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 Emergency Relief
Operations and the UNHCR.
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RESUME OF THE INTER-AGENCY SYMPOSIUM ON REPRODUCTIVE HEALTH
IN REFUGEE SITUATIONS, Geneva 28-30 June 1995
The Inter-Agency Symposium has a long background history. A first
proposal was written in November 1993. But this project did not
receive support. At that time, UNHCR and UNFPA were still hesitant.
It was too early.
After the ICPD Conference, the proposal was updated. It was
immediately approved, with two conditions: (a) co-organisation
with UNHCR, (b) sharing expenses, each associated agency financing
its own expenses.
The objectives of the Inter-Agency Symposium were quite clear. They
consisted of defining minimum reproductive health activities to be
implemented in refugee situations and the necessary tools to
facilitate their implementation, and coordination of activities
among agencies.
It should be noted that reproductive health as such is not a new
science but the tricky issue consisted of adapting it to refugee
situations.
The Symposium was the "confrontation" between personnel specialised
in emergencies, and reproductive health technicians. Attendance at
the different events was as follows:
Date Agencies Participants
First Preparatory Meeting 14-15 Dec. 1994 13 27
Second Preparatory Meeting 5-6 Apr. 1995 22 61
Field Meeting in Nairobi 10-11 May 1995 15 32
Symposium 20-30 Jun. 1995 50 135
The First Preparatory Meeting consisted of defining the main themes
to be debated, with identification of working groups with team
leaders and resource persons. Each group wrote a paper on the theme
it was responsible for. Nine themes were identified to begin with:
- Safe motherhood
- Family planning
- STD/HIV/AIDS
- Sexual and gender violence
- Abortion
- Advocacy for refugee women, reproductive health activities -
Conceptual framework for refugee reproductive health activities -
Lessons learned
- Assessment and evaluation.
In a second phase, two more themes were added:
- Men
- Adolescents
At the Second Preparatory Meeting in April 1995, each working group
presented its paper and debate took place on the issues presented,
and on the organization of the Symposium.
It should be noted that during the meeting a first draft of a
practical manual was assembled from the papers written and from the
discussions.
It is worth noting that the experience from the field was extremely
limited. Some reproductive health activities were habitually taking
place with various degrees of quality of care, depending on human
and financial resources.
The question of abortion linked with sexual violence was
broadly debated. The dilemma is whether abortion should be
performed or not after rape when it is not legal in the host
country. The interfaces between cultural and religious contexts of
the refugees and the ones of the host countries have to be taken
into consideration. Reproductive health interventions should always
be extended to surrounding local host populations when needed. It
was made clear also that women's point of view and participation
should receive high priority in setting up services. The holistic
concept of reproductive health activities was considered essential.
- The Nairobi meeting in May 1995 put us back on the right
track. The first and second preparatory meetings gathered mostly
reproductive health professionals. The Nairobi meeting, conversely,
was filled by emergency professionals. The discussions and
conclusions are summarised as follows:
A Field Manual on Reproductive Health is badly needed. It
should take into account the needs and demands of the population,
put emphasis on the participation of the country, respect national
policies, insist on coordination of activities, be sure of the
feasibility of the project. Propositions were made on the
reorganisation of the Manual. Finally, details were given on
content. This exercise was extremely useful in terms of
practicability of proposed activities.
Following this exercise, a draft version of the Manual was
written and made available to all participants of the Symposium.
The Symposium itself from 28-30 June 1995 was a real success with
the presence of the Executive Director of UNFPA of the High
Commissioner for Refugees, in terms of attendance and the number
of agencies present, quality of presentations and debate, and
outputs. The extremely precise conclusions and recommendations will
facilitate not only implementation of reproductive health
activities, but also their coordination.
The main outputs were:
- For the first time, the subject of reproductive health in
refugee situations was debated openly between UN agencies and NGOs.
There was discussion between reproductive health professionals and
emergency specialists.
- The type of reproductive health services to be implemented has
been defined.
- The concept of a minimum central service package has been
proposed in order to provide services at the outset of all refugee
situations.
- Community participation has to be reinforced, insisting on its
establishment not only within the refugee population, but also
within the surrounding local population.
- Coordination is considered an essential factor for success. To
this effect, the nomination of a reproductive health coordinator
is recommended.
- A global, comprehensive and culturally-sensitive project
should be an essential component of the basic health package, as
soon as possible.
- Quality of care has to be reinforced, with special emphasis on
two points - adequate skills and cultural sensitivity of providers.
To follow up the Symposium, an Inter-agency working group is to be
established under the coordination of UNHCR. This group should
facilitate reproductive health issues in refugee situations. It
will also develop and finalise practical tools such as the field
manual, and work closely with ad hoc consultative bodies.
In conclusion, the Symposium was a good start, a useful and
valorizing exercise. It has allowed open debate between agencies on
the subject of reproductive health and developed concrete ways to
implement reproductive health in difficult situations. It has
established the willingness of UNFPA to become a vital partner in
this field and has linked closely policy and activities of UNFPA
and UNHCR.
The objective should be reached before the year 2000: all refugees
and internally displaced persons should receive the same
reproductive health services as non-conflict populations. This
objective is attainable if all humanitarian agencies include
reproductive health on their agendas as part of routine health
activities.
D. Pierotti
UNFPA Geneva
31 July 1995