CONTENTS
November, 1996 |
Refugees and internally displaced persons typically have left their homes suddenly and arrive in camps often with virtually no money, provisions, or possessions. The result is an emergency situation, formally defined as "any situation in which the life or well-being of refugees will be threatened unless immediate and appropriate action is taken, and which demands an extraordinary response and exceptional measures" (292). In an emergency, providing food, shelter, clothing, safety, and sanitation are first priorities for relief agencies. Only when these needs are met do they address other issues such as STDs, contraception, and other reproductive health needs (253). The United Nations states that priorities in an emergency situation are shelter, protection against abuse and violence, safe drinking water and food, and basic health services. Basic health services are now understood to include reproductive health care (302). To date, however, only a few emergency responses have done so (125, 202, 235). The development of the Minimum Initial Service Package (MISP) for the emergency phase of a refugee situation was an important outcome of the Inter-Agency Symposium on Reproductive Health in Refugee Situations, held in 1995 (see sidebar, International Relief Agencies). Originally developed and used by Marie Stopes International, the MISP focuses on reproductive health care that saves lives and thus establishes common ground between traditional emergency care and reproductive health care (278). The Reproductive Health for Refugees Consortium is working to have MISP provided as part of the emergency phase of all relief efforts (189). The MISP contains a mix of essential information, services, and commodities for reproductive health care, including delivery kits for use by refugee women themselves, midwife kits from the United Nations Children's Fund (UNICEF), condoms, and guidelines on enforcement of universal blood precautions to prevent the spread of HIV/AIDS and other blood-borne diseases and on prevention of sexual violence and management of its consequences, such as offering emergency oral contraception (a regimen of combined oral contraceptives taken after unprotected sexual intercourse). The MISP also calls for a reproductive health coordinator in each refugee camp (119, 129, 242, 280, 299). To make the MISP effective, refugee relief workers require training, because many know little about reproductive health care (222). |