This World Humanitarian Day we reflect on the incredible work undertaken by our humanitarian response teams over the last 12 months. Last year, IPPF reached approximately 5.5 million people in humanitarian crises through our local Member Associations. This achievement would not have been possible without the dedicated and heroic healthcare teams providing vital sexual and reproductive healthcare in the most fragile humanitarian settings. COVID-19 response in Papua New Guinea Papua New Guinea Family Health Association (PNGFHA) PNGFHA responded to the COVID-19 outbreak in PNG, supported by the Australian government. With access to emergency healthcare facilities now extremely limited, PNGFHA health workers travel to hard-to-reach areas providing sexual and reproductive healthcare to the most marginalized communities.Clients like Vavine Kila receive a consultation at the PNGFHA mobile clinic. Share on Twitter Share on Facebook Share via WhatsApp Share via Email The humanitarian response teams taking healthcare into people's homes in Gaza Palestinian Family Planning and Protection Association (PFPPA) On 10 May 2021, Israel launched airstrikes on the Gaza Strip, killing over 220 people (including women and children) and leaving over 75,000 displaced. At the time, an estimated 87,000 women in the Gaza Strip and nearby areas were pregnant. The PFPPA humanitarian response team visited families in their homes, with each household expected to have four to five women of reproductive age needing healthcare. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Offering holistic care to families in Gaza Palestinian Family Planning and Protection Association (PFPPA) Children account for close to 50% of the population in Gaza. As part of the response, PFPPA youth volunteers entertained the children while their family members received life-saving sexual and reproductive healthcare and psychosocial support by the humanitarian response teams in privacy. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Ensuring ante- and post-natal care in the aftermath of an earthquake in West Sulawesi Indonesia Planned Parenthood Association (IPPA) On 15 January 2021, a 6.2 magnitude earthquake struck the West Sulawesi province in Indonesia leaving over 15,000 displaced, including many pregnant people and nursing mothers.As part of its response efforts, the IPPA set up mobile clinics near the shelters to provide vital ante- and post-natal care. Share on Twitter Share on Facebook Share via WhatsApp Share via Email A super cyclone and a pandemic Family Planning Association of India (FPAI) On 20 May 2020, severe Cyclone Amphan hit the Indian state of West Bengal, affecting millions of people in and around the state capital Kolkata. Emergency crises during the COVID-19 pandemic intensifies the impact of the disaster and puts a strain on health systems and access to sexual and reproductive healthcare.FPAI responded by providing emergency sexual and reproductive healthcare to affected communities, particularly focusing on the most marginalized and vulnerable people including the LGBTI community, sex workers, pregnant women, and survivors of sexual and gender-based violence (SGBV). Share on Twitter Share on Facebook Share via WhatsApp Share via Email Providing healthcare to hardest hit communities after Cyclone Yasa The Reproductive and Family Health Association of Fiji (RFHAF) In mid-December 2020, a category 5 severe Tropical Cyclone Yasa hit the island of Fiji and neighbouring Lau group of Islands. IPPF’s Member Association, RFHAF, was supported by the Australian government to provide life-saving sexual and reproductive healthcare in the hardest hit communities, including counselling on STI risk reduction, first-line support for survivors of SGBV, and contraceptive and ante-natal care. Share on Twitter Share on Facebook Share via WhatsApp Share via Email

In August 2017, weeks of continued and heavy rainfall across Nepal resulted in flash floods and landslides that affected 36 of the 75 districts. Many people lost their homes or were displaced. It was estimated that of those affected, 112,500 were women of reproductive age, including 8,694 pregnant women.  IPPF Humanitarian, through their Member Association, The Family Planning Association of Nepal (FPAN), activated its emergency response system early on. With funding support from the Australian Government, FPAN and IPPF Humanitarian initially mobilised their response in four of the worst affected districts (Sunsari, Saptari, Bardiya, and Dang). Mobile medical camps were established to meet the sexual and reproductive health needs of the affected population, including through the distribution of short and long acting methods of contraception, STI and HIV screening, and GBV referrals. In collaboration with the USAID-SIFPO project, services were then expanded into five more affected districts. IPPF Humanitarian spoke with 21-year old Muna in her home district of Sunsari in Nepal.  “I got married at 16 years old and have two children, a four-year-old girl and two-year-old boy.  In my caste, we get married early, so my parents took me to get an arranged marriage. I was in the 8th class at the time, and returned to school after I got married, but only lasted one year.  My husband works in construction and had to stop working for two weeks when the floods came. When he doesn’t work, he doesn’t get paid, so it’s been very difficult.  A FPAN social worker told me about the mobile medical camp today. I used to be on the three-month injectable but today I changed to the five-year implant in my arm.  When my youngest child was eight months old I found out I was pregnant again. I decided to discontinue that pregnancy, so I took the five small tablets given to me by my neighbourhood doctor. I was two months pregnant at the time.  From this, I had two days bleeding and cramp like pain, and then weakness. I decided to abort that pregnancy because my youngest will still only eight months old, and I didn’t want any more children.  If I had more than two children, it would be very difficult to feed and educate them, and would badly affect my body too. I’m so happy I now don’t have to worry about contraception for another five years.” Want to know more about safe abortion access? Join IPPF'S I Decide movement

Muna Shrestha lives with her husband and two children in Bakultar, a rambling village of mud houses, tea shacks and vegetable, miles off a main road, at the end of a long dirt track in Kavre district, a few hours west of Kathmandu. On the morning of Saturday 25 April 2015, when the earthquake struck, she and her family were cleaning the cowshed. “It was so scary,” she says. “The children were not at home: we were so worried about the children and went looking for them. They were also looking for us.” The days after the earthquake were chaotic. “The schools were closed for a month,” Muna says. “And because all our clothes and possessions were in the ruins, it was difficult to get our things.” Their children were deeply traumatised. “They became scared, and, because of this fear, they wouldn’t eat and they suffered from nausea,” Muna says. As she speaks, she gestures around the family’s old home, at the deep fissures in the mud walls. “This home is cracked by the earthquake. Our family also have another house but that was completely destroyed.” Like many families across Nepal, the Shresthas have been unable to afford to rebuild and make their old home structurally safe. It is a story now ubiquitous across Nepal: a family losing their house and possessions, scarred by trauma, and unable to return home.

“After the earthquake, there were so many problems. So many homes were destroyed. People are still living in temporary homes because they’re unable to rebuild their homes.” Pasang Tamang lives in Gatlang, high up in the mountains of northern Nepal, 15 kilometres from the Tibetan border. It is a sublimely beautiful village of traditional three-storied houses and Buddhist shrines resting on the slopes of a mountain and thronged by lush potato fields. The 2000 or so people living here are ethnic Tamang, a people of strong cultural traditions, who live across across Nepal but particularly in the lands bordering Tibet. The earthquake of 25 April had a devastating impact on Gatlang. Most of the traditional houses in the heart of the village were damaged or destroyed, and people were forced to move into small shacks of corrugated iron and plastic, where many still live. “Seven people died and three were injured and then later died,” says Pasang. These numbers might seems small compared to some casualty numbers in Nepal, but in a tightknit village like Gatlang, the impact was felt keenly. Hundreds of people were forced into tents. “People suffered badly from the cold,” Pasang says. “Some people caught pneumonia.” At 2240 metres above sea level, nighttime temperatures in Gatlang can plunge.  Pregnant women fared particularly badly: “They were unable to access nutritious food or find a warm place. They really suffered.” Pasang herself was badly injured. “During the earthquake, I was asleep in the house because I was ill,” she says. “When I felt the earthquake, I ran out of the house and while I was running I got injured, and my mouth was damaged.” Help was at hand . “After the earthquake, there were so many organisations that came to help, including FPAN,” Pasang says. As well as setting up health camps and providing a range of health care, “they provided family planning devices to people who were in need.” Hundreds of families still live in the corrugated iron and plastic sheds that were erected as a replacement for tents. The government has been slow to distribute funds, and the villagers say that any money they have received falls far short of the cost of rebuilding their old stone homes. Pasang’s house stands empty. “We will not be able to return home because the house is cracked and if there was another earthquake, it would be completely destroyed,” she says. Since the earthquake, she has begun working as a volunteer for FPAN. Her role involves travelling around villages in the area, raising awareness about different contraceptive methods and family planning. Volunteers like Pasang perform a crucial function in a region where literacy levels and a strongly patriarchal culture mean that women marry young and have to get consent from their husbands before using contraception. In this remote community, direct contact with a volunteer who can offer advice and guidance orally, and talk to women about their broader health needs, is absolutely vital.

Two years after the earthquake that struck Nepal in April 2015, the village of Gatlang in the country’s mountainous north still lies in partial ruin. The houses here are built from enormous slabs of local stone, carved windows and doors, and roofs of stacked wooden planks. They face east towards the rising sun, their facades bedecked in intricate wooden carvings patterns linked to the ancient Buddhist culture of the Tamang people. Today, most of these houses lie in ruin, emptying the heart of the village of people, with most moving to temporary shacks on Gatlang’s fringes. Kopila Tamang is a 24-year-old farmer and mother to two young boys. Her husband, Nakul, works as a lorry driver and is often away. “When the earthquake struck, I was working in the fields,” she says. “If I had been at home, I would have died.” Kopila’s house – or what remains of it – lies at the centre of old Gatlang, on a street of traditional houses that have either entirely collapsed or are uninhabitable due to cracks and structural damage. Piles of stone and wooden cross beams are strewn in what was once a thriving village street. Like many families here, Kopila and her husband and boys have moved into a small shack built from corrugated iron and plastic. This was meant to be a temporary solution, but two years later, they are still living in it, unable to afford the enormous cost of rebuilding their old home. “It needs lots of money,” she says. “I don’t know when we will have the money to build this home again.” FPAN provided emergency health support to families like Kopila’s in the weeks and months after the earthquake. Mobile health camps offered medicines, health check ups, dignity kits, family planning, antenatal checks and other vital services.  These days, Kopila gets regular advice from Pasang Tamang, the FPAN reproductive health female volunteer in the village. Kopila had suffered after the birth of her last child. “I didn’t menstruate for eight months, and then after that I started using the [contraceptive] injection,” she says. “But there were some side effects: I started menstruating twice a month.” She then went to a mobile health camp run by FPAN and started using the intrauterine coil. “After that, my menstruation went back to normal,” she says. In a village scarred by the earthquake, access to family planning has brought some much needed stability and relief to Kopila and her small family. “FPAN provide different services and knowledge: I have come to know that having more children can bring suffering, because it’s not enough to just feed children, they must be educated too” she says. “A small family is a happy family.”

For 22-year-old student Anjal Auwal, April 25 began as an ordinary day. She had been up late the night, preparing for an exam. Tired after revising, she woke up late and went into the kitchen to eat. It was then that the earthquake struck. “When it struck and I saw the walls shaking and falling down, I collapsed,” Anjal says. “I knew nothing after that. It was just like a dream.” Anjal, a business student from Bhaktapur, spent five hours trapped in the rubble of her family’s house. They lived in one of the traditional mud and wooden houses that line the streets of this ancient temple city. Some of the mud walls and wooden support structure fell on Anjal’s legs and arms, trapping her. “I was thinking to myself: this is going to be the end of my life: I won’t survive,” she says. “I could hear sounds from outside and I began shouting and shouting, but no one heard me. My throat began to get sore and eventually I couldn’t make any more sounds. I felt so hopeless.” Hours later, Anjal heard her uncle’s voice from somewhere beyond the rubble that surrounded her. “I thought this is my chance, and I shouted again in the hope my uncle might hear me.” Eventually, five hours after being trapped, Anjal was pulled from the rubble, injured but alive. “My left side was not working, so my family took me to hospital,” she says. “But the hospital rejected me because they had such limited services. Eventually we found another hospital to care for me.” Anjal’s injuries were extensive. It took six months of medication, rest and rehabilitation for her hand and leg to recover. She also suffered digestion problems: whenever she ate, she would vomit, and the doctors became alarmed that her body was getting little nutrition.   Two years later, she has more or less recovered. “I still have a few problems with digestion, I have scars from the wounds and I occasionally gets pain in my hands, but things have improved a lot,” she says. Her sickness and long rehabilitation meant her studies were interrupted, but eventually she managed to take the exam and passed. Having time off has given her time to reflect on what she wants to do with her life. She’s now planning to volunteer for FPAN, after hearing about it from friends at school. “I haven’t so far because of my health problems,” she says. “But now I’m eager to join and to learn about sexual health and family planning. I’ve realised it’s very important.”