This blog is co-authored by Charlotte Gallagher and Lewis Emmerton. Charlotte is the Programme Officer at Refugee Rights Europe, working on the organisation’s human rights advocacy at the international, European and national level. Lewis is Advocacy Officer at CHOICE.
Amongst the rights violations experienced by refugees and displaced people across Europe, barriers in accessing sexual and reproductive health information and services have often been overlooked by policy makers, international agencies and camp management. This is a concrete shortcoming within the European refugee response which can and must be rectified throughout camps and transit points in Europe, as the continued neglect of these issues can have detrimental effects on individuals’ health and well-being.
Across Europe, refugees and displaced people often face a number of barriers in accessing sexual and reproductive healthcare as a result of legislation restricting access to services based on immigration status. Meanwhile, camps and transit points remain under-resourced and over-crowded, where camp management and service providers often lack capacity and resources to provide adequate sexual and reproductive healthcare services and information, including culturally appropriate sexual health information, discrete access to contraception, vital maternal care and psycho-social support for victims of gender-based violence. Difficulties in accessing sexual and reproductive healthcare services are further compounded by the acute lack of available and appropriate translators at healthcare facilities.
Research by Refugee Rights Europe has found that, while such shortcomings in the refugee response affect all demographic groups, women and girls tend to be disproportionately affected. Gender-based violence is rife across camps and transit points in Europe, exacerbated by inadequate camp design and lack of safeguarding structures. In Greece, Refugee Rights Europe has found an alarming absence of the Minimum Initial Service Package (MISP), a set of services and practices which ought to be in place in all crisis situations, resulting in many women and girls having no access at all to quality sexual and reproductive healthcare services.
Examples of missing components of the MISP across many camps and transit points include the absence of adequate access to healthcare during pregnancy. In Greece, 33.9% of general survey respondents (both men and women) said they did not know where a woman could seek medical care if pregnant, while of female respondents, 24.3% did not know where they could seek this care. This absence of information and services can lead to childbirth without even the most basic items for clean, safe delivery, which puts pregnant women and girls at greater risk of complications. There is moreover a widespread lack of access to condoms and contraceptives for both pregnancy planning purposes as well as the prevention of sexually transmitted infections (STIs). Furthermore, research found alarming shortcomings in the prevention and management of the consequences of sexual violence.
In this context, it is highly problematic that information and education relating to sexual and reproductive health and rights appeared to be inadequate across research locations. Where essential sexual reproductive information and health services do exist, women and girls often face other barriers to independently and safely access them. For instance, only 12% of women interviewed privately in Refugee Rights Europe’s research study in mainland Greece knew where they could access contraceptives – one of the key components of the MISP guidelines. Some camps only made contraception in the form of condoms available to men, while some women had had their requests for contraceptive pills or the coil declined by health service providers in the camp. One woman stated: “there is no contraception in the camp except condoms, they gave us condoms.” Women, therefore, lack the means to have control over their own reproductive health.
In response to sexual violence, most components required by the MISP guidelines were lacking in the camps in mainland Greece during Refugee Rights Europe’s research. In some camps, emergency contraception was accessible in instances of rape – but, notably, not in cases of marital rape. A health service provider said: “A husband forcing himself upon his wife when she doesn’t want to have sex, this is not categorised as rape… we only give out emergency contraception when it is reported rape, outside the marriage and [when] the police are involved.” This report is particularly worrying as many women may not feel able to report rape to the police. Fear of police is founded on previous negative experiences with police authorities which often involved intimidation, arbitrary detention and physical abuse. Over 40% of women stated that they had been detained at some point on their journey. One woman reported, “I was detained for 20 days and I was emotionally abused. We were not treated as humans. We were shouted at and abused by the prison guards and the police.” Therefore, it is imperative for health services to offer post-assault care regardless of the perpetrator’s relationship with the victim and irrespective of police reporting.
Overall, there is an urgent need for effective policy action to ensure that the European Union and countries hosting displaced populations are successfully implementing the MISP and strengthening reception procedures whilst also taking into account the specific needs of women and girls. MISP guidelines must be implemented in a coordinated manner by appropriately trained staff, ensuring that service providers, camp staff and volunteers have the resources and support to respond to the reproductive health needs of displaced people. Preventing gender-based violence must also be a central aim of Europe’s approach to displacement; ensuring anonymous and effective avenues for women and girls to seek safety and redress needs to be prioritised as a matter of urgency, in order to realise their fundamental rights.
As such, strong commitment is required at all levels, from policy-makers to service providers, to ensure that sexual and reproductive health interventions are strengthened so that the basic reproductive rights of displaced persons are protected and upheld, and that services are appropriate and sufficiently resourced across Europe.
- Those responsible for camp management across Europe must ensure that a dedicated and sufficiently resourced organisation is identified to lead the implementation of the MISP;
- Camp management must take all possible measures to prevent and manage the consequences of by providing women and girl friendly spaces and ensuring robust safeguarding systems are in place across camps;
- Camp management, alongside service providers on-site, must put in place referral mechanisms aligning psychological, legal and judicial response services as well as support and care services in languages and formats accessible to the refugee population;
- Camp management, alongside service providers on-site, must ensure that women have discreet access to pregnancy tests as well as the provision for a wide-range of contraception empowering women and girls to be in charge of their reproductive rights;
- Health care service providers in camps and transit points must meaningfully engage camp residents in the design and implementation of sexual reproductive health services; including specific measures to involve young people in the design and implementation of youth-friendly approaches to ensure that services meet their needs;
- Health care service providers in camps and transit points must provide essential care to prevent maternal and newborn death and illness;
- Health care service providers in camps and transit points must make available culturally appropriate education materials and information regarding pregnancy and sexually transmitted diseases including HIV;
- Health care providers in camps and transit points must take effective measures to reduce HIV transmission while offering health support for those affected;