Protecting the health and rights of women, girls and newborns during conflict and crisis

The situation in Gaza, Israel and the surrounding region exposes women, children, newborns and other vulnerable people to extreme risk, including social, gender and reproductive injustices. At the time FIGO publishes this statement, more than 4,000 people have been reported killed in the region. At least 400,000 people are displaced and more than 1 million people have been ordered to move.[1] UNFPA estimates there are 540,000 women of reproductive age living in Gaza – where the majority of conflict is occurring – among whom 50,000 are currently pregnant, and 5,500 are expected to deliver in the next month.[2] Furthermore, over half the population in Gaza is under 18 years of age.[3]

As the global voice for women’s health and the leading international membership organisation of obstetricians and gynaecologists from 139 countries, FIGO recognises the innate risks of childbearing and childbirth that are present at all times. Violence, conflict and forced relocation pose extreme risks to all civilians – in particular pregnant women, women who have recently delivered, newborns and children.[4], When planning and giving birth under such conditions, the risks of maternal and infant death or injury are dramatically exacerbated.[5]

During conflict, women face barriers that impede access to and provision of basic services like maternity care, and reproductive health services such as contraception and abortion. They are also at higher risk of mental, sexual and physical abuse. Violence against women and girls is a persistent human rights violation that threatens their safety, security, and physical and mental wellbeing.[6]

FIGO position

Health is a human right

All people have a human right to life, health and dignity.[7] FIGO reiterates our position that all women deserve the highest possible standards of physical, mental, reproductive and sexual health and wellbeing throughout their lives.

FIGO urgently calls on all parties involved to end hostilities, open humanitarian corridors, provide for basic needs (including the security of food, water, fuel and energy) and ensure access to and provision of health care to all those in need. It is crucial that international humanitarian laws are respected to ensure the safety, security and life of all, including healthcare workers and care givers who are risking their lives to ‘do no harm’.[8]

Health care workers must be protected

FIGO joins the World Health Organization and civil society organisations the world over to call for the immediate active protection of civilians and health care systems and to enable health care workers to effectively respond to the needs of all affected. International humanitarian law must be abided by, which means health care must be actively protected and never targeted.[9]

Evacuation orders for hospitals and other dedicated areas for civilians and health care workers may be impossible to carry out, due to insecurities, the critical condition of patients, and lack of transport and alternative medical facilities.[10] Attacks against medical facilities, medical personnel and the wounded and sick are prohibited under international humanitarian law.[11]

Access to SRH services must be upheld

FIGO is committed to upholding the right to sexual and reproductive health care in humanitarian and fragile contexts.[12] FIGO urges all governments, non-state groups and international bodies to do the same. FIGO regards reproductive choice, including access to safe abortion services, a basic and non-negotiable tool for ensuring the human rights of every woman and girl, not just in one region or country, but globally.[13],[14],[15].

FIGO asserts that the right to safe abortion is an integral part of sexual and reproductive health and rights (SRHR), gender equality, reproductive justice and universal health care. FIGO recognises that abortion care, management and timely provision of non-judgmental services is essential, even in times of conflict and crisis.[16]

Conflict-related sexual violence is unacceptable

Sexual violence as a method of warfare represents a violation of our shared humanity that must not be accepted as an unpreventable part of armed conflict. It is a wholly unacceptable tactic that has no place in modern warfare.[17] Conflict-related sexual violence destroys families and communities, and inflicts harm over generations – for example through HIV transmission, the rejection of children born of rape, and collective psychological trauma.[18]

FIGO has advocated through the Red Line Initiative[19] against conflict-related sexual violence which is widespread and systemic in many conflicts. Resilient health systems must be developed to address those afflicted, and to provide safe care and services for pregnancy and childbirth. Political and legal obligations must be enhanced with punitive measures for violators.

FIGO recommendations

FIGO calls on all governments, parties and international organisations to commit to bringing an end to the conflict and ensuring equitable provision of and access to health care and services.

Key recommendations for immediate action

  • Immediately end hostilities, open humanitarian corridors, provide for basic needs (including the security of food, water, fuel and energy) and ensure access to and provision of health care to all those in need.
  • Actively protect civilians, health care systems and health care workers to ensure effective responses that meet the needs of all affected.
  • Upholding the right of all people to access sexual and reproductive health care and services, including safe abortion.
  • Enforce the prohibition of sexual violence in conflict: prevent and punish such actions, and provide services and care to repair all harms caused.
  • Accountably address preparedness, recognition and response through the provision of technical assistance and resilient health systems for the safe and unimpeded delivery of humanitarian aid to affected populations.
  • Ensure accountability for human rights violations and address the root causes of conflict to bring long-term peace to the region.

Further recommended actions

Engage in diplomacy and negotiation

  • Recognise the voice of and provide agency for the women and children who face the brunt of conflict, to uphold their human dignity, human rights and reproductive rights.
  • Prioritise global health diplomacy and negotiations as the primary means of resolving conflict.
  • Engage in dialogue with all parties, including government officials, opposition groups and international mediators.
  • Establish trust-building measures and confidence-building mechanisms.

Provide humanitarian assistance

  • Protect and respect the rights of civilians and ensure the provision of and access to basic needs (food, water, shelter, energy sources and medical care).
  • Prevent torture, inhumane or degrading treatment, and sexual and gender-based violence.
  • Reduce gender and health inequalities and inequities related to safe spaces and safeguarding.

Ensure sexual and reproductive health justice

  • Uphold international humanitarian law and human rights principles.
  • Ensure equitable access to safe, respectful and high-quality SRH care that promotes and protects the health and wellbeing of women, girls and children.
  • Provide technical assistance and medical supplies within safe humanitarian corridors and health facilities.
  • Prevent, investigate and punish all forms of gender-based violence and ensure survivors’ access to justice, comprehensive medical treatment and psychosocial support

Limit environmental damage

  • Forbid the use of chemical, biological, or nuclear weapons.
  • Recognise and mitigate the effects of conflict on climate change, the environment and reproductive health.

Promote peacekeeping and peace building

  • Provide social accountability through advocacy with duty bearers, health care professionals, civil society and monitoring bodies.
  • Promote the use of responsible and unbiased communication and reporting that adheres to professional standards as a tool for peace and conflict resolution.
  • Work collaboratively with international organisations and regional bodies, civil society, and grassroots organisations to promote peace.
  • Impose sanctions on individuals and collectives responsible for human rights abuses and violence.

Develop conflict and post-conflict resolution curricula

  • Provide training in health diplomacy, ethical competencies and mediation to health care professionals and other providers of services (including SRHR) working in crisis settings.
  • Implement protections to ensure the mental wellness of health care professionals during and after humanitarian crises.
  • Focus on long-term follow-up recovery, reconstruction, reparation, repatriation and development in the aftermath of conflict.
  • Promote reconciliation, social, gender and reproductive justice, the rule of international human rights, and laws governing peace, security and healing spaces.

FIGO commitments

FIGO will support the efforts of our member societies, regional federations, health care colleagues, partners and humanitarian organisations to call for an immediate end to all hostilities, returning the people of Israel and Gaza to their homes, and allowing peace to reign.

FIGO will demand that all efforts be made to provide for the safety of all civilians, hospitals, schools, food, and water and sanitation facilities – including the provision that no weapons be used.

FIGO will advocate for the involvement of women in decision-making and peace-building processes to ensure that the responses to this humanitarian crisis respect the specific needs and rights of women and children.

References

[1] OHCHR. 2023. www.ohchr.org/en/press-briefing-notes/2023/10/latest-occupied-palestinian-territoryisrael

[2] UNFPA. 2023. www.unfpa.org/news/%E2%80%9Crace-against-death%E2%80%9D-amid-relentless-bombardment-gaza-pregnant-women-tell-unfpa

[3] WHO. 2023. www.who.int/news/item/13-10-2023-who-pleads-for-immediate-reversal-of-gaza-evacuation-order-to-protect-health-and-reduce-suffering

[4] UNFPA. 2023. www.unfpa.org/crisis-gaza

[5] United Nations. 2023. https://news.un.org/en/story/2023/10/1142347

[6] UNFPA. 2023. www.unfpa.org/news/%E2%80%9Crace-against-death%E2%80%9D-amid-relentless-bombardment-gaza-pregnant-women-tell-unfpa

[7] United Nations. 1948. www.un.org/en/about-us/universal-declaration-of-human-rights

[8] United Nations. 2023. www.un.org/pga/77/wp-content/uploads/sites/105/2023/09/UHC-Final-Text.pdf

[9] World Health Organization. 2023. www.who.int/news/item/17-10-2023-who-statement-on-attack-on-al-ahli-arab-hospital-and-reported-large-scale-casualties

[10] United Nations. 2023. https://news.un.org/en/story/2023/10/1142282

[11] FIGO. 2020. www.figo.org/figo-ethics-and-professionalism-guideline-078-violence-against-healthcare-professionals

[12] FIGO. 2019. www.figo.org/icpd25-srhr-humanitarian-settings

[13] FIGO 2022. www.figo.org/resources/figo-statements/cartagena-declaration

[14] FIGO. 2023. www.figo.org/resources/figo-statements/supporting-access-safe-abortion-conflict-and-humanitarian-settings

[15] Fetters T, Rubayet S, Sultana S, et al. Navigating the crisis landscape: engaging the ministry of health and United Nations agencies to make abortion care available to Rohingya refugees. Confl Health 14, 50 (2020). https://doi.org/10.1186/s13031-020-00298-6

[16] FIGO. 2022. www.figo.org/resources/figo-statements/figo-calls-total-decriminalisation-safe-abortion

[17] Mukwege D, Conry JA. A call to action: Drawing a red line to end conflict-related sexual violence. Int J Gynecol Obstet. 2023. https://doi.org/10.1002/ijgo

[18] FIGO. 2023. www.figo.org/resources/figo-statements/red-line-initiative-end-conflict-related-sexual-violence

[19] The Red Line Initiative: www.endcrsv.org

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About FIGO

FIGO is a professional membership organisation that brings together more than 130 obstetrical and gynaecological associations from all over the world. FIGO’s vision is that women of the world achieve the highest possible standards of physical, mental, reproductive and sexual health and wellbeing throughout their lives. Our work to achieve this vision is built on four pillars: education, research implementation, advocacy and capacity building.

FIGO leads on global programme activities, with a particular focus on sub-Saharan Africa and South East Asia. We advocate on a global stage, especially in relation to the Sustainable Development Goals (SDGs) pertaining to reproductive, maternal, newborn, child and adolescent health and wellbeing, and non-communicable diseases (SDG3). We also work to raise the status of women and enable their active participation in achieving their reproductive and sexual rights, including through addressing female-genital mutilation (FGM) and gender-based violence (SDG5).

We also provide education and training for our Member Societies and build capacities of those in low-resource countries through strengthening leadership, translating and disseminating good practice and promoting policy dialogues.

FIGO is in official relations with the World Health Organization and a consultative status with the United Nations.

About the language we use

Within our documents, we often use the terms ‘woman’, ‘girl’ and ‘women and girls’. We recognise that not all people who require access to gynaecological and obstetric services identify as a woman or girl. All individuals, regardless of gender identity, must be provided with access to appropriate, inclusive and sensitive services and care.

We also use the term ‘family’. When we do, we are referring to a recognised group (perhaps joined by blood, marriage, partnership, cohabitation or adoption) that forms an emotional connection and serves as a unit of society.

FIGO acknowledges that some of the language we use is not naturally inclusive. We are undertaking a thorough review of the words and phrases we use to describe people, health, wellbeing and rights, to demonstrate our commitment to developing and delivering inclusive policies, programmes and services.

Referencing this statement

International Federation of Gynecology and Obstetrics (FIGO). Protecting the health and rights of women, girls and newborns during conflict and crisis. 2023. Available from: www.figo.org/resources/figo-statements/protecting-health-and-rights-women-girls-and-newborns-during-conflict-and-crisis