The Women’s Refugee Commission works to ensure that women’s and girls’ vital needs are recognized and addressed from the very onset of a humanitarian emergency by promoting basic standards for sexual and reproductive health care. We are a member of the Interagency Working Group (IAWG) on Reproductive Health in Crises, which developed a set of priority practices for health care professionals called the Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations, designed to:
When implemented from the onset of a crisis, the MISP saves lives and prevents illness, especially among women and girls. The MISP outlines both the necessary equipment and the actions that trained staff should undertake during the early days of a crisis (see a “cheat sheet”). The MISP cuts across many sectors besides health—such as safety and security, water and sanitation.
Health professionals can access the MISP online and get certified in the distance learning module. Quick resources to help you implement the MISP are also available here.
Globally 15 percent of pregnancies will result in a life-threatening complication, and the risks for such complications are compounded in places that have been hit by conflict or disaster. It is essential that women and newborns receive the care they need, even in such settings. To prevent unnecessary maternal and newborn infections and deaths, skilled birth attendants should be present at all births and basic supplies—such as soap, plastic sheets, clean string and clean razor blades—must be available.
Gender-based violence (GBV) may be physical, sexual or psychological in nature, and can be affected by cultural or economic pressures. Across all cultures, GBV usually impacts women and girls (though not exclusively) and leads to significant disabilities and illnesses. GBV can increase dramatically during war and other conflict. Implementing the MISP can help to prevent sexual violence and provide assistance to survivors by ensuring protection, medical services and psychosocial support.
Often neglected, adolescents and young women are especially vulnerable to sexual violence in crisis settings. It is crucial that they are assured access to emergency contraception, postexposure prophylaxis (PEP), care for injuries and psychological care.
Sexually transmitted infections (STIs) can spread quickly where there is poverty, powerlessness and instability. The MISP helps prevent the transmission of HIV by providing guidance on standard precautions, such as making free condoms readily available and ensuring blood for transfusion is safe. Introducing these basic services from the start of a crisis can substantially reduce HIV transmission. When a patient presents with symptoms of an STI, treatment should be provided. The MISP also requires that those on antiretroviral treatment continue to receive this medication and that antiretrovirals be administered to prevent mother-to-child transmission of HIV.
At the onset of a humanitarian crisis, it is essential to make contraceptives—such as condoms, birth control pills and emergency contraceptive pills—available. During conflict, women may not have brought their routine contraceptives with them or be unable to access them at their site of refuge. Additionally, women and adolescents are more likely to be subjected to violence, including sexual assault and attacks. Many adolescents also take part in risky sexual behavior. Contraceptives must be accessible from the early stages of the crisis, and more comprehensive family planning programs need to be implemented once the situation stabilizes.
The Women’s Refugee Commission has advocated for improved implementation of the MISP. Read more about our work: