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UNHCR support for comprehensive primary health care programs in refugee camps now often includes reproductive health services, as in the Caucasus, Ethiopia, Nepal, Rwanda, Sudan, Uganda, and West Africa (53). UNHCR and the International Federation of Red Cross and Red Crescent Societies have provided reproductive health materials and supplies as well as technical assistance to nongovernmental organizations working in Rwanda, Tanzania, Uganda, and the former Zaire.

The United Nations Fund for Population Activities (UNFPA) is not, by definition, a relief agency. Since 1995, however, UNFPA policy has been to assist in providing support for reproductive health services in emergency situations, providing equipment, supplies, and drugs (302). In 1997 UNFPA is supporting reproductive health programs for refugees in more than 40 countries, including Ethiopia, Kenya, Tanzania, Uganda, and Zambia, as well as camps in the Caucasus and Palestine (302).

During the refugee crisis in the Great Lakes region of East Africa that began in 1996, UNFPA supported the International Federation of Red Cross and Red Crescent Societies with a US$500,000 emergency grant, providing refugees with contraception, delivery kits, and condoms to help protect against HIV (119, 134). This project was the first time that reproductive health services have been included at the beginning of a refugee emergency (301).

UNFPA gives high priority to the needs of adolescents (54). Among refugees living in camps, schooling is rarely available above the primary level; adolescents have little to do, and frequent sexual activity is one result (222). Often separated from their parents and other family members (54), refugee and internally displaced adolescents are particularly powerless and thus subject to abuse (287). UNFPA is developing a program in central Africa to address reproductive and other health needs of adolescents returning from refugee situations (302).

The International Rescue Committee (IRC) provides reproductive health services to refugees in nine countries (12). In 1992 IRC started two pilot projects to deal with the needs of Liberian refugee women in Côte d'Ivoire and Ghana (117, 118). IRC provides family planning education, contraceptive supplies, and transportation so that women can reach providers who insert IUDs or give injections (119).

The International Planned Parenthood Federation (IPPF) and its affiliates are involved in many refugee projects. For example, the Arab World Regional Office (AWRO) of IPPF, with UNFPA support, is providing clinic and community-based reproductive health services around the port city of Bosaso in northeast Somalia. Most of the original 120,000 residents had fled to other parts of the country during the long civil war, but recently they returned (54). Also, the Ivorian Association for Family Well-Being (AIBEF), an IPPF affiliate, has launched a project to improve access to reproductive health services among Liberian refugees who have settled in the west and southwest parts of Côte d'Ivoire (38, 260). IPPF's Rokhana Kor project in Peshawar, Pakistan, has provided reproductive health services to Afghan refugees since 1989. Other refugee areas in which IPPF provides services include Bosnia and Herzegovina, Guinea, Palestine, Sierra Leone, and Tanzania (54).

CARE has provided reproductive health services to refugees living in camps in Rwanda, within a maternal and child health program designed for internally displaced persons. This is the only reported instance of extending services initially intended for internally displaced persons to serve refugees as well (335).