1. Introduction
During an emergency, health is one of the most important issues for the population’s survival. Health care is a basic right for all. This right includes equal access to health care to treat and prevent excess mortality and morbidity. During the first stages of an emergency, health and sexual and reproductive health services must be prioritised as part of a rapid multi-sectoral response. Health-related interventions determined to be priorities should be addressed in coordination with local authorities and other responding agencies, as well as in collaboration with the other priority sectors of water, food security and shelter.
Reproductive health (RH) is an essential component of basic health service provision in crisis and there are many aspects to good quality sexual and reproductive health in humanitarian crisis settings. As of 2015, of the more than 100 million people in need of humanitarian assistance, 26 million are women and adolescent girls of reproductive age (UNFPA, State of the World Population, 2015). Women and children make up about 80% of the world’s displaced population, (The Lancet, 2015). In conflict settings, three out of five of all maternal deaths occur and one out of five women will die from childbirth in their lifetime– much higher than the global average even within the developing world, (WHO, 2015). Sexual activities continue even in crisis settings. Additionally, rates of sexual assault and gender-based violence (GBV) are likely to increase in the forms of intimate partner violence, rape as a weapon of war, or facilitated by unsafe living conditions, (UNFPA, 2015). Further, women and girls are more vulnerable in emergencies and have specific health needs that must be addressed if we want to ensure equity in health service delivery. Therefore, during an emergency, reproductive health is one of the most important issues for the population’s survival and well-being and must be an integral component of primary health care provision.
The crude mortality rate (CMR) is the most specific and useful health indicator to monitor the health of a population. When the CMR doubles, it means an immediate response is required. Each region has a baseline reference for mortality and can be found in the Sphere handbook (Annex 26.5.1). When baseline rates are unknown, the CMR should be maintained below 1.0/10,000/day. Baseline references for children under five years of age (Under 5) are also region-specific. When regional data is unavailable, a rate below 2.0/10,000/day for U5s should be maintained.
In an emergency, the model for health infrastructure and system delivery should be based on the knowledge that 50% to 95% of mortality will be caused by the following communicable diseases: diarrhoeal diseases, acute respiratory infections, measles and malaria; with malnutrition as an underlying factor that aggravates illness.
