Four Months On: A Snapshot of Priority Reproductive Health Activities in Haiti An Inter-agency MISP Assessment Conducted by CARE, International Planned Parenthood Federation, Save the Children and Women’s Refugee Commission May 17-21, 2010 The Minimum Initial Service Package (MISP) for reproductive health (RH) is a coordinated set of priority activities to be implemented at the onset of every new emergency to prevent and re- spond to sexual violence; prevent the transmission of HIV; prevent excess maternal and newborn morbidity and mortality; and plan for the provision of comprehensive RH services. The MISP is an international standard of care as articulated in the SPHERE Humanitarian Charter and Minimum Standards in Disaster Response and the Inter-agency Standing Committee Health Cluster Guide. Context Purpose of the Assessment At the time of the assessment, four months after the January The purpose of this assessment was to examine the extent 12 earthquake, an estimated 2 million individuals1 remained of MISP implementation as a response to the January 12 displaced in settlement sites in earthquake-affected areas, earthquake in three areas that were severely impacted by the including Port-au-Prince, Jacmel, Leogane, Petit Goave and earthquake. The assessment examined MISP implementation Grand Goave.2 The Government of Haiti and humanitarian in Port-au-Prince, Leogane and Jacmel, through structured in- organizations have scaled up their response and contingency terviews with 34 staff from 21 United Nations (UN) agencies, planning, particularly for food, water, health and emergency local nongovernmental organizations (NGOs), international shelter with the advent of the rainy and hurricane season.3 NGOs and the Ministère de la Santé Publique et de la Popu- lation (Ministry of Public Health and Population) (MSPP) of The February 18 revised Flash Appeal included a historic Haiti; 10 facility assessments of nine agencies; and 14 focus level of commitment to RH: among the 51 health projects in group discussions with 329 displaced women, men and the revised Appeal, eight addressed MISP implementation adolescent boys and girls. and nine addressed broader RH.4 As of mid-May, 63 percent of the Health Appeal and 64 percent of the Protection Ap- General Findings on MISP peal had been funded, with the average for RH under Health, and prevention and response to gender-based violence Implementation (GBV) under Protection funded at 45 percent and 47 per- Over all, the assessment team found an unprecedented level cent, respectively.5 of awareness among international organizations about the need for priority RH services and stronger efforts to address Of the 1,341 camps and spontaneous settlement sites in them—more so than in any previous emergency setting Haiti, only 206 were reported to have camp management. assessed by the Women’s Refugee Commission. Notable Hence, those with a dedicated agency for camp manage- improvements in coordination and in efforts to implement ment registered coverage of only 15.5 percent of sites or each of the MISP priority activities were observed. The over- 37 percent of the affected population.6 Food, water, shelter arching magnitude of the disaster in an urban context, with and livelihoods remain a predominant concern for displaced more than 400 diverse agencies participating in the health populations, and the environment remains ripe for risks to response, understandably posed unique challenges. Gaps physical security. remain in addressing critical needs to prevent and respond to sexual violence; sustaining and decentralizing RH coor- dination throughout the response; expanding coverage of 1 EARTHQUAKE-AFFECTED AREAS AND POPULATION MOVEMENT IN HAITI mechanisms to prevent and respond to sexual violence, such CUBAEARTHQUAKE INTENSITY 73° W 72° W NORTHWEST The Modified Mercalli (MMI) Intensity Scale* Palmiste as the GBV Sub-Cluster under the Protection Cluster, exist, N N 20° NORTHWEST 20° ESTIMATED MMI INTENSITY Port-de-Paix 45,862 Saint Louis Du Nord 4 LIGHT 8 SEVERE Anse-a-foleur NORTH but effective implementation was weak at the community Jean Rabel 13,531 Monte Cristi 5 MODERATE 9 VIOLENT Le Borgne NORTHWEST Cap-Haitien NORTHEAST 6 STRONG 10^ EXTREME Bassin-bleu Port-margot Quartier 8,500 level, given risk factors such as intimidation by rogue male Limbe Marin Caracol 7 VERY STRONG Baie-de-Henne Pilate Acul Plaine Phaeton Anse Rouge Gros Morne Limonade *MMI is a measure of ground shaking and is different Du Nord Du Nord Fort-Liberte Plaisance from overall earthquake magnitude as measured Trou-du-nord Ferrier by the Richter Scale. NORTH Milot community members, insufficient lighting, lack of a dedicated Terre-neuve Sainte Suzanne ^Area shown on map may fall within MMI 9 Dondon Grande Riviera Quanaminthe classification, but constitute the areas of heaviest Dajabon ARTIBONITE Du Nord Perches shaking based on USGS data. Marmelade 162,509 Gonaives Bahon NORTHEAST Source: USGS/PAGER Alert Version: 8 Ennery Saint-raphael camp management agency in each camp, insecurity within HAITI EARTHQUAKE Vallieres Ranguitte Saint Michel Mont Organise 230,000 killed ARTIBONITE De L'attalaye Pignon 196,595 injured La Victoire POPULATION MOVEMENT * the camps and an overall lack of basic necessities, including 1,200,000 to 1,290,000 displaced CENTER Source: OCHA 02.22.10 Dessalines Cerca 3,000,000 affected Grande-Saline 90,997Carvajal * Population movements indicated include only Maissade Cerca-la-source individuals utilizing GoH-provided transportation *All figures are approximate. Commune Petite-riviere- Hinche and do not include people leaving Port-au-Prince food, water and livelihoods. While many agencies reported population figures are as of 2003. de-l'artibonite utilizing private means of transport. Saint-Marc SOURCES: OCHA/GoH 02.22.10 Thomassique DOMINICAN REPUBLIC Verrettes N N 19° CENTER 19° having employee codes of conduct, SEA was of particular Elias Pina GRESSIER* CARREFOUR* Belladere Mirebalais Lac de WEST Peligre concern for women and girls, who noted having to trade sex 40-50% destroyed 40-50% destroyed Magasin Baptiste Arcahaie Lascahobas Commune population: Commune population: Saut-d'eau 25,947 373,916 Pointe-a- Duvalierville Raquette Savenette Jeremie PORT-AU-PRINCE with international and local humanitarian agency staff, among Cornillon Thomazeau Commune population: GRANDE 704,776 Cap Dame- Abricots Marie ANSE Roseaux WEST Metro area population Corail Petit Trou NIPPES Carrefour estimate: Over 2,000,000 119,871Moron Pestel De Nippes Gressier 7 Croix Des others, for protection from rains or for money or food. Chambellan Ganthier 33,351 Leogane Î! Bouquets Anse- GRAND ANSE Gressier Carrefour PORT-AU-PRINCE Petite Rivieres Fond DOMINICAN Dhainault Baraderes Anse-a-Veau Petit-Goave De Nippes Sources Chaudes L é o g â n e Parisien Jimani REPUBLIC C o m m u n e Fonds- Miragoane MAGNITUDE 7.0 Les Irois Lasile NIPPES Petit-Goâve Grand- Trouin Verrettes Unconfirmed Maniche C o m m u n e Goave 1/12/10 21:53:09 UTC La Cahouane Camp-perrin J a c m e l Numbers Cavaillon Aquin C o m m u n e WEST Tiburon Chardonnieres Les Anglais SOUTH SOUTHEAST 32,253 Jacmel Belle-anse All assessed agencies were aware of the need to refer cases La Vallee De Jacmel Thiote Port-a-piment Coteaux Chantal Saint-louis-de-sud Les Cayes Cayes- Marigot Bainet Jacmel Roch-a-bateau Cotes-de-Fer Grand-Gosier Banane Torbeck SOUTH of sexual assault for clinical care; many in Port-au-Prince and Port Salut 88,533 Saint-Jean Pedernales PETIT GOÂVE* LÉOGÂNE* JACMEL* N Anse-a-Pitres N 18° 15% destroyed 80-90% destroyed 50-60% destroyed 18° 0 10 20 mi Leogane were equipped with referral cards for heath facili- Commune population: Commune population: Commune population: 134,190 137,966 The boundaries and names used on this 0 10 20 30 km 117,504 map do not imply official endorsement or 74° W 72° W #!" 73° W acceptance by the U.S. Government. ties, and several agencies in Port-au-Prince provided referral transport. Facilities reported challenges to ensuring privacy services; and making beneficiaries aware of good quality, free however, and the need for psychosocial support for survivors. MISP-related services. While there are referral cards for services in distribution, it is not clear if the information listed is current or whether servic- MISP Assessment Findings es have been thoroughly vetted for quality and 24-hour avail- ability. Communication to the community about the availability 1. Coordination and benefit of seeking care is also lacking. Unlike in previous emergencies in other settings, RH issues were profiled in the media and among donors and respond- 3. Preventing the Transmission of HIV ing agencies. Led by the UN Population Fund (UNFPA) with Given Haiti’s strong pre-existing HIV programs, efforts the MSPP, RH coordination was initiated under the Health to continue prevention efforts post-earthquake were well Cluster in Port-au-Prince within a week of the earthquake. established. UNFPA ordered and distributed 7 million male The RH working group, tasked with coordinating the RH condoms in the earthquake-affected areas. While camps in response and MISP implementation, continues to meet on Port-au-Prince appeared to be initially saturated with con- a weekly basis. RH coordination at the sub-national level doms, communities reported having to purchase them now was less established four months post-earthquake, although and they were apparently more difficult to access in settings agencies were taking steps to initiate coordination efforts in further from Port-au-Prince. In Jacmel, girls reported repeat- Leogane and Jacmel in the Southeast. edly testing for HIV simply to receive five condoms. Demand Inter-agency Reproductive Health Kits7 were available to health care providers from the onset, although supplies were quickly exhausted, particularly clean delivery kits and preg- nancy tests. Supplies were procured to serve a population of 1 million, while the affected population totaled an estimated 3 million.