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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

In May 2017, flash flooding in Sri Lanka triggered landslides resulting in many people losing their homes, forcing them to seek shelter in camps. IPPF’s member association the Family Planning Association of Sri Lanka (FPASL) assisted those affected and provided health camps with the support of IPPF Humanitarian. Chathurika Jayalath, a youth volunteer for FPASL, took part in the response. Chathurika is a 24-year-old student from Kegalle, a large town about 80 km from Colombo, and she has been working with FPASL for the last three years. She started out as a youth volunteer and recently became a member of the Youth Technical Advisory Committee. During her engagement with FPASL, Chathurika has learned about sexual and reproductive health and rights (SRHR) and gender issues and has organized workshops on similar topics in her own community. In fact, she runs a youth club at her university to inform her peers about SRHR.  Shortly after the floods began, Chathurika received a WhatsApp message from FPASL where they called for youth volunteers to take part in the response.  “I wanted to volunteer during the response,” Chathurika told us. “As a university student I didn’t have money to donate so I figured I could contribute with my strength instead. I volunteered in the health camp. There, I assisted the medical staff with basic things such mobilizing affected people, making sure they queued up when seeking health care and packed medicine.” Ongoing SRHR needs, even in a crisis Chathurika is keen to learn more about humanitarian work. She received training with FPASL on the needs of people in humanitarian settings in which she and other trainees were presented with different case studies. “There was particularly one story that struck me. We were told that when the flash floods came, women fled without anything, they fled with the only pair of clothes they were wearing,” recalls Chathurika. “When they reached the camp, they received donated water and food. Some of them got their period while living in the camp. They did not have any sanitary pads nor additional cloths. Some of them even fled without underwear. This story made me realize that people’s SRHR needs don’t disappear just because there is a crisis.” Youth empowerment is important to Chathurika and she would like to continue this work while learning more about development and humanitarian work. She is a firm believer “that young people can contribute. Through my own experience I have seen that it is possible.”   

Incessant rains across Sri Lanka during May 2017 affected over half a million people in seven districts. Most affected was the Ratnapura district where over 20,000 people faced flash floods, and where 46 deaths were reported. IPPF Humanitarian, in partnership with FPA Sri Lanka, responded to this catastrophe through the distribution of over 700 dignity kits in Ratnapura Dr. Rohan Jayasuriya and midwife Chaturika Lakmale were on the ground during and after the floods providing family planning services and contraception to women affected by the disaster. “When the floods came our clinic was located on higher ground, so it wasn’t damaged. The floods finished on the 31 May 2017, and we reopened one day later on the 1 June 2017. After the floods, we arranged several special clinics just for family planning, and distributed condoms and emergency supplies of the pill to camps in case women missed their regular form of contraception like injectables, implants or IUDs. In Sri Lanka, approximately 67% of couples use family planning, 26% of which prefer IUDs” We offered condoms and emergency supply of the pill. We told women to keep one packet of the pill in their handbag, and one in their home, should they ever have to run quickly in an emergency. One pregnant woman was delivering at this time, so she had to go on a boat to dry land, and then onwards in a vehicle to the hospital. Once we reopened the clinic, two of our own midwives were unable to attend work as the floods had affected them, but I was here. It was so busy.” Stories Read more stories from Sri Lanka

Incessant rains across Sri Lanka during May 2017 affected over half a million people in seven districts. Most affected was the Ratnapura district where over 20,000 people faced flash floods. “When the flood came, my husband was feeding my eldest child and the baby was asleep in the bed. I was outside of the house. My mother was brushing her teeth outside the back of the house. I looked up and saw trees falling near my neighbour’s house up the hill. My neighbours died. I couldn’t take any possessions – I just had to run for my life. My husband took my younger child. They were all screaming. Since then, I have had my children checked here in the Ministry of Health clinic; their weight, height and nutrition. We had two houses on the one block of land, but we will only get compensation for one house. We can’t live in a tent with a baby so are currently renting a house with our own money, but for a while my mother and father slept in this clinic.” Stories Read more stories from Sri Lanka

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.”

“When the earthquake struck, I was on the sixth floor of my family’s house, with my son. For 15 or 20 minutes, I couldn’t do anything. I tried to open the door but I couldn’t: I was trapped.” Rita Chawal is 32 years old and married with a small son, who was four at the time of the earthquake. They lived together with 15 other members of her husband’s family in one of the tall, traditional houses that line the streets of Bhaktapur, an ancient temple city 15 kilometres from Kathmandu. The earthquake caused extensive damage to the city, bringing down old brick houses, shops and schools, and destroying some of the medieval temples in the network of squares that make up the city’s historic centre. The entire back of Rita’s house collapsed. “Eventually, we managed to come down from the sixth floor, but once we got to ground level, we saw that many houses had collapsed,” she says. “It was really terrifying seeing those scenes. Nevertheless, we managed to cross over the demolished buildings and get to the public football grounds, where we stayed together and lived in tents.” Sexual health and the menstrual needs of women and girls tend to be neglected by aid organisations in the aftermath of natural disasters. One problem is that WASH (Water, sanitation and hygiene) response tends to be coordinated and designed by men, who can more easily overlook women’s needs. This is why organisations like FPAN are so vital in frontline response after disasters. “After the earthquake, family planning services stopped for a few days,” Rita explains. “But after that there were health camps [run by FPAN] that distributed dignity kits and family planning devices. I received dignity kits [sanitary pads etc] from them.” Rita was so moved by the suffering around her and so inspired by the work of FPAN and other NGOs, that, after attending to her own and her family’s needs, she began working as a volunteer distributing dignity kits to women and girls living in tents. FPAN services are vital, both during emergency response and in normal life. Rita says the fact that FPAN community mobilisers and volunteers can mediate well between local people and the health services, and articulate their needs, makes them unique in Nepal. “The activities that FPAN are doing are really good,” she says. “I and the women in this community really want FPAN to continue their services because they are the best ones we get. We are really worried they might stop.”

The April 2015 earthquake in Nepal brought death and devastation to thousands of people – from which many are still recovering. But there was one positive outcome: after the earthquake, thousands of young people came forward to support those affected as volunteers. For Rita Tukanbanjar, a twenty-two-year-old nurse from Bhaktapur in the Kathmandu Valley, the earthquake was an eye-opening ordeal: it gave her first-hand experience of the different ways that natural disasters can affect people, particularly women and girls. “After the earthquake, FPAN was organising menstrual hygiene classes for affected people, and I took part in these,” she says. The earthquake severely affected people’s access to healthcare, but women and girls were particularly vulnerable: living in tents can make menstrual hygiene difficult, and most aid agencies tend to neglect these needs and forget to factor them into relief efforts. “After the earthquake, lots of people were living in tents, as most of the houses had collapsed,” Rita says. “During that time, the girls, especially, were facing a lot of problems maintaining their menstrual hygiene. All the shops and services for menstrual hygiene were closed.” This makes FPAN’s work even more vital. The organisation stepped into the breach and organised classes on menstrual hygiene and taught women and girls how to make sanitary pads from scratch. This was not only useful during the earthquake, but provided valuable knowledge for women and girls to use in normal life too, Rita says: “From that time on wards, women are still making their own sanitary pads.” In an impoverished country like Nepal, many women and girls can simply not afford to buy sanitary pads and tampons. Nepal is one of the poorest countries in the world with gross domestic product per capita of just $691 in 2014. In this largely patriarchal culture, the needs of women often come low down in a family’s priorities. “This is very important work and very useful,” Rita says. The women and girls also learned about how to protect themselves from sexual violence, which saw a surge in the weeks after the earthquake, with men preying on people living in tents and temporary shacks. Rita and her family lived in a tent for 20 days. “There was always the fear of getting abused,” she says. Eventually they managed to return home to live in the ruins of their house: “one part was undamaged so we covered it with a tent and managed to sleep there, on the ground floor.” Seeing the suffering the earthquake had caused, and the work FPAN and other organisations were doing to alleviate it, cemented Rita’s decision to begin volunteering. “After the earthquake, when things got back to normal, I joined FPAN.” She also completed her nursing degree, which had been interrupted by the disaster. “Since joining FPAN, I have been very busy creating awareness about sexual rights and all kinds of things, and running Friday sexual education classes in schools,” Rita says. “And since I have a nursing background, people often come to me with problems, and I give them suggestions and share my knowledge with them.” She also hopes to become a staff nurse for FPAN. “If that opportunity comes my way, then I would definitely love to do it,” she says.