The Need for Sexual and Reproductive Health in an Emergency Context
When I arrived, the insurgency was still trying to push back, launching attacks and using suicide bombers; the Nigerian army fought back. We could hear and feel bombs and shells going off every now and then. It is not something you get accustomed to: You just say your prayers and hope it is the soldiers warding off the insurgents.
I arrived in Borno state in December 2016 as a consultant epidemiologist with Médecins Sans Frontières/Doctors Without Borders (MSF) to set up a nutritional surveillance system among internally displaced persons (IDPs). During the period I spent there, the Nigerian military had regained some control of the town. There was a sense of victory in the air: The town felt safer, rebuilding was beginning, the people were finding safe passage and returning home —yet there was still a looming sense of insecurity. Although people had returned home, many were still displaced from their homes and living in the IDP camps.
Borno state was the area most affected by the Boko Haram insurgency, which began in 2009 and whose terrorist activity has been confined to the northeastern part of Nigeria. The insurgency has led to massive numbers of displaced individuals, food scarcity, destruction of health care facilities, lack of access, insecurity, and death. Currently, about 1.8 million people are living in host communities in Northeastern Nigeria. Conditions have improved as the Nigerian army has taken over most cities and driven out the insurgents, helicopter services have provided access to NGO personnel and cargo, and temporary clinics have been set up by various NGOs, providing primary health care services, nutrition programs, and midwifery services. However, sexual and reproductive health services are still largely inadequate.
Once again it is past curfew, but we have received a communication through the radio channel: Someone is in labor, and the midwife is needed in the clinic. The project director must decide whether to break security protocol and send a driver and a midwife out to help.
This was often the case, and there were more than a dozen births in the makeshift MSF clinics while I was there. We also heard the harrowing experiences of women who had their babies in the mountains as they were hiding from Boko Haram, and those who lost pregnancies and young children while fleeing the insurgents.
When working in complex emergency situations, health care concerns such as family planning, contraception, and reproductive health issues tend to be pushed to the back burner and may not be considered at all. IDPs are susceptible to sexual violence and exploitation, and there is a strong relationship between conflict and STI increase, including HIV; these conditions are made worse by the lack of access to reproductive health services. In 2004, the World Health Organization recommended that both mental health and reproductive health be essential components of emergency programs. Implementing reproductive health services in such circumstances continues to be an issue. In Borno, we had a shortage of medical staff, no obstetricians (cesarean sections were not an option), and contraception and family planning services were basically non-existent.
The chaos and instability in the region continues to pose challenges to accessing reproductive health care services. To provide urgent and comprehensive reproductive health care services to IDPs, we need increased collaborative effort between NGOs, other international organizations, and the government. There is also a need for more field staff with expertise in reproductive and sexual health areas, and for feasible strategies to start and keep such programs in place.
The sexual and reproductive health challenge in the IDP and migrant camps in Northeast Nigeria represents a pressing health crisis. However, it also represents a unique opportunity for action and for sustainable investments in health systems including health care staff, resources, and supplies. Protecting reproductive health and promoting reproductive rights is socially and culturally expedient, politically beneficial, and economically feasible. For health leaders, inaction in Northeast Nigeria is no longer an option.
Visit K4Health’s Reproductive Health in Humanitarian Settings Toolkit to access state-of-the-art guidance and tools for providing vital sexual and reproductive health services in conflict and other emergency settings.