30 November 2016

Panel on urban humanitarian crises focuses on quality, accessible healthcare for women, children and adolescents

The Governments of the United Arab Emirates and Norway convened the second panel in the Every Woman Every Child Everywhere series on 29 November at the United Nations, this time examining urban crises as part of its coverage of the reforms, operating principles, and interventions required to ensure health services for women, children and adolescents in humanitarian settings.

Moderated by H.R.H. Princess Sarah Zeid, co-Chair of Every Woman Every Child Everywhere, the panel integrated discussions on implementation of Habitat III’s New Urban Agenda, the New York Declaration for Refugees and Migrants, and Agenda 2030’s imperatives on health, gender, youth, and children.

H.E. Geir O. Pederesen, Ambassador and Permanent Representative of Norway to the United Nations, remarked upon Aleppo as a tragic example of urban crisis, and the unacceptable targeting of hospitals and other social infrastructure in conflicts.  He noted the 26 million girls of reproductive age globally living in emergency settings, and the estimate that a considerable percentage of preventable maternal deaths occur in fragile settings. He emphasized that without addressing the needs of the most vulnerable, we will not be able to achieve the Sustainable Development Goals. Ambassador Pedersen called for strong urban contingency planning and local government leadership to address urban crises, in partnership with humanitarian aid and programming. He also noted the cost efficiencies of integrating development and humanitarian work, and of strengthening national governments’ ability to provide health services, citing the El Niño response in Ethiopia.

Mr. Jamal Al Musharakh, Deputy Permanent Representative of the United Arab Emirates to the United Nations, emphasized that, similarly to other fragile settings, women, children and adolescents in urban areas are hit first, hardest, and often helped last during crisis.  He contextualized the panel within three key trends—(1) the growing proportion of conflict, contagion, and disaster occurring in cities; (2) the rapid shift of displaced persons from camps to cities, now globally around 60 percent; and (3) the continuing highly disproportionate mortality and morbidity rates of women and children in humanitarian settings.  As a result, he said, we are in a new era for humanitarian planning and response, with merging requirements for host communities and arrivals, and an opportunity to efficiently reach more women and children—and to include them in the design, delivery, and monitoring of humanitarian programming. Mr. Al Musharakh emphasized that besides the moral imperative of preventing mortality and morbidity, there was no chance for recovery and longer-term development without healthy, empowered mothers, children, and adolescents.

Dr. David Nabarro, Special Adviser to the UN Secretary-General on the 2030 Agenda for Sustainable Development and Climate Change—especially drawing on his Ebola field experience—discussed the overlapping complexities of disease, conflict and climate change in cities, noting the potential to concentrate misery and produce extremes. Dr. Nabarro cited the clear link between higher mortality rates for women during crises and gender roles that mean women often stay behind to care for the children, the elderly and the sick.  He made three recommendations: (1) ensure that humanitarian programming is owned by the local people, and not the service providers; (2) respond to the realities and needs of women and children; and (3) ensure that services are evidence-based and outcomes are measured.

H.E. Sima Bahous, Ambassador and Permanent Representative of Jordan to the United Nations, described the situation in Jordan, where 89 percent of refugees currently reside in cities, towns, and villages—and not in camps. Most of them are women and children, and 53 percent under the age of 18.  She noted the influx of 1.3 million Syrian refugees is exhausting existing health and social services, creating poverty (which disproportionately reduces women’s and children’s health), and affecting social cohesion. Ambassador Bahous stressed the need for better data on urban health, as well as a multisectoral and engendered approach to dealing with refugees that prioritizes women’s perspectives in service provision and delivery. She emphasized the need to focus on reproductive health, from pre-natal and post-natal care, to dealing with postpartum depression; as well as the growing and specific needs of elderly women.

Mr. Philip Spoerri, Head of Delegation, International Committee of the Red Cross (ICRC),  New York Office, emphasized the need to engage local communities in humanitarian work. He noted that ICRC works with mixed focus groups, including women and adolescents, to ensure that they have a full understanding of the needs and issues of crisis-affected urban residents. Given the integration of host communities and refugees in cities, and the resulting blurring of development and humanitarian needs, Mr. Spoerri highlighted the importance of reducing donor earmarking and providing multi-year funding.

Mr. Hamish Young, Chief of Humanitarian Action and Transitions, UNICEF, stressed that if the international community carried out just 20 percent of these commitments over the last 18 months (from Sendai to the World Humanitarian Summit), we would make great strides in meeting the needs of women and children in humanitarian settings. Mr. Young also cited some advantages of urban settings for service provision, where there is often existing infrastructure. He emphasized two key interventions: (1) unconditional cash transfers to women—calling it one of the most empowering interventions for maternal, adolescent, and child health; and (2) enhanced data generation to “make the invisible visible.” He also flagged that while adolescents and youth are often categorized as “at-risk” or “potential threats,” data shows the actual number is tiny; and that young people can actually be vital resources in identifying the most at-risk, vulnerable populations—particularly through mobile phone technology.  He noted, however, that 80 percent of humanitarian needs derive from conflict, so investment in conflict and peacebuilding might overall be the best intervention for Every Woman Every Child goals.

Ms. Ninette Kelley, Director, UNHCR New York Office, described UNHCR’s significant expansion into cities and out of camp settings. She noted that camps are not a sustainable solution, and exact an emotional and physical toll on refugees. In cities, she emphasized the importance of ensuring refugees have access to services on the same terms as those of the host community, in order to avoid setting up parallel structures that damage social cohesion and longer-term effectiveness. Ms. Kelley welcomed the trend in the last three years to more actively engage development actors early in humanitarian operations to work together to ensure that the work being done for refugees matches with what is being done for the host community.  However, she noted stark inequities in funding in different cities and countries, citing that 66 percent of Syrian refugee needs in Lebanon, Turkey, and Jordan are met, vs. only 17 percent in the Central African Republic.

Ms. Ugochi Daniels, Chief of Humanitarian Response, UNFPA, also emphasized the unsustainability and desirability of camps, and the importance of strengthening existing urban health systems.  While she noted UNFPA has delivered over 6,000 babies—and not lost a single mother—in the Za’atari refugee camp in Jordan, she said putting money into host community systems was critical for long-term economic growth and parity.  Ms. Daniels underlined that women and girls remain a low priority in emergencies, with funding for reproductive health systematically at the bottom, next to funding dedicated to protection needs. She stressed the need for specific funding for reproductive health for women and girls, and a management commitment to ensuring support for women and children.

In his concluding remarks, Mr. Filiep Decorte, Deputy Director, UN Habitat New York Office, emphasized how understanding urban specificities drives better humanitarian response—which will become increasingly critical as 70 percent of the world is expected to be urban by 2050.  He noted that the Ebola response suffered because it was initially premised on the country-level, not the city-level, and did not take into account how urban health services—often informal and unscientific in slum settings—were provided.  He also flagged that the international community should reduce its concerns around financially supporting the private sector, given how much healthcare is privately provided in cities.  Noting a systems-approach is particularly critical in urban humanitarian response, as health is directly linked into water, energy, waste, and other sectors. In terms of New Urban Agenda implementation, he discussed the Global Alliance for Urban Crises, a multi-stakeholder coalition to improve urban preparedness for and response to crisis. He cited its inclusion of local authorities and city-level networks, such as UCLG, as a critical evolution.

The next iteration of the Every Woman Every Child Everywhere series will focus on the implications of climate change—from contagion, disaster, and displacement—on the provision of health services for women, children and adolescents.