 live births.39

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Earthquake in Ecuador

Ecuador
Reproductive Health Lead Agency
Dr. Gina Tambini
tambini@paho.org

Earthquake in Ecuador

On April 16, 2016 a 7.8 magnitude earthquake hit Northern Ecuador. This earthquake was followed by six aftershocks of 6.0 or more. Major infrastructural damaged resulted; an estimated 1,808 buildings were destroyed and 1,856 buildings were severely affected which forced many people to flee their homes. It is estimated that 750,000 individuals have been affected by the earthquake, including 650 deaths, 4,605 injuries, and 33,366 relocated to shelters. In May 2016 government groups and organizations met to analyze the humanitarian response needed, including the response to gender-based violence. UNFPA coordinators set up workstations within Ministry of Health facilities in the city Portoviejo on sexual and reproductive health and GBV. In addition, SRH kits are currently being distributed in Manabí and Esmeraldas.31

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Internal conflict in the Democratic Republic of the Congo (DRC)

Democratic Republic of Congo
(Formerly Zaire)
Reproductive Health Lead Agency
OMS
Rosine Sama Kanembe , Valentin Mukinda
samak@who.int , mukindav@who.int

Internal conflict in the Democratic Republic of the Congo (DRC)

Decades of ongoing conflict has greatly damaged most of the country’s infrastructure leading to 7.5 million people in need of humanitarian assistance and protection. In addition, disease outbreaks in the Great Lakes Region has resulted in 250,000 displaced people moving into DRC. Up to 80% of internally displaced persons/and or refugees have limited access to health care.29 In 2013, the maternal mortality ratio was 1,000 deaths per 100,000 live births and the total fertility rate 5.9 children per woman.30

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Humanitarian crisis in the Central African Republic

Central African Republic

Humanitarian crisis in the Central African Republic

With a history of coup d’états and extended civil conflict since gaining independence in 1960, the Central African Republic (CAR) continues to face turmoil, with periods of relative stability disrupted by  considerable violence.25 September and October of 2015 were marked by extreme violence between Bangui, Dekoa, Bambari, and Kaga Bandoro which led to several deaths and many injuries and displaced tens of thousands of people.26 Extreme poverty, continuing violence, and a weak government has led to 2.7 million individuals in need of assistance, 451,985 internally displaced people, and 456,514 refugees who have left the country. Depleted infrastructure and inadequate funding makes supplying basic services and meeting needs challenging. In 2013, the total fertility rate 4.4 children per woman and the maternal mortality ratio was 882 deaths per 100,000 live births.28 In such environments women are extremely vulnerable; in October 2015 alone 12,366 cases of rape that were reported.27

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Humanitarian crisis in Cameroon

Republic of Cameroon
Reproductive Health Lead Agency
Adventist Development and Relief Agency
Adra Ntone Dikongue Isaac Armand
ntonediko@adra.cm

Humanitarian crisis in Cameroon

Cameroon has faced three crises which have left 2.7 million people in need of assistance. From 2015-2016 the number of people needing assistance to meet basic health needs increased by 20% to 1.1 million. Violence in Nigeria and in the far North of Cameroon has led to the displacement of thousands of people and an estimated 2.5 million have fled their homes as a result of armed groups.20 New refugees from Nigeria and the Central African Republic are living in settings characterized as having a high risk of epidemics.21 Numerous centers have closed down due to conflicts, placing pressure on other clinics to meet burgeoning demand. Children and women are most affected by the lack of health care services.22 In 2013, the maternal mortality ratio was 590 deaths per 100,000 live births.23 Approximately 40% of married/in-union women of reproductive age had their need for family planning satisfied with modern contraceptive methods.24

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Cholera in Iraq

Iraq
Reproductive Health Lead Agency
UNFPA
Saidkasim Sakhipov
sakhipov@unfpa.org

Cholera in Iraq

Cholera is currently endemic in Iraq. The outbreak, which was declared in September 2015, has resulted in 4,945 confirmed cases in 17 of the 18 governorates across the country.3 The United Nations reports that approximately 3.3 million Iraqi people are displaced and would benefit from direct access to health care services. As of March 2016, the WHO has provided Iraq with 27 mobile medical clinics and 30 ambulances and health personnel are being trained to ensure governorates across Iraq are receiving care.4 For women specifically, weak health infrastructure makes supplying adequate health services an ongoing concern and access to delivery rooms in the Al-Habanyia tourist city and Al-Khaldia district in Ramadi City are limited. In January 2016, in an attempt to increase access to services, the Al-Anbar Department of Health, the WHO, and the UNFPA established two delivery rooms in these two areas. These facilities are also providing 5,150 internally displaced families in the Al-Habanyia tourist city and 12,000 families in the Al-Khaldia district with reproductive health services.5 However, women and children have been disproportionately affected by the crises in Iraq and their compromised access to reproductive health services, referrals, safe birthing options, and post-natal care remains of great concern.6

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Armed conflict, violence, disease and climatic shocks in South Sudan

Sudan
Reproductive Health Lead Agency
UNFPA
James Wanyama
wanyama@unfpa.org

Armed conflict, violence, disease and climatic shocks in South Sudan

South Sudan has been affected by complex emergencies resulting from prolonged conflict, climate change, a broken health system, and outbreaks of communicable diseases. Toward the end of 2015, South Sudan’s people faced multiple threats, including armed conflict that began in 2013, inter-community violence, disease, and climatic shocks. More than 2.3 million people have fled their homes since 2013 and there are now 1.66 million internally displaced people, 50% of whom are estimated to be children. When tens of thousands of people fleeing the conflict sought refuge in United Nations’ bases positioned around the country, these sites were quickly overwhelmed, with families crammed together with little or no access to safe water or sanitation.

More than 686,200 children under the age of five are estimated to be acutely malnourished; 231,300 of these children are classified as severely malnourished. On a population level, by September 2015 there were 3.9 million people classified as severely food insecure, with an estimated 30,000 people facing “catastrophic food insecurity.”

In terms of disease, malaria is the biggest recorded killer; there were more than 1,100 deaths reported in health facilities between January and October 2015. Throughout the country, communicable diseases are a concern due to poor sanitation, lack of access to safe water, and crowded living conditions. There has been a notable upsurge in the scale and frequency of outbreaks of epidemic-prone diseases, especially in displacement sites; malnutrition and weakened immunity makes young children and pregnant women particularly vulnerable.11 Sexual and gender-based violence are pervasive in South Sudan.

An estimated 4.42 million people are in need of emergency health care and approximately 304,000 refugees are expected to need health assistance in 2016. 11 Displacement has caused a severe shortage of medical professionals; there are only 12 trained midwives, one anesthetist, and one obstetrician/gynecologist per 200,000 people in South Sudan; there are no pediatricians in the country.11 As of September 2015, some 55% of the health facilities in Unity State, Upper Nile State, and Jonglei were no longer functioning since the majority of health facilities in these areas had been attacked and looted. In Unity State, there is only one county hospital for more than a million people. Essential medicine shortages are likely to exacerbate this already critical situation.11 

Between late December 2015 and early May 2016, the National Health Regulation Focal Point (NFP) of South Sudan notified the WHO of an outbreak of hemorrhagic fever syndrome. As of May 9, 2016, a total of 51 suspected cases of hemorrhagic fever syndrome were reported from the counties of Aweil North and Aweil West; 74.5% of the suspected cases involves those under the age of 20.  Between August and November 2015, Darfur, Sudan reported at least 469 cases of undiagnosed viral hemorrhagic fever, including 120 deaths. Because of frequent cross-border movement between Sudan and South Sudan, the risk of international spread of the disease must be considered.12

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Internal displacement in the Syrian Arab Republic

Syrian Arab Republic
Reproductive Health Lead Agency
International Rescue Committee WoS Health Sector/ Cluster Coordinator
Will Cragin
Will.cragin@resue.org

Internal displacement in the Syrian Arab Republic

More than 1.2 million Syrian people have been internally displaced over the course of 2015; the ongoing and massive population displacement has made humanitarian planning for health interventions increasingly difficult13. After five years of conflict, over a quarter of a million Syrians have been killed. Over half the population has been forced from their homes and 4.6 million people are displaced in regions beyond the reach of aid. An additional 4.8 million people have fled the country seeking refuge.13 Malnutrition rates have increased, especially among children under five years of age. Almost two thirds of the Syrian population has no access to safe water, drastically increasing the risk of waterborne diseases.

According to Physicians for Human Rights, there were 112 attacks on medical facilities in 2015, which represents a 25% increase since 2012. Since the conflict began, almost 700 medical personnel have been killed in 336 separate attacks. In Aleppo, more than two-thirds of hospitals are no longer functioning and roughly 95% of doctors have either fled or been detained or killed. The current ratio of doctors to residents in Aleppo is eight times less than the ratio before the crisis began.13

A recent WHO update from March 2016 declared that the attacks on medical centers have continued. The recent attack on Al Quds Hospital in Aleppo resulted in the death of two doctors, including one of the only remaining pediatricians in the city, three paramedics, and numerous patients, among them children.14

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Internal displacement in Yemen

Yemen
Reproductive Health Lead Agency
WHO
Alfred Dube , Kamal Ollery , & Syed Haider Ali
aldreddube@msn.com , ollerik@who.int , alisyedh@who.int

Internal displacement in Yemen

As a result of the ongoing conflict within Yemen, approximately 21.2 million Yemenis are in need of some form of humanitarian assistance, including 14.4 million people unable to meet their food needs, 19.4 million who lack clean water and sanitation, 14.1 million without adequate health care, and at least 2.7 million who have fled within Yemen or to neighboring countries. As of late January 2016, health facilities had reported more than 35,000 deaths linked to the conflict; many are thought to be civilians.15

From January to November 2015, there were 747 cases of children being killed and 1,120 reports of injuries. Furthermore, there are approximately two million acutely malnourished children and pregnant or lactating women in need of treatment, and an additional one million children requiring preventive services.15

As of November 2015, almost 600 health facilities had closed due to damage, shortages of critical supplies, or lack of health workers. This figure includes nearly 220 facilities providing treatment for acute malnutrition, a condition currently afflicts about 320,000 children.15

Girls and women are particularly disadvantaged by a lack of female health service providers, especially those who live in rural areas or are pregnant.15 In March 2016, the UNFPA estimated that 3.4 million women and girls of reproductive age require aid.16 More than 520, 000 pregnant women lack access to reproductive health services.15

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