UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)
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| UN Population Division, Department of Economic and Social Affairs, with support from the UN Population Fund (UNFPA) |
|
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This document is being made available by the Population Information
Network (POPIN) Gopher of the United Nations Population Division,
Department for Economic and Social Information and Policy Analysis, in
collaboration with the United Nations Population Fund Emergency Relief
Operations.
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Please note that the following contains the general proceedings
and conclusions. Those who wish to obtain copies of the chapter
specific sections and the annexes should contact the Symposium
Secretariat.
SUMMARY REPORT OF THE SECOND PREPARATORY MEETING
I. INTRODUCTION
The Second Preparatory Meeting of the Symposium on Reproductive
Health in Refugee Situation was held in Geneva on April 5 to 6 at WHO
Headquarters. The Meeting was attended by 61 participants from 22 different
organizations (see list attached in Annex 2).
The Second Preparatory Meeting is one of a series of events
(see below calendar of activities) designed to meet the objectives defined
during the first preparatory meeting held on 14-15 December 1994:
- to increase project development in reproductive health
- to improve quality of cost-effective services
- to facilitate cooperation and coordination between the potential partners
(funders and implementors)
- to develop refugee-specific tools that provide technical guidance to
implementing agencies
- to ensure that field experiences and realities are the essence of the
guidance manual to be prepared.
Dr. Tomris Turmen, Director of the WHO/FHE Division, welcomed the
participants on behalf of Dr. H. Nakajima, Director-General of WHO. Mrs
Yvette Stevens, Chief of the Programme and Technical Support Section of the
United Nations High Commissioner for Refugees (UNHCR) was designated as
the Chairperson of the meeting, Mr. Roushdie El-Heneidi, Director of the
European Liaison Office of the United Nations Population Fund (UNFPA)
was Co-Chair and Ms. Marilyn Rice, Health Education Specialist of the
Division of Family Health of WHO, Chief Rapporteur.
Minutes of the First Preparatory Meeting were sent previously to all 27
participants of that meeting (14 - 15 December 1994, UNFPA, Geneva) and
they were approved during this first general session.
Mrs. Stevens reviewed the objectives of the meeting, for each technical
topic of the Guidance Manual (which was later termed "Field Manual"):
defined the technical contents (what to do), the basic implementing
mechanisM. (when and how), and provided a range of costs (where
applicable). The target audience for the Field Manual is field staff, and
particularly health coordinators from agencies responsible for planning,
implementing, monitoring and evaluating programmes and activities in refugee
situations.
The manual should not replace existing ones or guidelines but should help
to agree upon reproductive health services to be implemented, at what
stage, develop plan of action, and facilitate coordination between and
among agencies. It was also expected that a calen-dar of subsequent
activities in preparation for the June Symposium would be developed during the
course of the meeting.
II. MEETING PROCEEDINGS
(see Agenda, Annex 1) were threefold:
- small groups discussions
- presentation in plenary sessions
- definition of a calendar of activities.
Small groups discussions.
Participants to the meeting separated in 8 groups to review the
background documentation prepared on each technical topic as identified
during the first preparatory meeting. The objectives of the discussions
were to: reach a consensus on the technical contents of each
topic-specific chapter, ensure that the chapter is practical and based on
realistic field situations and make recommendations on which parts of the
chapter should be selected to be integrated in the Field (guidance) Manual.
Summaries of the discussions of each small group are attached: Safe
Motherhood (Annex 6), Family Planning (Annex 7), STDs/HIV/AIDS (Annex 8),
Sexual and Gender Violence (Annex 9), Assessment, monitoring and
evaluation (Annex 10), Adolescents (Annex 11), Men (Annex 12) and
Abortion counselling and services (Annex 13).
Presentation in plenary sessions.
At the first preparatory meeting, three general topics had been
identified and were subject to presentation in plenary sessions.
Dr. Turmen summarized the WHO Framework for Action for Reproductive Health in
Refugee Situations (see Annex 3 for the list of reference documents on
this topic distributed to participants).
Ms. Stevens outlined the preliminary results of the UNHCR/UNFPA analysis
of past and current experiences in the delivery of reproductive health
and counselling services to refugees (see Annex 4 for the complete
reference of this background document). The analysis is based on the replies
received from UNHCR/UNFPA field offices to whom a questionnaire had been sent
and phone interviews realized for selected NGOs.
Ms. Corine Packer of UNHCR submitted the results of the working group on
Advocacy for reproductive health. She highlighted the need to better
define and advocate for reproductive health services in
refugee-situations. She also reviewed issues of international
humanitarian and human rights laws (a paper prepared by UNHCR Division of
the Protection, was distributed to participants). This paper supports the
rights of refugee and displaced women to reproductive health counselling
and clinical services. Advocacy in this area has to be conducted for
specific target groups, such as refugee women, adolescents, men,
traditional and religious leaders, health and social workers,
international and NGO staff as well as host authorities. The presentation
concluded with some recommendations on general advocacy, training staff
in the areas of refugee rights, and involving refugees themselves in
understanding and demanding for their rights. (see Annex 5 for the
complete reference of the background document).
The discussions highlighted concern about how realistic the conceptual
reproductive health framework is when applied to local refugee
situations. It was felt that even if circumstances made interventions
difficult, it was extremely important to ensure that the best possible
services are provided. There was discussion also on the needs of youth
and men and how to adapt services wherever possible to respond to them.
Another issue raised was violence, particularly sexual violence against
women. There is a need to work closely with local health care providers
to improve their skills in dealing with the prevention and consequences of
violent gender acts. Female genital mutilation (FGM) and other harmful
traditional practices are also a specific form of sexual violence against
women and should be prevented and treated, as well. Education of the
population responsible for these practices is essential for their
prevention. One of the challenges consists of appropriately informing and
educating the refugees, to identify the best way to channel the health
message on key reproductive health issues. It was suggested that
successful field examples on prevention of these practices be identified
in selected refugee camps. These examples could be presented during the
symposium, putting emphasis on their practicability, their constraints
and their health impact.
III. OVERRIDING ISSUES
The following overriding issues emerged from the discussions during
plenary sessions or small groups discussions:
Food, water, shelter, sanitation and targeted public health interventions
remain the key vital sectors to be addressed in refugee emergencies in
order to prevent significantly excess morality. However, reproductive
health activities should be part of the basic health package to be
delivered as soon as the situation stabilizes and permits it. In order to
timely and in a coordinated way strengthen and develop cost-effective
reproductive health, clinical and counselling services, the participants
proposed the nomination of a reproductive health coordinator as soon as the
preventive health measures can becomeimplemented.
The cultural, ethical, religious, traditional, linguistic and legal
context of the refugees within the context of the host country
populations should always be taken into consideration and respected when
defining and planning interventions. This should be part of the
assessment process. It is particularly important to obtain the agreement
and participation of the populations themselves, as well as in
approaching sensitive areas such as contraception.
Reproductive health activities should be implemented after the
identification and incorporation of key community leaders, groups and
individuals. Women's groups should be identified, reproductive health
activities initiated and continued in collaboration with them. Agencies
and organizations must take into consideration the perceived needs and
priorities of the refugee populations when designing and implementing
programmes and activities. Self- help, self-care and problem-solving
mechanisms should be reinforced and strengthened. Consideration should be
given when appropriate to the use of traditional healers.
Refugee contexts differ as do the reasons for fleeing and the composition
of populations concerned (women, men, children). The situation in refugee
camps may be constantly changing as well, depending upon the in and out
flux of population groups. Therefore, there is a need for continual
review and flexibility in planning services and interventions. Non-camp
situations may illustrate different circumstances. Integration of
services for refugees into the regular health services, where they exist,
should be considered. The presence of refugees may serve as a catalyst
for improving or rehabilitating existing health services. Guidance provided
should be general but practical, and in a format that can be adapted to
the context and to the changing conditions.
Different groups may have interrelated needs that can be addressed
simultaneously. For example, the issue of male violence and sexual abuse
can be addressed at the same time as that of security of women;
adolescent-specific services and the need for privacy and confidentiality
can be treated while informing and educating parents.
Training of international staff as well as local field staff, which will
remain working over the long term, will be needed. Training should not be
exclusively technical but focus on the provision of integrated
reproductive health, clinical and counselling services, taking into
account the cultural identity and sensibility of population to be served.
For the preparation of the Field Manual it was considered that
all 8 technical topics should be integrated into a set of recommendations
for the implementation of comprehensive Reproductive Health services.
Consequently duplications will be eliminated through a unified approach.
IV. CALENDAR OF ACTIVITIES
The meeting closed with a general discussion on the planning of
preparatory objectives for the June symposium in order to meet
the overall objectives of the process. The following has been
agreed upon:
24 April 1995 - Team Leaders (see list attached in Annex 14)
will prepare a topic- specific chapter based on the small
groups discussions of the 2nd preparatory meeting. A clean
copy should be addressed to Serge Mal‚ (UNHCR) as well as to
all members of the working group. It should be remembered
that the audience of the Field Manual is primarily field
health coordinators so the papers should focus on feasible,
practical action-oriented recommendations. Each paper should
be lead by the following structure: guiding principles,
special considerations linked to the topic, timely solutions
within the framework of migration phases, references and
appendices.
End May 1995 - Each Team Leader should submit to UNFPA/UNHCR
Secretariat of the symposium a final version of their paper
after integrating the comments of the working groups members.
10-11 May 1995 - UNHCR is organizing a meeting in Nairobi
with the participation of field staff (health and community
services) of various agencies to analyze the papers prepared
by Team Leaders and match their contents to field perceived
needs and realities.
May 1995 - Team Leader papers will be distributed among M‚de-
cins Sans FrontiŠres branches in order also to be analyzed.
May-June 1995 - Preparation of the draft Field (guidance)
Manual integrating the papers prepared by the Team Leaders.
This draft will be distributed beforehand to participants to
the June symposium.
May-June 1995 - Two consultative meetings will take place in
Geneva and New York to further prepare the June symposium and
review documentation (draft Field Manual in particular).
28-30 June 1995 - Symposium on Reproductive Health in refugee
situation to be held in the Palais des Nations, Salle XVI,
Geneva.
June-October 1995 - Finalization of the Field Manual.
1995-1996-1997 - Testing of the Field Manual: promotion of the
development of reproductive health activities in as many refugee
situations as possible; development of model reproductive health services.