Louise Lee-Jones, Special to the Pulitzer Center
Louise Lee-Jones is in Georgia accompanying a mini-study tour from the European Parliament looking at the reproductive health needs of women and young people following the recent fighting and displacement. As well as meeting with officials, they will be visiting temporary camps in both Tbilisi and Gori. Lee-Jones is in Georgia to provide technical input and to ensure that the message about the needs of women and young people is communicated.
Irene smiles shyly as she waits to be seen in the small tent that is the reproductive health clinic in Gori Tent City. She is 21 years old and is nine months pregnant with her first baby. Her baby is due in the next few weeks and she wants to have it in the hospital when the time comes. Fortunately, the hospital in Gori wasn't destroyed unlike many others in the areas to the north of the city.
Irene fled her home with her husband and his family when the fighting between the Russian and Georgian forces came too close for comfort. Fearing for their lives, they fled first to her husband's sister's house and then to a camp for displaced people. The camp is near their home in Gori and they've been living there for the last month. "We are all staying together in one tent, with other people" says Irene. "There are eight of us in one tent. It is ok, but noisy and there's no privacy," she adds.
I've come to Georgia as part of a fact finding delegation from the European Parliamentary Forum on Population and Development to assess the reproductive health needs of the displaced people in the region. ...
Most of the delegation is made up of MPs and MEPs but I am representing Marie Stopes International (MSI).
So why was MSI included? MSI, together with Columbia University, coordinates a multi agency, multi country programme which brings together 10 leading service delivery and advocacy organisations to scale up comprehensive reproductive health services in crisis settings. The programme, known as the Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative, helps refugees, internally displaced people (IDPs) and returnees in crisis areas such as Colombia, Northern Uganda, and Darfur in Sudan.
The reproductive health needs of displaced people are often neglected, even once the immediate priorities have been addressed. Yet failure to address these needs at the outset of an emergency stores up problems for women and the broader population.
In Georgia, an estimated 192,000 people fled their homes following the fighting in South Ossetia and to the south, in and around the city of Gori. Of these 30,000 are women of reproductive age, of whom approximately 1,400 are pregnant. The majority of people fled first to Tbilisi where they were housed in temporary shelters, known as collective centres. The collective centres are mostly schools and kindergartens that were out of use during the school holiday, but these are now needed as the new school term has started. Approximately half of the displaced have now returned home, to the city of Gori itself and to the villages south of the city, but for those that remain displaced more uncertainty lies ahead.
Some of those, like Irene and her family, have moved to the tent city which has been set up in Gori, at the edge of the "buffer zone". More than 2,200 people are living there now but that still leaves many thousands displaced.
In the tent city some people are alone but families have fled together and at night in there are empty beds in many of the tents as husbands and wives are sleeping together as they would if they were at home. Yet many will not be using contraception, as remembering to pick up your pills or condoms is not high on most peoples list of things to bring when you are fleeing your home in the middle of the night. Given that, it's essential that reproductive health services are available in the camps to prevent unwanted pregnancies, which can lead to unsafe abortion. Although abortion is legal on demand up to 13 weeks in Georgia, health services in Gori have been largely disrupted and prevention is always the best option.
The Minimum Initial Service Package (MISP) is a coordinated set of priority activities to be implemented at the outset of an emergency, designed to save lives and prevent illness especially among women and girls, in emergency settings. With a focus on prevention, the activities need to be implemented from the outset of humanitarian response, as food distribution, water and sanitation and health services are being established. Ensuring that pregnant women like Irene receive the energy and nutrition needed for healthy pregnancy and breast feeding is essential.
The United Nations Population Fund (UNFPA) is providing reproductive health services through its mobile team in the tent city, including contraceptive pills, condoms, antenatal care and general reproductive health consultations. The small tent that acts as the health centre has only limited supplies and the two doctors are busy seeing women wanting contraceptive supplies and other services. For cases such as ectopic pregnancies (when the embryo starts to grown in the fallopian tube which can cause it to rupture and haemorrhage), they used the UNFPA vehicle to take women to the hospital in Gori for emergency surgery. When they time comes, they will help Irene get to the hospital in the town to deliver her baby.
As well as providing services in the clinic, the UNFPA are distributing dignity kits to men, women and young people. The women's kits include basic supplies of multivitamins, soap, towels, toothbrush-paste, underwear, sanitary towels, toilet paper and toothpaste. While the kits for men include the same apart from razors instead of sanitary towels. Youth volunteers in Tbilisi are busy putting the items together into plastic bags for distribution to the 500 centres for displaced people.
Back in the tent city in Gori, I talk to Natasha, a 27 year old mother of three young children who has just received a dignity kit. She and her husband and children have spent the last month in a school near Tbilisi airport which was being used to house displaced people. Conditions were basic, with little in the way of sanitation and it was noisy and crowded. When the authorities told them they must leave as the school was needed for its proper function, they decided to return home. However, when they got to Gori, they heard that there were still many soldiers in the village. "I was happy when I heard our village was not so badly damaged by the bombs" said Natasha. "But then I heard that the soldiers are still in the village. They get drunk and then no one knows what they will do. I have heard of many cases of women being raped. I am too scared to go home. My husband goes to the village every day, but he comes back to sleep here in the camp at night. He says it is not safe in the village. It is best for me and the children to stay here."
An essential part of the MISP is the prevention and management of the consequences of gender based violence, particularly rape. It is not uncommon for the risk of rape to be as real in camp settings as in the villages women have left. In an attempt to maintain community and family structure food distribution is often organised with the assistance of community leaders and heads of households who are often men. This can leave women in a position of having to negotiate for food, resulting in coercive and transactional sex. As well as the psychological distress this causes, women are put at risk of unwanted pregnancy and sexually transmitted infections (STIs). The UNFPA have appealed for funds to be able to provide emergency contraception and drug supplies for the prevention of STIs and HIV for women who have been raped.
Before I leave the camp to move on to a newly opened youth centre, Irene and her mother in law, also called Irene, tell me how excited they are about the new baby. "I already have one grandchild" says Irene senior. But this one will be special." Both smile broadly as they think of the new bundle of life that will soon be part of their family and the hope of a better future ahead. As for me, I return to London and will keep in touch with parliamentarians on the tour to encourage them to raise these issues with their governments to ensure that the needs of women in Georgia and other emergency settings are not forgotten.
All photos credited to MSI/RAISE/Louise Lee-Jones