More with Less: Disasters in an Era of Diminishing Resources

Providing for the Most Vulnerable in the Twenty-First Century

| 77 | Providing for the Most Vulnerable in the Twenty-First Century FL AVIA BUSTREO, M.D. Whether it was Iraq after the first Gulf war, Sarajevo during the siege, or Sudan during the protracted conflict, it was always the eyes of women and children that conveyed to me the horror and tragedy of conflicts. It is through their eyes that I am writing this chapter and for their health that I have committed twenty years of my professional life. When discussing disasters, humanitarian response, reconstruction, and risk reduction, it is appropriate to begin with women’s and children ’s health. Women and children usually are the most affected by civil conflict, displacement, disaster, and war. As the Beijing Agenda for Global Action on Gender-Sensitive Disaster Risk Reduction (2009) set out: “We are fully aware that women comprise 70 percent of the world’s poor and women are more vulnerable to the impact of disaster due to the existing socio-economic, political and cultural disadvantages .”1 Millions of children throughout the world are subject to crises that last for years and that compromise their well-being and increase their vulnerabilities.2 Both women and children are also vulnerable to violence and sexual abuse in crisis situations. Women today also increasingly help to shape the world in public arenas . They play an important role in art, business, development, human rights, politics, science, and technology. Women also shape the world in private spaces, and continue to remain the primary carers of the family. In disasters, women often continue in their roles as primary caregivers for children, the elderly, and the injured. Women’s ability to care for themselves and their families is limited by the loss of livelihoods and 78 | Flavia Bustreo, M.D. support, sometimes caused by the deaths or displacement of male heads of households. Children are looked to as the future of our world, and ensuring their health, education, and flourishing must be considered a fundamental human commitment. And yet for many women and children today even survival, their basic right to life, is a challenge. Every day, almost 1,000 women3 die while giving birth and around 21,000 children4 under the age of five die from preventable and treatable causes. In disasters, these health and life vulnerabilities of women and children are multiplied. A World Health Organization (WHO) analysis reports on “adverse reproductive outcomes following disasters including early pregnancy loss, premature delivery, stillbirths, delivery-related complications and infertility.”5 For children in disasters, addressing malnutrition, the need for safe water and immunization, child protection from violence, and access to education and play are critical challenges.6 This chapter focuses on the two Millennium Development Goals (MDGs) that are related to the challenge of preventing and reducing maternal and child mortality. Addressing these two goals will help increase the resilience of women and children and of families and communities in times of disasters, and provide the necessary support for the reconstruction and development of affected societies. Promising Commitments for Women’s and Children’s Health After the child-survival revolution in the 1980s and early 1990s,7 along with the Safe Motherhood Initiative in Nairobi in the 1980s,8 the interest and commitment to maternal and child health in the humanitarian sphere began to decrease. But in the year 2000, the MDGs, which were agreed upon by all 191 United Nations (UN) Member States, included a central focus on poverty, development, and health, with an emphasis on women’s and children’s health.9 Academics played a critical role in this renaissance. There were landmark articles that appeared in the British Medical Journal and the Lancet; the latter’s focus on child survival, maternal mortality, and newborn survival brought the attention of Providing for the Most Vulnerable in the Twenty-First Century | 79 policymakers and leaders to the fact that not enough progress was being made. The WHO also contributed to the renaissance in 2005 with their report entitled Make Every Mother and Child Count.10 In 2005, the WHO launched the Partnership for Maternal, Newborn and Child Health (PMNCH), which currently has more than 450 members.11 It comprises a number of partners in different constituency groups: academics, governments, multilateral organizations, donors , professionals associations, nongovernmental organizations, and the private sector. But the moment the renaissance really came together occurred in 2010. For the first time, the Group of Eight (G8)12 launched...