~ An Overwhelming Need ~
Primo Madra with UNFPA in Ukraine
Sexual and Reproductive Health Coordinator
The war in Ukraine has had a serious impact on people’s ability to access health care. According to WHO’s surveillance data on attacks on health services, the Russian invasion of Ukraine in February 2022 led to partial or total destruction of hundreds of health facilities by missile attacks. Heavy shelling has also caused massive population displacements from the eastern, north-eastern, and south-eastern parts of the country towards relatively more secure areas in the western parts of the country. Millions even had to cross the border to seek refuge in neighboring countries.
The influx of the Internally Displaced Persons (IDPs) overwhelmed health facilities in the receiving host areas within Ukraine. Health workers were overworked, and they had to work under very stressful conditions in the midst of continuous missile attacks. Many health workers have also fled from the war. Supplies ran short before the next resupply as the normal health supplies systems were disrupted.
According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), in 2022, over 14 million people needed assistance to access health care. This included 9.4 million women of reproductive age of whom over 250,000 were pregnant and some 80,000 delivered every quarter. Skilled care during pregnancy and at childbirth are of utmost importance and must be maintained even during war times to prevent escalation of maternal and newborn deaths and ill health. Women who needed continued supply of contraceptives to avoid unintended pregnancy particularly during the period of crisis must also be provided for. Women and girls’ rights must therefore remain at the center of humanitarian response and their rights to give birth safely and to live in peace cannot be put on hold in times of war.
International partners as well as local NGOs came in to support the government to ensure continued access to health care for the affected populations. It is crucial that partners have coordinated action to avoid duplication of efforts and ensure that their combined interventions were complementary and synergistic. It is also important to ensure that the most vulnerable populations are identified and assisted. Yet the pre-crisis coordination mechanism during normal times led by government has been somewhat compromised in the wake of the crisis. The humanitarian cluster coordination system was therefore activated to support government to ensure a coordinated response.
I was deployed by CANADEM as a Sexual Reproductive Health Coordinator with United Nations Population Fund (UNFPA). One of my roles was to lead the Sexual Reproductive Maternal and Child Health (SRMCH) Technical Working Group under the Health Cluster to support coordination of sexual reproductive Health services and ensure that the people affected by the crisis had access to lifesaving reproductive health services.
Our actions were guided by the humanitarian standard for sexual reproductive health, that is, the Minimum Initial Service Package for reproductive health, which is a package of sexual reproductive health interventions that have been proven to be most effective in preventing escalation of deaths and ill health due to sexual reproductive health conditions in crisis settings.
The SRMCH coordination forum brought together more than 50 agencies with expertise in provision of sexual reproductive maternal and child health care services. The platform enabled Ukrainian government and health care workers to closely engage with their international counter partners who have had experience in delivering sexual reproductive health interventions in crisis settings elsewhere to come out with contextualized solutions that kept services going even after the disruption of health system caused by the crisis.
“At the height of the crisis we were overwhelmed with heavy influx of IDPs although activities have now somewhat stabilized and become more planned, thanks to the help of international partners who have shared successful practices and strategies appropriate to these conditions and provided sorely needed supplies”, said a director of a health facility in Vinnytsia Oblast during a coordination meeting.
“… the delivery strategy and delivery practices were changed, bomb shelters were adapted for delivery, as well as the practice of working with women in women’s consultations and family practice doctors were changed, she added.
The distribution of the Inter-Agency Reproductive Health Kits (IARH Kits) that are needed for implementation of the reproductive health package in crisis settings was also discussed in these meetings. The IARH kits that are packaged and stockpiled by UNFPA where designed ready for rapid deployment at the onset of a crisis anywhere in the world. UNFPA delivered and distributed reproductive health kits to cover the needs of over 5 million women and by end of October 2022, more than 10,000 women were served with various reproductive health services through UNFPA supported mobile teams.
The kits provided by UNFPA proved very useful in this setting as testified by a health facility director in Vinnytsia: “The Inter-Agency Reproductive Health Kits provided by UNFPA were very useful indeed. For example, the sterilizers contained in these kits that did not need electricity were particularly useful following power outages which have become common due to the missile strikes. The sterilizers we had in the hospital all needed electricity”.
The coordination mechanism that was setup in Ukraine therefore helped to bring together humanitarian partners to closely engage with the local health authorities to ensure that the most affected populations were reached so that no one was left behind in terms of sexual reproductive health care. The support helped to ensured that women and girls’ rights remained at the center of the humanitarian response in Ukraine so that their rights to give birth safely and to live in peace were not neglected during this war.
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