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Pulitzer Center Update December 1, 2014

"Dignity Kits" and Integrated Efforts: How To Protect Women in Times of Crisis

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A woman stands in the flooded 'protection of civilians' (POC) site on the U.N. base in Malakal, South Sudan. Thousands continue to live partially submerged in contaminated water. From the Pulitzer Center-supported project 'When Militiamen Rule.' Image by Ty McCormick. South Sudan, 2014.

Sarah Chynoweth, an independent consultant for sexual and reproductive health in emergencies, pinpointed what she considered one of the great mistakes of humanitarian aid.

"Get away from the idea that if we build it, they'll come," she said. "That's just not true for reproductive health."

Chynoweth was referring to pop-up health facilities following Haiti's earthquake, one of several emergency responses examples specialists examined during a Wilson Center panel on November 20 to identify reoccurring failures in preventing gender-based violence during crises. The Wilson Center event, titled "Addressing Maternal Health and Gender-Based Violence in Times of Crisis" included representatives from the Wilson Center's Maternal Health Initiative, International Medical Corps, Partners in Health, PSI, Track Impunity Always, JSI, and UNFPA.

According to Chynoweth, aid should be gender-sensitive and reproductive health should be prioritized. All camps should have been designed with latrines segregated by sex and equipped with locks. In cases of gender-based violence, post-exposure prophylaxis and psychosocial care services should have been readily available to survivors. And women who needed contraception should have been given easy access.

"If the condoms are tucked away in drawer at the clinic, and you need to ask permission to have one, they aren't accessible," Chynoweth said.

Many of Chynoweth's comments echoed the Pulitzer Center's 2010 reporting on "Haiti After the Quake".

Panelists agreed that some past failures have led to at least one key lesson learned: overcoming women's health barriers during crises calls for coordination among clusters. Examples of recent improvements included at Syrian refugee camps, where organizations like UNFPA have replaced excess soap and toothpaste donations with equally essential items like flip flops, whistles, and underwear. They now refer to the packages as 'dignity kits.'

"We want these women to feel and be safe walking around," said UNFPA's Chief of Humanitarian Branch Ugochi Daniels. "They did not leave their rooms without underwear. Now, they can move around."

Such simple coordination among disaster responders increases efficiency and, in turn, impact. But during crises with enduring antagonists—like the Ebola virus—coordination is not enough to protect females. Women are the chief caretakers, for both the living and the dead, so it is unsurprising that they make up 70% of all Ebola patients.

Partners in Health (PIH) Chief Clinical Officer of Ebola Response John Welch, who recently returned from West Africa, cited NPR's recent article on maternal health and Ebola in his remarks. He called the mortality rate for pregnant women and fetuses who contract Ebola "abysmal".

And, for Ebola-free pregnant women, signs of labor complications like pre-eclampsia are almost identical to those of Ebola, so fearful health workers place them in Ebola treatment centers, where their complications go untreated, and they usually contract the virus.

Welch argues that solving these health system issues requires not just responding to the epidemic, but enhancing the health system infrastructure to prevent women's deaths. The panel participants all agreed that the current Ebola outbreak is the epitome of a call for integrating emergency response and restoration.

"Restoration efforts cannot wait until after the crisis," Welch said. "What will be left of the health system infrastructure is the invisible crisis."

Resources from the panel can be found through the Wilson Center here.

Learn more about the Pulitzer Center's reporting projects on women, children, and crisis.