Wishful thinking versus operational commitment: is the international guidance on priority sexual and reproductive health interventions in humanitarian settings becoming unrealistic?

Catrin Schulte-Hillen,Nguyen Toan Tran

doi:10.1186/s13031-018-0157-x

Abstract

Twenty-one years ago, a global consortium of like-minded institutions designed the landmark Minimum Initial Service Package (MISP) for sexual and reproductive health (SRH) to guide national and international humanitarian first responders in preventing morbidity and mortality at the onset of chaos, destruction, and high insecurity caused by disasters or conflicts. Since then, the MISP has undergone limited change and has become an international reference in humanitarian response. This article discusses our perspectives regarding the 2018 changes to the MISP that have created division among humanitarian field practitioners, academics, advocates, and development agencies. With more than 50 pages, the new MISP chapter dilutes key guidance and messages on the most life-saving activities, leaving actors with excessive room for interpretation as to which priority activities need to be first implemented. Consequently, non-life-saving interventions may take precedence over essential ones. Insecurity, scarce human and financial resources, logistics constrains, and other limitations imposed by field reality at the onset of a crisis must be considered. We strongly recommend that an institution with the mandate, legitimacy, and technical expertise in the review of guidelines reexamines the 2018 edition of the MISP. We urge experienced first-line responders, national actors, and relevant agencies to join efforts to ensure that the MISP remains focused on a very limited set of essential activities and supplies that are pragmatic, field-oriented, and, most importantly, immediately life-saving for people in need.

Highlights

In the face of the massive scale of sexual violence during the Rwandan genocide and its aftermath, and following the 1994 International Conference on Population and Development (ICPD) in Cairo, which enshrined access to sexual and reproductive health (SRH) for refugees and internally displaced populations, the Inter-Agency Symposium on Reproductive Health in Refugee Situations gathered UN agencies, NGOs, donors, and academic institutions in Geneva in 1995
The responsibility of altering the Minimum Initial Service Package (MISP) should be collaborative but not dependent on a democratic voting process among Inter-Agency Working Group (IAWG) members that creates a bias towards the opinion of advocacy, rights-based, academic or other institutions that have no experience or first-line responsibilities in the acute phase of a humanitarian response: in the end, they are not the agencies setting up services nor is their staff living with the day-to-day trade-offs between limited resources, protecting rights, and deciding what can be done amidst chaos, insecurity, and political uncertainty
The success of the IAWG is largely due to its openness and inclusiveness towards a large and growing range of institutions working on SRH

Summary

Introduction

In the face of the massive scale of sexual violence during the Rwandan genocide and its aftermath, and following the 1994 International Conference on Population and Development (ICPD) in Cairo, which enshrined access to sexual and reproductive health (SRH) for refugees and internally displaced populations, the Inter-Agency Symposium on Reproductive Health in Refugee Situations gathered UN agencies, NGOs, donors, and academic institutions in Geneva in 1995. The responsibility of altering the MISP should be collaborative but not dependent on a democratic voting process among IAWG members that creates a bias towards the opinion of advocacy, rights-based, academic or other institutions that have no experience or first-line responsibilities in the acute phase of a humanitarian response: in the end, they are not the agencies setting up services nor is their staff living with the day-to-day trade-offs between limited resources, protecting rights, and deciding what can be done amidst chaos, insecurity, and political uncertainty.

Results

Conclusion