Humanitarian Crisis: Impact Across the Lifecycle
What is a humanitarian crisis?
A humanitarian crisis results from events such as natural disasters, epidemics, armed conflicts or famine and often involves population displacement. These events can culminate in a critical threat to the well-being of a population, and usually compromise health, safety and security. Humanitarian assistance is urgently required when in-country infrastructure is disrupted and the coping capacity of the affected community overwhelmed 1. There are currently 70.8 million forcibly displaced people worldwide, half of which are children under the age of 18 2.
What is the impact on women and girls throughout the lifecycle?
Women and children suffer disproportionately in a disaster and they are 14 times more likely to die than men 4. Over 60% of all preventable maternal deaths, more than half of the world’s under-five deaths, and 45% of neonatal deaths occur in countries affected by humanitarian crises 5.
Every day, an estimated 500 women and girls die in humanitarian settings from complications due to pregnancy and childbirth, or unsafe abortions 6.
Countries facing instability and conflict have the highest rates of neonatal mortality and stillbirths 7.
Emergencies erode normally protective social supports and increase the risk for sexual and gender-based violence 8.
Food insecurity leading to hunger and malnutrition are common in emergency settings. Severe acute malnutrition (comprising wasting and oedematous malnutrition) has a particularly high case fatality, but other forms of malnutrition also occur and include micronutrient deficiencies (e.g. iodine, iron and vitamin A). As we have learnt in previous weeks, nutrition is important for optimal health and development across the lifecycle 8.
Humanitarian contexts produced by conflict are increasingly protracted and the average length of displacement for refugees is now 17 years 10.
Insecurity, displacement, poverty, trauma and the collapse of social structures and systems can exacerbate underlying mental health conditions and trigger new psycho-social challenges 10.
What can we do?
The Sphere Handbook and Humanitarian Charter provide an internationally recognised set of common principles and universal minimum standards for humanitarian response. Now in its 20th year, the Handbook has been extensively field-tested and includes core service delivery principles for child health, sexual and reproductive health, and nutrition.
The Minimum Initial Service Package (MISP) for Reproductive Health (RH) is a coordinated set of priority activities for initial humanitarian response designed to: prevent and manage the consequences of sexual violence; prevent excess maternal and newborn morbidity and mortality; reduce HIV transmission; and plan for comprehensive RH services beginning in the early days and weeks of an emergency 1.. The MISP is essential to reducing death, disability, and illness, particularly among women and girls, and has been agreed via the Inter-Agency Working Group on Reproductive Health in Crisis (IAWG), a consortium of non-governmental organisations, donors, governments and the United Nations agencies.
The Newborn Health in Humanitarian Settings Field Guide provides information and tools to reduce neonatal mortality and morbidity in humanitarian crisis situations. This Guide focuses on implementation of lifesaving newborn health services and provides guidance to programme managers and health staff to initiate, design, manage, and monitor health services in humanitarian settings.
→ Service Provision and Utilisation
Progress has been made in terms of guidance materials and in drawing attention to the needs of women, children and adolescents, however service availability and utilization remains persistently challenging with many gaps 11, 12.
→ Preventable newborn deaths and stillbirths
Deaths in the first month of life account for 46% of all mortality amongst children under 5 in every region of the world 13 and are largely preventable. To help address this huge loss of life, and bring more strategic focus to the 2,6 million stillborn babies every year, the Newborn Health in Humanitarian Settings Field Guide has been developed in compliment to the MISP 14.
Improving newborn survival during humanitarian crisis requires a life course perspective, with a greater focus on newborns as part of the continuum of care. In service of this agenda, the Roadmap to Accelerate Progress for Every Newborn in Humanitarian Settings 2020-2025 was agreed by more than 80 multi-sectorial partners and outlines key next steps to address this critical gap.
→ Early childhood development and caregiver support in humanitarian response
Children represent 51% of the refugee population. In 2015, 1 in 8 births worldwide occur in conflict zones 15. The first years of life are critical to set the foundation for long term health, behaviour and learning. Currently, there is no comprehensive response to the need of young children or their caregivers in humanitarian emergencies. A targeted focus and investment in programming that promotes stimulation, early education, positive caregiver-child interaction, and mental health and psychosocial support, is urgently needed to ensure children thrive during and after crises 16.
To achieve Sustainable Development Goals and Universal Health Coverage, programmatic data are essential 17. However, most deaths still occur in settings with the least data on coverage and quality of care 18. In humanitarian settings, there are often many different actors operating both within and outside existing or pre-existing health management information systems culminating in data gaps, duplication and/or a failure to collect comparable information.
To address this gap, all actors should report data into an internationally agreed overarching humanitarian coordination platform, where all stakeholders can access data for public health action. In collaboration with global consortia such as Countdown to 2030, ongoing work is needed to strengthen national data systems to ensure that robust and usable data are collected and reported to monitor trends, assess quality of delivered interventions, and evaluate impact and accountability 19.
Know your resources: The Sphere Handbook, The Minimum Initial Service Package (MISP), the Newborn Health in Humanitarian Settings Field Guide, Adolescent Girls in Disaster & Conflict, Procurement & Kits (find further resources in the ‘See also’ section & reference list).
Data: Strengthen the availability of data to monitor and evaluate equitable coverage of essential interventions, in addition to reliable mechanisms for tracking mortality and morbidity across the lifecycle, including stillbirths.
Investment: Many humanitarian contexts are not resolved quickly and the evolution from humanitarian crisis to development context is not linear. Providing investment and support to existing health systems, referral pathways, infrastructure, health management information systems and human resources are essential, even from the start of a crisis.
Research: Explore innovative approaches and improve the scientific evidence to inform all aspects of service delivery in various humanitarian crisis settings with reference to key reviews of the current evidence base 20, 21.
Despite progress in the delivery of essential maternal and child health and nutrition services in humanitarian settings, many research and programmatic gaps remain for sexual and reproductive health, newborn health, stillbirths, and adolescent health. The recent draft global action on “Promoting the health of refugees and migrants” endorsed at the World health Assembly in May 2019 proposes a five-year plan to achieve universal health coverage and the highest attainable standard of health for refugees, migrants and host populations 22. This includes delivering safe, quality and affordable health care to women, children and adolescents, whose health and safety are disproportionately affected by humanitarian crises. The humanitarian community including donors, practitioners, researchers, and policymakers alike must prioritise the delivery, documentation, and evaluation of essential services for women, children, and adolescents in crisis settings to achieve progress toward global benchmarks including the Sustainable Development Goals.
© London School of Hygiene & Tropical Medicine 2019