World Refugee Day: Interview with HRH Princess Sarah Zeid of Jordan, UNHCR Patron

In 2018, the United Nations Refugee Agency named HRH Princess Sarah Zeid of Jordan one of its first-ever patrons, in recognition of her advocacy work in the area of maternal and childhood health. Princess Sarah works as a Special Advisor to the World Food Programme on Maternal and Child Health and Nutrition and as a Champion of the Newborn Health in Humanitarian Settings Initiative. 

Princess Sarah says, “the most important, emotional moments I have are those of outrage.” Women and girls around the world face “relentless indignity”: lack of services and information; limited livelihood opportunities and ownership of the land they farm; political indifference and lack of responsibility. “I feel outraged by patriarchal structures which deny women and girls knowledge of their own bodies and choices,” she adds. “Fourteen-year-old Congolese mothers in Rwanda who found out what they needed to know after they were pregnant! The raw grief of a grandmother in Chad weeping as she told me about the babies she had lost in her youth. Women in Pakistan and Lebanon talking about the exhaustion and health consequences of six, eight, 10 pregnancies, one after the other.”

This World Refugee Day, Every Woman Every Child interviewed Princess Sarah Zeid about why the gender lens is so critical for this vulnerable group, the progress that has been made and misconceptions that still exist, and what a world that is welcoming for refugees will look like. 

What originally sparked your interest in refugee advocacy? 

The health and wellbeing of women and girls, along with all they care about and are responsible for, are the focus of my work and advocacy. In any crisis, be it a sudden shock or a prolonged humanitarian emergency, women and girls suffer first, worst, and for the longest duration, with their specific needs and vulnerabilities rarely met. This is despite the massive and transformative role women and girls play as first responders. They are at the heart of their children’s, family’s and communities’ health, wellbeing, peace and prosperity for generations to come. 

Women and girls who are displaced or refugees are especially vulnerable, and exposed to violence and exploitation both as a result of the crisis or persecution which forced them to move in the first place, and because of their dependence on others for relief provisions and protection.

Approximately 85 percent of refugees and internally displaced persons (IDPs) live in countries with weak health and health-enabling systems. Limited access to these services can have a catastrophic impact on woman and girls, increasing preventable maternal mortality and morbidity and sexually transmitted infections and unintended pregnancy. Inequalities in coverage of reproductive, maternal, newborn, child and adolescent health (RMNCAH) inventions are significantly worse in conflict-affected countries, with an estimated 500 women and girls dying from complications of pregnancy and childbirth every day in fragile and humanitarian settings.

The health and wellbeing of their children and newborn babies is also at heightened risk. Recent analyses indicate that 45 percent of newborn deaths occur in countries affected by a humanitarian crisis or fragile conditions, and the highest rates of stillbirth occur in conflict and emergency settings too.

Why is the gender lens so crucial when addressing the wellbeing of refugees? 

In any crisis setting, 75 percent of a population in need are women, girls and their children. In 2018, 83 percent of South Sudanese crossing the border into neighboring countries were women, girls and children. How could we not apply a gender lens?

The majority of mortality, morbidity, malnutrition, suffering and loss in humanitarian and fragile settings are preventable. They need not and should not be happening! It is unconscionable that governments, organizations and communities do not prioritize women and girls, or apply a gender lens to policies and practices.

How has the landscape of refugee issues changed in the past few years? What progress has the world made and what misconceptions still need to be addressed? What new challenges might there be now?

I think that if you were a refugee examining your everyday and looking out to the world at large, the landscape can only be considered a very grim one. The global number of refugees and IDPs has reached yet another all-time high, with 79.5 million people now forcibly displaced worldwide. Eighty percent are surviving in places affected by acute food insecurity and malnutrition. In the last five years, conflict, persecution and political/economic crisis in Syria, Myanmar and Venezuela have forced millions from their homes and made them dependent on host and donor governments already weary of providing support to multiple generations of refugees from Afghanistan, DRC and South Sudan, to name but three countries.

All this is managed by a humanitarian architecture not designed for—nor been able to adjust to—populations living as refugees displaced for almost 20 years; not designed to provide comprehensive healthcare, education, water and sanitation facilities, energy, livelihoods, food and nutrition to millions for decades.

The foundations for change and improved impact do exist—for example the recently finalized Newborn Roadmap, a five-year, multi-sectoral, multi-agency global strategy aimed to catalyze progress for newborn health in humanitarian and fragile settings. This document does not just consider how to deliver more high-quality interventions during the first 28 days of life. It advocates for a continuum-of-care approach, from family planning through to early childhood development. It calls for linkages and investments in nutrition, immunization, mental health, WASH (water, sanitation and hygiene), and for services that are delivered to women, girls, adolescents and children. It recognizes that a multi-sectoral approach is the only way to ensure sustainable improvements to healthcare for the world’s most vulnerable.

However, funding structures and resources continue to be insufficient. The humanitarian community needs long-term, sustained and flexible funding, and responses need continued funding beyond the acute crisis, into protracted stages. Supply chains need to be strengthened and, of critical importance, more support, funds and authority need to be given to local actors and responders.

What does a world that is welcoming to refugees look like? What steps and policies are necessary to build this world? 

A world that welcomes refugees is a world that cherishes equity, shares resources, values human rights and makes every preventable death count. A world that welcomes refugees is not driven by short-term domestic politics, or showmanship. Instead, all governments would genuinely strive for peace, inclusion and equitable long-term prosperity.

In the meantime, the following would be a good start! 

1. Support for low and middle-income/developing countries that host the vast majority—86 percent—of the world’s refugees.
2. Recognize the specific needs of women, girls and children, and the importance of supporting them today for building a better tomorrow.
3. Systematically implement the evidence-based high-impact approaches for maternal and newborn care that have been developed to meet the needs of all women and newborns and are adapted to humanitarian, fragile and low-resource settings 
4. Long-term, predictable, flexible financing to humanitarian organizations and increased funding to national civil society organizations, especially those led by or focused on women.
5. Attacks against humanitarians, healthcare workers, hospitals, ambulances and other international humanitarian law violations must not be allowed to continue.

How has COVID-19 affected the lives of refugees—and how can we make sure that refugees are not forgotten when leaders begin enacting relief plans? 

Nearly everyone is suffering economic consequences from this pandemic, with of course the harshest impact felt by individuals and families who were already struggling. Daily-wage workers or those employed in the informal economy were already living hand-to-mouth, are now potentially exposed to the virus or without their livelihoods, excluded from national safety net schemes and health facilities, and often in cramped, overcrowded conditions with limited access to clean water and soap. In Cox’s Bazar in Bangladesh, for example, 33 percent of the Rohingya do not own soap and lack water for regular handwashing.

With the shutting of schools, we know from previous research that refugee girls are less likely than boys to return to their education once it has been interrupted. World Vision has warned that an additional four million girls are at risk of early and enforced marriage due to the deepening poverty and school closures caused by COVID-19. Gender-based violence—already a huge problem in refugee situations—is dramatically increasing during this terrible time.

Also of grave concern is the reduced access to nutritious foods and nutrition services. Women and girls, already 50 percent more likely to face malnutrition than men and boys, are bearing the brunt of this crisis. Not only are they less likely to have the economic means to purchase nutritious foods, they are also often the first members of the household to sacrifice their meals so the rest of the family can eat, especially during times of food insecurity.

Malnutrition heightens existing risks to women’s health, especially pregnancy and childbirth, and increases by 30 percent the likelihood of delivering low-birthweight babies who are, in turn, much more susceptible to malnutrition and death.

In a study published in May in Lancet Global Health, researchers at the Johns Hopkins Bloomberg School of Public Health said that the spillover effects of COVID-19 could result in an additional 56,700 maternal deaths over the next six months in 118 low- and middle-income countries, the majority of them in sub-Saharan Africa.

Past epidemics have shown that shifting healthcare efforts to address new, arising risks (and away from sexual and reproductive health), combined with lack of access to essential health services and the shutdown of services unrelated to the epidemic response, results in more deaths than those caused by the epidemic itself. UNAIDS, and its co-sponsors including UNHCR, warn of the potential negative impact on gains made in the fight against HIV and TB, and UNICEF of a massive increase in preventable diseases as vaccine coverage declines.

In addition, at a time of extraordinary global socioeconomic decline—and as World Food Programme warns of a “global hunger crisis” with millions more suffering from acute hunger by the end of 2020—it is predicted that reductions in routine health services and access to contraceptives could result in seven million unintended pregnancies and future mouths to feed.

While the COVID-19 pandemic respects no borders, it is also the latest and most comprehensive reminder of global and systemic inequities and weaknesses. We cannot ignore them anymore and continue to allow women, girls and their children to pay the highest price!

Photo ©WFP/Noemi Renzetti.