The Road Ahead: Mothers and Children in Humanitarian Crises

This moving keynote speech was delivered by Her Royal Highness Princess Sarah Zeid of Jordan on November 4, 2015 at the Canadian Network for Maternal, Newborn and Child Health Annual Meeting in Montreal, Canada.

The worst rates of preventable mortality and morbidity among women, adolescents, and children occur in humanitarian and other crises.

« Rarely before have we witnessed so many people on the move, so much instability, so much suffering. In armed conflicts in Afghanistan, Iraq, Nigeria, South Sudan, Syria, Yemen, and elsewhere, combatants are defying humanity’s most fundamental norms. Every day, we hear of civilians being killed and wounded in violation of the basic rules of international humanitarian law, and with total impunity. Instability is spreading. Suffering is growing. No country can remain untouched.”

This is what Peter Maurer, President of the ICRC said on Sunday in a joint press conference with the UN Secretary General.

Dear friends, something has gone horribly wrong. Our success should be evidenced in our own redundancy – our unemployment. All individual needs met, universal rights upheld, dignity fulfilled, with peace and goodwill between and towards all. Instead? We are overwhelmed, under funded, out of our depth, employed fully and more, in a booming growth industry whose demands we cannot meet!

In every sphere and sector, scale of need is outmatching us. So, it is we who have to change! To change our results – we must first change ourselves – change how we work, and with whom we work.

For me the answer is very simple: prioritize the sexual and reproductive health rights of women and girls, meet their needs, uphold their dignity and unleash their full power and potential to act as first responders, partners, and agents of change.

To do so, our efforts must focus on life cycles more than electoral ones; on menstrual cycles and not financial ones; on the ebb and flow of El Nino rather than those of political polling, and on the constant and unchanging need for courageous leadership in the face of certain crisis.

We need to be far sighted and not merely focus, short sighted-ily on our own back yard, or be accountable to the loudest voice on the bench.

Our actions and inaction, unless grounded in constant compassion and anchored in our obligations to uphold the rights of those in greatest suffering, will come back to haunt us at triple the cost, radicalizing local politics and ultimately breaking the back of our collective future.

Depressing? Absolutely, but consider what it is like in the region I call home: the civil war in Syria has entered its 5th year, thanks to Security Council paralysis. It has exploded into a massive refugee crisis for Europe, one that has been the reality for its neighbors for over more than four years now. In Syria, indiscriminate killing – barrel bombs and chemical weapons – are deployed with impunity, and where the radical despair of young people from near and far readily converts – under force of hateful propaganda – into radical violence.

In Yemen, the very poorest and least developed of the Arab states, is now devastated with no promise of development – and yesterday to add insult to injury the west of the country was battered by a rare tropical cyclone, with winds the equivalent to a category 4 hurricane!

In Iraq, the legacy of enduring conflict, feeds collapse in Libya, impacts Turkey’s recent elections and continues to threaten peace and stability elsewhere.

To be very Game of Thrones about it: “winter is coming”!

Even if we here are unable to transform the politics of hate; cannot end the violence; are powerless to prevent the hurricane, still the earthquake or stem the tide, we can and we must end preventable deaths and the untold suffering they bring. And if we do so, we can also preserve, enable and uphold the contribution of women and young people to sustainable development, to resilience, to recovery and to peace and security.

The evidence regarding the constructive power of women’s contribution to peace and security is well proven, encouraged and often touted – even by the Security Council which recently completed its 20th year review of its ground breaking resolution 1325 acknowledging just that.

However, two decades later women’s right and ability to access quality sexual reproductive health services remains contested. And as the Women’s Refugee Commission has demonstrated are among those essential services least supported at the time of crisis: left out, neglected or rejected.

Yet, in order for her to participate and contribute, to claim her rightful place at the table to broker peace or just to search out drinkable water for her family, she and her children must first be healthy. For a girl to remain in school, she must have access to hygiene products. For newborns to be healthy, their mothers can not themselves be children, and in all circumstances they must have adequate levels of nutrition and support to conceive when they choose, carry, deliver and nurse.

Pregnancy waits for no one – not war zones, hurricanes, or epidemics. As predictable as hunger and as essential as shelter, reproductive health is most gravely eroded in humanitarian and fragile settings, just when access to services most severely declines.

And neither conflict, nor contagion nor climate changes the enduring reality that women need services if both mother and child are to survive and thrive.

Survive, thrive and transform. Those are also the clarion calls of the new Global Strategy for Women’s, Children’s and Adolescents’ health – the very first implementation platform under the 2030 sustainable development agenda – launched by the SG in September on the sidelines of the General Assembly. It is a strategy for Every Woman, Every Child and it must be a strategy relevant to, and adaptable for, Everywhere!

There are many reasons to celebrate our achievements under the MDGs, and Canada should be celebrated as a constant champion of global efforts. But when disaggregated, those same results also reveal just how much is still to be done for newborn and adolescent health, and for access more broadly to sexual and reproductive health: Where poverty is greatest, where fragility and insecurity have been at their most extreme, and where inequality between men and women is most severe, the outcomes for women’s, children’s’ and young people’s health have been at their worst.

Indeed, cast under the MDGs, the first EWEC Global Strategy for Women and Children’s Health, had a blind spot: it did not reach everyone everywhere. It did not include a focus on young people – despite the fact the world has never before witnessed such a large generation of adolescents, and it failed to consider context. Most glaringly, it failed to take into account humanitarian and fragile settings. It gave no strategic focus to the specific situation of women and children caught up in humanitarian crisis, whether rapid or slow in onset – whether the product of climate change, conflict or contagion.

Forged this time under the 2030 sustainable development agenda, the new EWEC Global Strategy for Women and Children’s Health is substantially different. It has to be. After all OECD data shows that 60% of preventable maternal mortality, 53% of under-5 and 46% of newborn deaths are occurring in humanitarian and fragile settings.

The universal promise of Every Woman Every Child is an empty one, until and unless it delivers everywhere. And that commitment must extend into the toughest of places, at the hardest of times, and for those most at risk of being left behind.

The strategy – which is intended to inspire political leaders and policy-makers anew, and enable communities to claim their rights and hold leaders to account – calls for much greater integration of RMNCAH across the continuum of care and over the life course, and for much more strategic engagement with health enhancers such as nutrition, water, sanitation, and education.

It is structured around 9 pillars:

  • Country leadership and collective action.
  • Financing and mobilization of resources.
  • Resilience of health systems particularly in emergencies.
  • Support for people as partners in development and as agents of change.
  • Community engagement.
  • Multisector action including particularly the private sector.
  • Research and innovation.
  • Greater transparency and accountability.

And, I am delighted to say, a commitment to: More effective action in humanitarian and fragile settings.

The new Global Strategy, grounded in human rights, will be accompanied by a five-year Operational Framework at country level, and a new financing platform – the Global Financing Facility – hosted by the World Bank, designed to radically improve investment for women’s, adolescents’ and children’s health, and chaired by your very own and very fabulous Diane Jacoveli!

Also thanks to Canada’s leadership a multi-stakeholder accountability framework – building on existing mechanisms – along with an Independent Accountability Panel, will drive a more unified approach to annual reporting and assure independent review.

Over the course of the Strategy’s development, I have led – in partnership with UNFPA, the World Health Organization and the Partnership for Maternal, Newborn and Child Health – the humanitarian technical work stream and, of course, we found that the “last miles” of preventable maternal, child and new born mortality lie in humanitarian and fragile settings.

However, we also learned that gender based discrimination survives even the worst humanitarian settings. Social norms continue to play out – impeding access to essential services, particularly for women and children forced to live on the periphery of society – those who are subjected to discrimination, abuse and exclusion on the basis of their ethnicity, caste, disability, culture or religion.

We learned too that even humanitarian actors perpetuate some of these same exclusions and neglect. Multiple international standards define sexual and reproductive health rights, even in humanitarian crisis: emergency obstetric care, essential newborn care, access to contraceptives, and clinical management of rape, and yet these interventions remain among the most poorly funded and poorly provided components of humanitarian response.

This is simply not tolerable.

All women, children and adolescents have the human right to the highest attainable standard of health — the renewed Global Strategy for women’s children’s and adolescent health is a roadmap for achieving those rights.

Too often money spent on health is seen as « costs », when in fact these are « investments ». And, there are real and tangible dividends to accrue when these rights are upheld. The Lancet has published research that shows money spent on good antenatal healthcare is a « triple » return investment, while investments to reduce teen pregnancy and ensure girls complete secondary school yield a 10% return in low- and middle-income countries, and money improving nutrition offers a benefit-cost ratio of 16:1.

However, as you know all too well, the human cost and consequence of humanitarian crisis – whether sudden onset or protracted – requires that we factor in people – women and men; young people and children – into both mitigation and adaptation.

For that we need both a deeper understanding of the ways in which people are affected, and a deeper valuing of how can people contribute to the change we need.

The human face of crisis is as tangible as it is unaffordable. Injury, illness, and death are on the rise while impacts on lifestyle and livelihoods also exact their price on health. But these health consequences are not born equally. The World Health Organization estimates 99% of all deaths related to climate change, for example, occur in low- and middle-income countries, and most intensively so where poverty is at its gravest.

80% of these deaths occur among children, of which a significant percentage is attributable to the 30-fold increase in dengue fever, and the intensifying impacts of malaria.

Where women are the primary caregivers of the family, they also shoulder the greater burden of managing and cooking food, collecting drinking water, and taking care of livestock. Climate change, for example, disrupts every element of their daily tasks and daily lives.

When crises impacts are rapid in onset, the outcomes for women and children are also exceptionally severe. Women and children are 14 times more likely than men to die during a disaster, and the graver the localized gender inequality, the greater the difference.

During the 1991 cyclone disaster in Bangladesh 90% of the 140,000 fatalities were women. 61% of Myanmar fatalities from Hurricane Nargis, and in Banda Aceh, as a result of the Indian Ocean Tsunami, 67% were women.

These gendered differences in disasters’ impacts and aftermath are more often the result of the differences that we ourselves create – through the social roles we play and the social expectations of how we should behave.

In disasters women die because, under force of the social norm that when outside the home they be accompanied by a male family member, they do not flee early or fast or far enough.

The particular role that women play in the care of children and of the elderly further slows their escape. Their lack of opportunity or permission to practice such protection activities as the ability to swim or to climb a tree – all account for the extraordinary differences in survival rates.

In the face of a disaster’s devastation, women and girls face additional barriers to accessing health-care services, with the provision of sexual and reproductive health services among disaster recovery interventions not being prioritized, even though these are essential to minimum levels of human dignity.

Women who were subjected to violence before a disaster, are more likely to experience increased violence after the disaster.

In short, women and men experience disasters differently. Inequities in the routines of their everyday lives drive profound differences in risks, exposure and survival – reducing the life chances for women and girls, and depriving communities of their contributions to recovery and regrowth.

Women and girls offer a wealth of capability for individual and communal survival before, during and after disasters. Still, time and again, we neglect or undermine the specificities of their needs and the value of their role in survival response, recovery and in rebuilding.

Adolescent girls in particular fall through the gap between the humanitarian and development response, and are a priority target group of neither. Yet they have the capacity to be energetic and influential proponents of disaster risk reduction and climate change adaptation in their families, peers, schools and communities.

In a time of such adversity, in an era of increasing scarcity, when all around us are speaking of austerity, how can we possibly justify failure to take fullest benefit from that most precious of resources, namely human capability?

It is right here, right now, that the inter-connections and inter-dependencies between people, planet, peace and prosperity which in September, the world’s leaders committed to transform together into sustainable development, must engaged and engaged anew.

I returned at the weekend from Fiji, where we went to examine the impact on and needs of RMNCAH in climate change. Staring down the barrel of a potentially devastating cyclone season, thanks to the effects of an unprecedented El Nino, the Pacific Island Health Ministers and key technical experts worked with a sense of real urgency and responsibility to produce, and then adopt, integrated recommendations on what the opportunity of the sustainable development agenda looks like in the context of climate change when seen through the lens of the global strategy for women’s, children’s and adolescent health.

In such a context, taking account of gendered and age related differences is critical for policy effectiveness, key to strengthening community resilience and made all the more pertinent given how young is the majority of the Pacific’s population.

What is clear to me from that brief visit is that in the Pacific climate change is so much more than the rise in sea levels, changes in rainfall, threats to land and fresh water, and disasters. It is about people!

This is also clearly the case across humanitarian disasters more broadly. In essence, our message must simply and plainly be this – “a healthy population is a prepared one”.

  1. our work with the Pacific Islands Ministers of Health last week, we sought to identify critical action points and priorities to further galvanize and focus integrated shared effort across sectors, disciplines and actors. Provided this agenda is supported and led by government, as long as it includes civil society, development and humanitarian actors, international partners and if it engages women, young people and children themselves, then we can deliver together a powerful contribution to the region’s overall resilience and adaptation process. As the women in rural northern Fiji declared on hearing about the climate change conference – “Paris or no Paris, we are going to build this house!”

To do this, we must tear down the schism between development and humanitarian response. Upholding humanitarian principles where needed, we must redesign our interventions at national and global levels for better risk management, and wiser investment in resilience – inclusive of prevention, protection, preparedness – response and recovery.

The health and dignity of women, their newborn babies and their children is NOT a business. They are NOT targets. Their needless suffering is NOT a mere percentage loss. Any more then they are JUST thousands of potential forced “migratory movements” or millions of faceless “displaced”, or the unknown “homeless” after the earthquake, or unnamed victims of climate disasters.

They are our beloved mothers, daughters, sisters and tiny babies. They are at the center of our lives, of our families, communities, our economies and at the very heart of peace and security, and we cannot afford to fail them.

If we can join together – across the richness of our diversity and founded on the uniqueness of our respective contributions and then frame this through the Global Strategy for women’s children’s and adolescent health, we can galvanize people, government, the private sector and international donors into a more predictable, longer term, more strategic engagements of real risks. We can do more, for more, and we can do it better in all settings.

In this, sexual and reproductive health and wellbeing – for ALL – particularly for women and girls – are not luxuries nor are they ideologies – they are life-saving, life-changing, life-enhancing, dignifying human necessities.

Having studied what makes for greatness in leadership – John Kenneth Galbraith found the key characteristic of great leadership to be “the willingness to confront unequivocally the major anxiety of their people in their time.”

  1. of a nervous people facing fearful times is a courageous business. And strangely few issues incite such anxiety as the notion that the body of the woman should be a site not for domination, containment and control but for autonomy, agency and self-determination. That intimacy should be freely expressed but never without consent. That there is place for cruel or inhumane treatment in the family home or the marital bed. That neither pregnancy nor marriage should rob a girl of her right to first become a woman. That no woman should ever die giving life. That no parent should ever be deprived of what they need to nurture and raise their children. That no child should ever have to live in fear of those who should love and care for them. That the future to which we must be accountable is already here with us, in the form of our children and our young people.

The Global Strategy for EWEC must be a framework for courageous leadership of nervous people. And it is now unswerving in its insistence that women’s children’s and adolescent health be understood to be a key driver of sustainable-development inclusive of humanitarian response.

The health of women and children is no panacea, but we cannot secure the future we want without it. We cannot speak meaningfully of peace and sustainability and ignore it. We cannot establish a truly inclusive development agenda and a truly responsive humanitarian approach without taking care of it.

I started by quoting Peter Maurer, and will use his words again: “Instability is spreading. Suffering is growing. No country can remain untouched.” And no place or person can continue without an urgent and honest change of heart and action.

The Prime Minister of Fiji – in a wonderfully bruising speech about the devastation brought to the Pacific Islands by climate change – talked about many beyond the Pacific as being “the coalition of the selfish”.

I don’t want to be part of that. I want to be part of a coalition of bold honest action to change the world, to make it better and in this, I want to be held accountable first and foremost to women and children who today are at gravest risk of being left far, far behind.


HRH Princess Sarah Zeid is a global maternal and newborn health advocate. Princess Sarah has successfully sponsored the addition of an unprecedented focus on humanitarian settings in the updated global strategy for the UNSG’s “Every Woman Every Child” (EWEC) initiative. Commissioned by the Partnership for Maternal, Newborn and Child Health and in collaboration with the H4+ multilateral agencies (UN and the World Bank), Princess Sarah continues to champion the priority of, and innovation for, reproductive, maternal, newborn, child and adolescent health in humanitarian and fragile settings as the EWEC Strategy moves into implementation. Princess Sarah is a former UN staff member, having worked in the Department of Peacekeeping Operations, and she was the Desk Officer for Iraq in UNICEF’s Office of Emergency Programmes. She holds a BA in International Relations from the University of St. Thomas in Houston, Texas, and a MSc in Development Studies from the School of Oriental and African Studies, University of London Princess Sarah is married to HRH Prince Zeid Ra’ad Al Hussein. They have three children.




novembre 18, 2015




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