1. Reproductive Health in Emergencies 2 nd International Medical Conference An-Najah National University Faculty of Medicine Ali Nashat Shaar, MD. MSc.

2. Reproductive health in crises situation  Natural disasters  Man-made disasters

3. In crises situation  Impact on affected population –Casualties –Displacement –Loss of social integrity and protection –Loss of income

4. In crises situation  Impact on institutions Disrupted or affected social services Order of law Access to services

5. What has this to do with RH- the hidden victims  RH issues usually fall behind the scene in times of crises  Women in reproductive age constitute 22% of the population  15% of all pregnancies are accompanied with complications and might require surgical interventions  Low status of women increase their vulnerability Ability to move and access care Displacement and loss of protection Psychological impact Increase exposure to violence

6. Gaza Crisis December 2008

7. Context  Crises came on top of 9 years of prolonged crises and 2 years of complete closure  High number of casualties 1400/ injured 5000  Attention was given to direct victims of strikes (protection, transportation, care)  Hospitals and maternities in large hospitals were transformed into surgical departments to cope with high number of casualties  23 PHC clinics were directly affected by military attack and infrastructure was damaged  100.000 were displaced including around 50.000 hosted in 58 UNRWA shelters  Among those, it is expected that 22.000 women reproductive age lived in shelters  Some communities were completely isolated in claves

8. Findings Access to care Based on population size in Gaza and the fertility rate, 170 deliveries occur every day form which 30 could require C/S. In the time of crises:  Denied access to health facility - transportation - insecure travel - priority in transportation was given to injured  Delays of receiving assistance in health facility due to overload with injured

9. Findings Quality of care  31% increase in miscarriage cases admitted to maternities (data from Awda, shifa and Naser)  50% increase in neonatal death (data from Shifa hospital).  Early discharge after delivery (within 30 minutes)

10. Findings Quality of care  Increased prevalence of complications as reflected by increased C/S proportion to reach 29% in January compared with 15% average prior to crises  Qualitative data from communities inform about severe impact of the crisis on mothers and infants not being able to reach care.  25% Increase in premature deliveries  Reported in-ability of mothers to initiate and/or continue with breast feeding

11. Findings Psychological Impact - Reported cases of panic disorders attending maternities (27 from Jabalia neighborhood registered in the local health facility) - Qualitative information report that pregnancy is perceived as a fearful experience due to uncertainty of outcomes and safe access to care - Severe psychological stress affecting women, who acquired disabilities (women stating they better die than be disabled)

12. Immediate Response  Due to triggers prior to the crises, a level of preparedness was built (available medical items in the local Gaza market and immediate delivery)  Immediate mobilization of resources (human and material) at the HQ level  Coordination with operations room and provision of a consultant to support in collecting field data  Political Briefings and advocacy fact sheet publications at the highest level (UNFPA, UN)  Coordination within the cluster approach to respond to crises (health, psychosocial, logistics, ER)  Needs assessment of damage in PHC was made public on 23 rd January (used by MOP to guide response plan)  Comprehensive assessment of RH and psychosocial impact published on 7 th February and quoted in the ER conference in Sharm  Material support in a value of 1,2 million USD and continues….

13. Response- medium and long term Three continua of care need to be taken into consideration:  Women to child continuum: safe pregnancy, delivery and care for the mother and newborn  Community to hospital continuum: ensuring that basic capacity for care is available at all and each of the three levels (community, primary care and referral hospital).  Emergency to development continuum: preserving a high level of integrity of services during crisis, but also beyond

14. Response Programmatic areas of intervention:  Rehabilitation of damaged infrastructure to preserve the critical life- saving functions.  Supply equipment and medical supplies including essential drugs  Capacity building of staff along the continuum in areas pertaining to basic and comprehensive emergency obstetric care and neonatal care  Strengthen the referral system between different care levels  Establish or strengthen existing logistic monitoring system to assure availability at all levels of health facilities and at least 6-9 month stock of reproductive health commodities at central level.  Psychosocial: preserve and support coping capacity of individuals and households  Support community-based organizations staff to cope and provide needed support  Link with the WHO-MOH community mental health program to ensure smooth and reliable referral of cases in need for specialized care

17. THANK YOU