Consultation on Reproductive Health
Technologies for Crisis Settings
13-14 May 2008
Seattle, Washington
Sandra Krause, Director
Reproductive Health Program
Women’s Commission for Refugee Women and Children
Who are Populations in Crisis?
Thirty-five million people live in the world
as refugees and internally displaced
persons, uprooted from their homes by
armed conflict, persecution and natural
A refugee has crossed an international
border; an internally displaced person has
fled her home but is still in her own
Origin of Major Refugee and Displaced
1. Sudan (including Darfur)....................6 million
2. Iraq...............................................3.8million
3. Colombia ................................3.2 million
4. Former Palestine....................3 million
5. Afghanistan......................2.3 million
6. Democratic Republic of Congo.......2.1 million
7. Uganda........................1.7 million
Rwanda Genocide 1994
Rwanda Genocide
Early Days of Crisis Situations
UNHCR: “Any situation in which the life or
well-being of refugees will be threatened
unless immediate and appropriate action is
taken and which demands and
extraordinary response and exceptional
WHO and Centers for Disease Control:
“Crude mortality is > 1 death per 10,000
people per day.”
Field Manual
Four technical areas of RH:
Safe Motherhood including
emergency obstetric care
Family Planning
Gender-based violence
Minimum Initial Service Package (MISP)
Basic, limited RH
for use in emergencies, without
site-specific needs assessment
services to be delivered to the
supplies and activities,
coordination and planning
Objectives of the MISP
Identify an organization or individual to facilitate
the coordination and implementation
Prevent and manage the consequences of
sexual violence
Reduce HIV transmission
Prevent excess neonatal and maternal
morbidity and mortality
Plan for comprehensive RH services
Reproductive Health Kits
1). Interagency Reproductive Health Kits
Provides the material resources to implement the
Designed for three months
Comprises 12 kits
Can be ordered from UNFPA
2). Interagency Emergency Health Kit
 Formerly the New Emergency Health Kit (NEHK)
 Includes: EC, PEP, materials for universal
precautions, midwifery kit
RH kits delivered
to the field
Clean delivery kit
Brief History and Evolution of RH in Crisis
Women’s Commission, Refugee Women and
Reproductive Health Care: Reassessing
Priorities (1994)
Sexual violence associated with genocide in
Rwanda and Bosnia Hercegovina
International Conference on Population and
Development (1994)
Reproductive Health for Refugees Consortium
Inter-Agency Working Group on Reproductive
Health in Refugee Situations (1995)
Overall Goal of MISP
To reduce mortality and
morbidity, particularly among
women and girls in the initial
phase of an emergency.
Terms of Reference for
RH Coordinator / Focal Point (1)
Be focal point for RH services and provide
technical assistance to refugees and agencies
Liaise with national and regional authorities
Liaise with other sectors to ensure a multisectoral approach to RH issues
Create/adapt and introduce standardized
strategies for RH – integrated with PHC
Terms of Reference for
RH Coordinator / Focal Point (2)
Initiate and coordinate information sharing
Introduce standardized protocols
Develop or adapt and introduce RH
monitoring forms
Report regularly to health coordination
Prevent and manage sexual violence
Systems to prevent violence are in place
 Women have their own registration cards
 Safe access to food (distributed to women),
fuel (firewood), water and latrines
 Women participate in the decisions that affect
 Code of Conduct against sexual abuse and
exploitation in place with reporting
mechanisms (protection officer)
Health services able to manage women
surviving sexual violence
The MISP only includes
sexual violence – not all forms of
gender-based violence
Reduce maternal and neonatal
morbidity and mortality
Referral system to manage obstetric
emergencies *follow up to ensure referral
facility is prepared for emergencies
Midwife delivery kits available for clean and
safe deliveries at the health facility
Clean delivery kits for mothers or birth
attendants for clean home deliveries
Planning for comprehensive RH
Data collection, including maternal, infant and
child mortality
Identification of sites for future RH service
Assessment of staff capacity and ordering
What the MISP is NOT
Reproductive health assessment
Ante and post-natal care
Family planning
Comprehensive RH services
All forms of gender-based violence
Training of staff (TBAs, CHWs, midwives)
Sensitization campaign for condom
The Emergency Response
Comprehensive RH diverts attention from
priority RH and other priority needs in an
SPHERE Guidelines
Integrated into 2000 version
Standard in 2004
MISP Assessments
Pakistan, 2003
Chad, 2004
Indonesia (tsunami) 2005
Uganda 2006
Jordan 2007
Research shows
humanitarian actors are
generally not familiar with
the MISP and it is not being
implemented at the onset
of an emergency.
Global Response
IAWG MISP Working Group
MISP Coordinator Job Description
Sample proposal
Integrate the MISP in complex emergency courses
Global Response
MISP Distance
Learning Module
Published in September
Available in multiple
Certificate of completion
– pass online post-test
Verifies 3.5 continuing
education credits for US
MISP Partnership
The MISP is a coordinated set of priority
activities for implementation in the early days
and weeks of a crisis.
The MISP reduces morbidity, mortality and
disability particularly among women and
newborns. It also sets the stage from
establishing more comprehensive RH
services as the situation stabilizes.
Although the MISP is a well established
standard of care it is not systematically
implemented in crisis situations.
What can you do to improve RH in
Humanitarian actors, donors, policy makers
and others could:
 get certified in the distance learning
module today
 submit and review proposals and budgets
to ensure the MISP is included in all health
sector proposals
 Fund the MISP
 Ensure there is a overall RH coordinator in
all new emergencies and an RH focal point
in every agency working in the health
Women’s Commission for
Refugee Women and Children

Presentation One