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PHOTO: IPPF/Isabel Corthier

In the Northern Ethiopian regions of Tigray, Amhara and Afar, an estimated 5.2 million people are in dire need of humanitarian assistance, and an estimated 3.5 million people from these regions have been displaced after more than a year of conflict, which began in November 2020. Among them are an estimated 118,000 pregnant women and 1.3 million women of reproductive age, with those figures set to grow with the ongoing crisis.

The dynamics of the conflict in northern Ethiopia remain complex and fluid, but one thing remains clear: at the heart of this crisis are millions of people in need, particularly women and girls.

Since July 2020, a government-imposed blockade of the Tigray region has prevented life-saving humanitarian aid from reaching the affected population. In addition to a food shortage that is pushing parts of the region into famine, non-governmental organisations (NGOs) and civil society organisation (CSOs) are struggling to provide life-saving sexual and reproductive health (SRH) services to internally displaced and refugee women that have fled the violence into neighbouring regions and countries.

The International Planned Parenthood Federation’s local partner, the Family Guidance Association of Ethiopia (FGAE), has faced a critical shortage of SRH commodities and medical supplies due to the blockade. The fragile security situation has made it extremely difficult to deliver even the most basic of services. Between October and December 2021, FGAE was able to reach 450 internally displaced persons with SRH services and sexual and gender-based violence support, but many more women are still without access to other essential services such as counselling, contraception, safe abortion care, sexually transmitted infections (STIs) including HIV, gynaecology and prenatal care.

Since the onset of the conflict, over 27,000 refugees have fled to neighbouring Djibouti while approximately 60,000 have arrived in Sudan. IPPF’s local partners, the Sudan Family Planning Association (SFPA) and the Association Djiboutienne pour l’Equilibre et la Promotion de la Famille (ADEPF) are on the ground in the Um Rakuba, Hamdayet and Tinidba refugee camps to deliver SRH services via mobile clinics. ADEPF is providing reproductive health awareness sessions and delivering the Minimal Initial Service Package (MISP) to provide crucial, lifesaving SRH services to refugee women and girls in need. Equally, the SFPA and its various national and international partners are providing basic SRH care for refugees and the host community population. But Sudan and Djibouti already have fragile health systems driven by years of economic and political instability. These systems have been stretched by the ongoing COVID-19 pandemic, further challenging their ability to cope with the arrival of high numbers of Ethiopian refugees.

Women and young girls are particularly vulnerable in conflict and displacement settings. According to the United Nations Population Fund (UNFPA), over 500 women in humanitarian and fragile settings around the world are estimated to die during pregnancy or childbirth every day. In the Tigray, Amhara and Afar regions of northern Ethiopia, many health centres have been damaged, destroyed or vandalized during the ongoing fighting, and they face a critical shortage of basic supplies and medicine. Eight FGAE clinics were damaged, and six vehicles looted resulting in a loss of $500k.This means that pregnant women are not able to deliver their babies in a safe and well-equipped facility, and access to contraceptive services and treatment for STIs are severely hindered. Many survivors of sexual and gender-based violence will not receive counselling or support services, which can lead to a rise in unwanted pregnancies and risks from unsafe abortion. Against this backdrop, it is clear that SRH funding and care must be scaled urgently.

Following the meeting of the High Level Global Compact on Refugees in December 2021, IPPF called for the prioritization and expansion of SRH services in humanitarian settings, with particular attention to the most vulnerable and marginalized communities, including displaced persons and refugees. UNFPA estimated that in 2019, out of nearly 132 million people in need of humanitarian aid and protection worldwide, 35 million women, girls and young people required sexual reproductive health and rights (SRHR) services and interventions to prevent SGBV and respond to the needs of survivors. These figures show that women’s health must be prioritised and further integrated into global humanitarian response programming.

Progress has been made already, with many state and federal humanitarian response strategies integrating SRH and recognising it as a crucial health service. But there is still a significant gap in funding. Often, IPPF’s local partners are amongst the few humanitarian actors providing SRH care to women and girls in global emergencies. SRH is a core humanitarian need, and in order to provide the most impactful services, humanitarian actors must fully understand and further integrate SRH and SGBV needs and services at every stage of planning, response and recovery, to ensure no one is left behind.

In responding to the sexual and reproductive health needs of women and girls affected by the conflict in Northern Ethiopia, international actors including governments, donors and international organizations can support in three key ways:

Provide safe abortion care in humanitarian settings: women living in humanitarian settings often have limited access to safe abortion and post abortion care. Abortion is still a taboo in many African countries and unsafe abortion is a major cause of maternal death globally. The laws and policies governing abortion vary across Ethiopia, Djibouti and Sudan. When access to safe abortion care is restricted, women often resort to dangerous procedures that may result in severe bleeding, infection, disability and death. IPPF and its local Member Associations are committed to promoting access to safe abortion care in humanitarian settings as part of their life-saving work for women and girls.
Champion local actors to lead the humanitarian response: Enhancing local and national capacity is essential for the effective delivery of SRH services. IPPF is a locally owned, globally connected civil society movement that supports local actors to lead the response on sexual and reproductive rights within their respective contexts. Localization facilitates smooth service delivery, and IPPF Member Associations that are deeply rooted in local communities often benefit from greater acceptance and access within conflict-affected communities. IPPF invests in the emergency preparedness of its local partners, by pre-positioning medicines and supplies as well as providing them with timely and direct funding so that they can quickly respond to a crisis.
Recognising and prioritising SGBV response and prevention as life-saving humanitarian activities: Refugee and internally displaced women are vulnerable to SGBV. Young girls who are out of school due to conflict are particularly at risk of such violence, including the 624,000 adolescent girls between the ages of 10-19 currently in the Tigray region. A recent UN report detailed the gruesome violent attacks and rape of Ethiopian women and girls caught in the conflict. SGBV survivors face further distress as many of the conflict-affected districts do not provide access to emergency medical treatment, let alone necessary psychosocial support and referrals and access to other services and providers. Another UN report suggests that healthcare workers in the Tigray region do not prioritise SGBV as a real threat to women and girls, despite the rise in incidents, particularly intimate partner violence. Through its local presence, IPPF ensures that services for SGBV survivors, including emergency medical care and urgent referrals to socio-legal actors, is prioritised in its humanitarian programming.

According to the Global Humanitarian Overview 2022, an estimated 22 million Ethiopians will continue to require humanitarian assistance this year. The need to empower local actors to meet the SRH needs of women and girls of reproductive age in this conflict is more acute than ever, and we as global citizens, governmental actors, local and international actors, must do our utmost to hear and respond to their urgent needs.

Julie Taft is the Humanitarian Director at the International Planned Parenthood Federation (IPPF).

The cost of the housing effort reported this week by the Defense Department inspector general is a snapshot of Operation Allies Welcome, the mission of eight stateside bases to host 67,000 Afghan refugees airlifted out of Kabul at the end of August when the U.S. military ended all operations in Afghanistan after a 20-year war.

The U.S. embrace of Afghans was emotional, painful and uneven as service members and civilians grappled with the war's legacy, and many worried allies would be left behind to face Taliban retribution. But the financial cost is also set to soar into the billions of dollars, sparking political opposition on Capitol Hill.

Congress has already approved $13.3 billion for the resettlement effort, which includes money for the Pentagon as well as the State Department and Department of Homeland Security. But it repeatedly had to overcome Republican opposition.

The first half of the money was included in a stopgap budget measure in September to keep the government funded after challenges by Republicans who wanted to put restrictions on the refugee spending. The second installment of $7 billion was passed Dec. 3 in another stopgap bill.

"Now Democrats want another $7 billion for the Afghan resettlement process on top of the $6 billion they have already spent in the last three months. For reference, Oklahoma's total budget is $8.83 billion -- for a state of 4 million people," Sen. James Lankford, R-Okla., said in a statement when the funding legislation was passed in December.

Quantico had been reimbursed $138 million of its $188 million cost by the Defense Department by the time the last bill passed Congress and was signed by President Joe Biden, according to the DoD inspector general report.

Seven additional bases provided housing for the refugees following the Aug. 30 withdrawal from Afghanistan: Fort Lee and Fort Pickett, Virginia; Fort McCoy, Wisconsin; Fort Bliss, Texas; Joint Base McGuire-Dix-Lakehurst, New Jersey; Holloman Air Force Base, New Mexico; and Camp Atterbury, Indiana.

Afghans are still staying at five of those bases, Maj. Meg Harper, media chief for U.S. Northern Command, wrote in an email Friday.

The DoD inspector general is planning to audit the department's entire housing effort, and the report this week is the first installment in a series.

The task force set up at Quantico included 924 DoD personnel, who had planned for a maximum of 5,000 refugees to move through the base on their way to permanent resettlement in communities across the U.S., according to the IG, which sent personnel to the base in September and followed up in December.

Afghans were moved into housing at Camp Upshur, an old officer candidate school used in the 1980s. The task force contracted for a second encampment of two massive tents, one capable of housing 2,000 refugees and the other, 1,000.

The "third encampment, named Pioneer City, consisted of 80 Marine Corps general purpose tents and was capable of housing 1,000 Afghan evacuees," the report found.

All the housing had electricity and internet services provided by a donated substation. The refugees who stayed there had four dining facilities that served three hot meals each day. Base civil affairs personnel and non-governmental organizations hosted Afghan-led classes on English, American culture, hygiene and women's health.

There were movie nights, dance nights, and soccer and volleyball tournaments.

The task force had three ambulances standing by and two landing zones for medical airlifts. Every day for the first month, it had to transport Afghans off base to civilian hospitals for medical emergencies, including pregnancies and a child's concussion.

About 150 Marines from 1st Battalion, 10th Marine Regiment, provided security to the Afghan refugee village at Quantico.

"Quantico had one major criminal security incident and it involved an Afghan evacuee committing what appeared to be an unlawful act with a child," the IG reported.

Security personnel quickly decided the incident violated U.S. law and turned the refugee over to the FBI.

-- Travis Tritten can be reached at travis.tritten@military.com. Follow him on Twitter @Travis_Tritten.