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Hold On A Minute - Episode 5 - Dignity And Disasters [Transcript]
HOST
Hello! You are listening to “Hold on a Minute!”, a podcast by UNFPA Asia and the Pacific. This podcast series presents inspiring and powerful stories on the sexual and reproductive health and rights of women across the Asia-Pacific region. I am Poupée, Chaowarat Yongjiranon, your host.
00:00:23:22
HOST
On this episode of Hold on a Minute! By UNFPA Asia-Pacific, we mark World Humanitarian Day on August 19th, to raise awareness on the importance of providing support to women and girls facing the brunt of humanitarian crises, who are often overlooked.
00:00:41:11
HOST
Asia and the Pacific is the most disaster-prone region in the world with nearly 45 percent of the world’s natural disasters occurring in the region. More than 75 percent of those affected by natural disasters globally live in the region. Humanitarian emergencies may occur due to political instability, pandemics and epidemics, economic collapse, and climate change.
00:01:05:21
HOST
Amidst the chaos, women and girls are vulnerable to gender-based violence, which includes sexual violence, exploitation, and abuse. Mothers die giving birth as access to safe delivery services are affected and unintended pregnancies increase due to the lack of contraceptives.
00:01:25:17
HOST
To gain more insight on how natural disasters traumatically impact women in labor, we join Bibi, a humanitarian and midwife who has been called to support an earthquake response.
Feature Story - STORY OF BIBI
My name is Bibi, and I am a humanitarian. By profession, I am a midwife.
One day I got a call to support the earthquake response that had destroyed a nearby village.
While I had received training on how to deliver emergency care, I will never forget this moment, as it was the first time that I had to assist childbirth without being in a delivery room.
I immediately joined the health outreach team and together we went to the village. The roads were destroyed and there was debris everywhere, but we were determined to somehow reach the village.
It was tiring and scary, but we finally got there.
I remember when I first saw Sara. She was eight months pregnant. She was injured and had lost her family members and relatives in the earthquake. She was shaking in shock and fear and was going into early labor.
There was a temporary tent clinic. I attended to Sara with the help of another midwife.
I was anxious, but we did our best to deliver the baby safely.
Thankfully, everything went well, and the mother and baby were fine after the delivery. I soon realized she also needed psychosocial support to cope with the emotional trauma.
When I looked around, I couldn’t believe what I was seeing. Many were in shock and were looking for their loved ones. Some were crying, holding lifeless bodies. I could see that there were more pregnant women.
In the tent, we saw up to 15 women that day for check-ups.
At night, we stayed in a nearby clinic in the district center. This was our temporary accommodation so that we could visit the village every morning.
That night I realized the important role midwives play, especially in a crisis.
During the first ten days, together with the team, we welcomed at least one new life into this world every day.
I also realized the importance of not only maternal health, but also emotional health, menstrual heath, and family planning – many things that we do not realize affect so many women and girls during emergency situations.
This experience has really changed the way I see the role of a midwife. I am proud of my job and I know that I can make a real difference.
No matter what, I will continue to do whatever I can to make sure every mother can bring life into the world safely.
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THIRD VOICE
‘Hold on a minute, the story doesn’t always end like this!’
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Host Introducing speaker
00:01:48:17
HOST
It is truly inspirational to see how important midwives like Bibi are at the scene of disasters.
00:01:55:06
HOST
Today we talk to experts from UNFPA to learn more about how dedicated humanitarian workers on the ground provide a lifeline of support for millions of women, girls, and young people by providing lifesaving sexual and reproductive health services, along with gender-based violence response services during times of crisis.
00:02:15:03
HOST
I am honored to have with me today, Tomoko Kurokawa, the Regional Humanitarian Advisor for UNFPA at the Asia-Pacific Regional Office based in Bangkok.
00:02:25:17
HOST
And Kristine Blokhus, the UNFPA Country Representative in Bangladesh based in Dhaka.
00:02:39:23
HOST
As a physician and public health specialist with over 15 years of clinical and teaching experience, Tomoko joined UNFPA in 2017 as the Deputy Director of the Pacific Sub-Regional Office in Suva, Fiji. Having worked with numerous international humanitarian NGOs including Médecins Sans Frontière and Project HOPE, she has led humanitarian responses in various countries.
00:02:59:00
HOST
Kristine has over 20 years of experience in international development and humanitarian response. Prior to joining UNFPA Bangladesh, she served as UNFPA’s Country Representative to the State of Palestine, leading UNFPA’s humanitarian response and development programming in the areas of sexual and reproductive health, gender-based violence, and youth and adolescent empowerment. Earlier in her career, she served as Deputy Representative in UNFPA Nepal.
HOST - INTERVIEW – EXPERT TALK
00:03:32:08
HOST
Tomoko and Kristine, thank you so much for coming on to our podcast today because this topic is definitely a very sensitive one - one that people are very concerned about, and that is what can we do to better support lives, especially women and children during times of crises. Bibi’s story is inspirational.
00:03:56:22
HOST
But with the intensifying effects of climate change, are such disasters increasing in the Asia-Pacific region, Tomoko?
00:04:00:20
TOMOKO
Absolutely, yes. Asia and the Pacific is the most disaster prone region in the world. Almost half of the world's natural disasters occur in this region, spanning from earthquakes and volcanic eruptions.
00:04:14:10
TOMOKO
Because we sit along what is called the Pacific ring of fire to floods, cyclones and landslides. In the past decade we've really seen an alarming increase in both the frequency and the intensity of natural disasters. And many disasters are following more unpredictable weather patterns and happening out of season. And all of these changes are due to the impacts of the climate crisis.
00:04:38:17
TOMOKO
Because of the geographic diversity of this region, though, we're seeing very different effects of climate change across subregions and countries.
00:04:46:11
TOMOKO
In addition, our region is experiencing political instability, epidemics and pandemics and economic crises. And very often these different types of disasters overlap and happen at the same time causing double, triple and even quadruple shocks. For example, in the Philippines, the COVID pandemic in 2020 came on the heels of a series of earthquakes, typhoons, a volcanic eruption, as well as dengue and measles outbreaks.
00:05:16:15
TOMOKO
Regardless of the type of disaster, though, what they all share in common is that disasters disproportionately affect women and girls. Men and women and boys and girls have very different experiences of disasters. And because of existing gender inequalities and social and cultural norms, women and girls face additional barriers in accessing services, especially health services like sexual and reproductive health services, which can be really catastrophic for women who are pregnant or women who are breastfeeding.
00:05:48:04
HOST
I often, I think a lot of us don't, I mean, we hear about it in the news but don't realize that, especially if you're living in this region, that we do have a lot of disasters that take place.
00:06:01:17
HOST
So, you know, during these crises, as you mentioned, it's very crucial that we ensure that there is enough access in terms of health care facilities for those who need it. But of course when the crises happen, roads are often blocked and access to health care facilities is disrupted. How would a pregnant woman be able to get the care that she needs to deliver her baby safely?
00:06:26:14
TOMOKO
Yeah, that's a great question. You know, no matter what type of disaster strikes, when or where, we need to remember that women do not stop getting pregnant and women do not stop giving birth.
00:06:41:02
TOMOKO
They don't stop caring for their children and families. But often their sexual and reproductive health needs are overlooked in disaster response - there is a need to prioritize this over food and shelter and other sectors. Without continued access to quality maternal health services, a pregnant woman's life and her baby's life are both at great risk.
00:07:01:23
TOMOKO
This is why it's absolutely critical to reach pregnant mothers and all women and girls, for that matter, with life-saving, sexual and reproductive health services from the onset of a disaster. So to answer your question of how a pregnant woman can get the care that she needs if she cannot access it easily, well, UNFPA invests in strengthening the health workforce who are working on the frontlines.
00:07:23:19
TOMOKO
So these are doctors, midwives, nurses and community health workers. And we make sure that they can mobilize quickly to disaster affected sites and deliver maternal health services.
00:07:34:24
TOMOKO
I'll give you a couple of examples. So in Indonesia, during the Ciencia earthquake response last year, UNFPA set up a reproductive health tent within 48 hours of the earthquake, and we fully staffed it with qualified midwives during a three month period that this tent was operational, 47 babies were safely delivered. In the Philippines during the response to Super Typhoon Odette in 2021, UNFPA worked with the government to set up ‘mobile women's health on wheels’.
00:08:08:08
TOMOKO
So it's an emergency mobile maternity facility that is fully equipped to support antenatal care deliveries, including basic emergency obstetric and neonatal care services and also postnatal care. And because it's a mobile truck, it was able to reach remote areas and to reach affected communities who were displaced by the typhoon. And of course, to ensure that these tents and mobile units can fully function and provide quality services for pregnant women, we also equip these units with lifesaving medicines, medical equipment and supplies, in addition to staffing.
00:08:45:20
HOST
But it's definitely a very huge task indeed to ensure that health care facilities are in access. And we can see here that we have a lot in place for such emergencies. But at the same time, though, Kristine, it is unfortunate, but we do have to face the reality that women and girls also face increased risk of gender-based violence during emergencies.
00:09:11:05
HOST
How and why does this happen? And what can be done to mitigate the risks?
00:09:15:18
KRISTINE
Yes, it's true. And I mean maybe let's first start by acknowledging the fact that all countries face challenges with gender-based violence even during normal times. So when an emergency happens, that risk is heightened because people are displaced. They might be sleeping in shelters. Maybe they're surrounded by strangers. They might have lost their family members or they might have been displaced from their family members. Their homes might have been destroyed. And the type of help and the type of supportive mechanisms that might normally be available are not.
00:09:51:12
Kristine
You cannot just call the police or ask the assistance of a social worker, for example. So the normal support systems that we have in a functioning society have broken down.
00:09:59:20
Kristine
And so on top of that situation, people are traumatized, they're stressed, they've been through very difficult things. They're anxious. And we know that in cases like that, people are more likely to behave unpredictably and they're more likely to behave with aggression.
00:10:14:22
Kristine
And so all of that combined leads to an increased risk of violence against women and girls, including both intimate partner violence within the family and also sexual violence. And we have seen that again and again and again in humanitarian situations.
00:10:31:19
Kristine
So when it comes to trying to mitigate that risk, I think it's important first to recognize that the first responders are always the community. So they're the ones who are there when it happens and they're the first people to try and help each other. So it's really important that the better the capacity of the community to deal with these kinds of issues, the better the first response can be.
00:10:54:12
Kristine
And so the more training we do in advance of an emergency to make sure that local people and local service providers have the ability to recognize cases of violence and to assist, the better our starting point.
00:11:08:03
Kristine
Besides that, though, it's really critical that we set up essential services as quickly as we possibly can. And that is why you will often see in the immediate aftermath of an emergency, UNFPA will provide services from a tent or from a mobile van.
00:11:24:11
Kristine
So after the Nepal earthquake, for example, we were providing services from tents in remote locations. And that's really about making sure that from the very beginning there is a safe place that women and girls can go to if they are facing violence or if they are afraid.
00:11:41:20
Kristine
And another thing I do want to say, though, which I think is really important, is that this risk of gender-based violence has to be mitigated throughout the humanitarian response.
00:11:53:18
Kristine
So we have to ask ourselves, are shelters and camps organized in a way that takes into account the safety of women and girls? You know, are bathrooms and wash facilities safe, is there adequate lighting, is food distribution organized in a way that doesn't put women and girls at greater risk? And so that's why it’s important. It's important to recognize that although providing GBV [gender-based violence] services is a very core part of UNFPA, its core activity is in an emergency.
00:12:23:23
Kristine
These preventative activities are the business of every humanitarian act. So we have a role to play. Also making sure that these concerns are mainstreamed.
00:12:34:03
HOST
It's so interesting, Kristine, how at the very beginning when you said, you know, we have to realize that this situation is not just something that we need to be concerned about during emergency situations. It's also, you know, outside of those settings and also across the whole world.
00:12:51:07
HOST
And, you know, as you mentioned, all those precautionary measures that need to be taken, it's going to take a lot of effort. So drawing from your experience in Bangladesh, as well as Nepal, Palestine and Indonesia. Can you share how your work is different in humanitarian emergencies as opposed to non-emergency settings?
00:13:11:09
Kristine
I think, you know, at the height of an acute crisis, so for example, in the first couple of days after an earthquake or cyclone or in a refugee situation and in the immediate aftermath of that, our overriding concern is to keep people alive and healthy, fed and sheltered and safe from harm. And really, we're doing this temporarily because during normal times there would be systems that people would rely on.
00:13:38:17
Kristine
So there would be a health system, there would be a system of protective services that the government provides or that exists for the benefit of people. And because those won't be working in many emergency situations, we're kind of stepping in as humanitarian actors to replace these functions for an individual period of time. So all of the humanitarian actors work very closely together to make sure that we cover these needs.
00:14:10:02
Kristine
And in UNFPA’s case, what we focus on in that situation is to provide essential sexual and reproductive health services and services for survivors of gender-based violence. So that means we're looking after we're making sure that women can access maternal health services, that if they're going to give birth, they can do it safely, even though they are in an emergency setting, they can continue accessing contraceptives.
00:14:28:24
Kristine
And women who experience violence can have assistance, counseling and health services and so on. But it's a spectrum. So we may be replacing these services and providing these services for a few months, or it might end up being many years. But eventually the aim is that people again will be able to access the health systems and protective systems that are provided by their government.
00:14:53:11
Kristine
And so as we deliver these emergency services, we're always keeping an eye on the longer term. We're always looking to make sure that the work that we're doing ultimately strengthens the longer term system and we're building the capacities of those systems. So we're, for example, providing training and capacity building to health service providers that will benefit the community. Also, after we're out of the emergency situation.
00:15:22:24
HOST
I can't believe that. You never really think about that. As an outsider, you'd often think that, okay, for those emergency cases you prepare for the short term or the time period where there is an emergency. But that's right. You have to think about it in the long term. And it's also a very huge, huge task to take over a lot of the services that are not provided that were there before.
00:15:48:19
HOST
So what would you say are the challenges then faced in ensuring the health, safety, dignity and rights of women and girls? You know, what are they, you know, in terms of the challenges that you face before, during and after a humanitarian crisis?
00:16:08:08
Kristine
Yeah, You know, fundamentally, I think if women and girls are not well prioritized during normal times, as unfortunately we know is often the case, and most likely they're also not going to be prioritized in a crisis response. So it's really important to ensure that we have the best possible protective mechanisms in place at all times before a crisis ever happens.
00:16:31:05
Kristine
So, of course, that's a lot of the work that we do in our regular development work. And then when a crisis happens, I think what often happens at the outset is that the voices of women and girls are not really heard. Humanitarian actors will go out and assess the damage and talk about what the needs are, but really they're often talking mostly to men because they're considered to be the community leaders, the heads of households. And so it's really important, we think, that we should also hear the voices of women.
00:16:59:06
Kristine
They often highlight different issues and they have different fears and concerns. And so I think a really major contribution that we often make is UNFPA is really making sure that from the get go someone is asking these questions of women. Do you feel safe in this town? When you go to take a bath, do you feel safe?
00:17:15:17
Kristine
Are there pregnant and lactating women in your family and community that need special care? It might not be the same things that men seek to highlight. Now I've seen firsthand how UNFPA works in humanitarian emergencies for nearly 20 years now. My first job with UNFPA was after the Southeast Asian Tsunami in 2005.
00:17:37:21
Kristine
And so I've seen really an evolution and I've seen firsthand that the work that UNFPA is doing to advocate for the needs of women and girls is having some important results. So I think the good news is, you know, 20 years ago, I'm not sure that I felt that the concerns of women and girls were — it was kind of seen as a little bit marginal, not so, so key and so priority.
00:18;02:09
Kristine
And I do think that the work that we have done has served to put the vulnerabilities of women and girls much more on the agenda. I think we are accepted as an important humanitarian actor with something important to provide. And I also think we have the support of many generous donors who really wish to make these vulnerabilities a priority.
00:18:25:14
Kristine
And yet, even so, it can be challenging to advocate for these particular needs when there are, of course, also many other competing sexual safety needs. So our job, I think, is really to do the advocacy and to make sure that women and girls are at the front and center in an emergency response.
00:18:45:10
HOST
Wow. Thank you so much for sharing your experience. I could say I feel kind of lifted a bit in terms of how you said that you've observed things have changed.
00:18:54:03
HOST
But at the same time, obviously ensuring that the rights of women and girls are there, it's a very huge task. And from what I understand is it's really in terms of the culture and the bigger picture in terms of not forgetting that they are there and to ask if they need help.
00:19:14:22
HOST
So with that, when we take a look at the whole region as itself, you know, in terms of how we can better work with all the different stakeholders when it comes to crises. Tomoko, what is UNFPA doing from a regional perspective to better respond to the intensifying crises?
00:19:34:18
TOMOKO
Yes. So given that the Asia-Pacific region is the most disaster prone and we experience frequent and intense disasters, it's absolutely essential to invest in strengthening preparedness and disaster risk reduction efforts.
00:19:50:09
TOMOKO
We work closely with governments and national partners first and foremost, to build capacity of health service providers through trainings and workshops. And we place a particular focus on the midwifery workforce because midwives are trusted within their communities and they are often the first point of contact in the health sector for many women and girls. We ensure that qualified midwives have the skills, the knowledge and the tools to deliver sexual and reproductive health services, both in normal times, but also in emergency settings.
00:20:23:21
TOMOKO
Also, the COVID pandemic forced us to think outside the box and explore digital technology applications, online platforms and virtual modalities of service delivery. So we're actually using a lot of those digital innovations and applying them in the field now for disaster response.
00:20:44:14
TOMOKO
We've also diversified our partnerships and countries to work more and more with local NGOs, local government organizations and also civil society organizations who are deeply embedded and trusted in their communities.
00:20:59:07
TOMOKO
They understand the local customs and also speak the local dialects, so they have a wider geographic coverage in countries to then reach disaster affected communities with essential services.
00:21:11:19
TOMOKO
We've also invested a lot in prepositioning of supplies and medicines, both in disaster prone countries, but also we stockpile in two strategically located regional hubs in Australia and Fiji. So having supplies procured in advance and then stored in national warehouses in disaster-prone countries has really been a game changer for UNFPA because it enabled immediate distribution of supplies to support delivery of lifesaving and sexual reproductive health services in the field.
00:21:45:24
TOMOKO
During the COVID pandemic, and as you know, global supply chains were widely disrupted during the pandemic. These pre-positioned stock made the difference between life and death for many women and girls affected both by the pandemic and also by overlapping natural disasters.
00:22:04:00
TOMOKO
We also invest a lot of effort in global, regional and national advocacy, with stakeholders, donors and partners to highlight the importance of prioritizing the needs of women and girls in disaster response.
00:22:17:22
TOMOKO
Some governments have also recognized the value of pre-positioning reproductive health supplies through the work that we do. And some have used national budgets to procure and pre-position similar items themselves.
00:22:31:18
TOMOKO
So these are some success stories, but of course there's still a lot more work to do.
00:22:36:07
HOST
Wow, it's amazing how we can see that things have progressed, especially during the pandemic, with the technology coming in hand and also more collaboration, more cooperation from governments,Tomoko.
00:22:53:05
HOST
Kristine, when you then take a look at the country-level, what can UNFPA do at the country-level to better respond to crises?
00:22:58:23
Kristine
I think maybe the most important thing is making sure that we're working in very close partnership with the government to make sure that the systems that they have are resilient.
00:23:08:17
Kristine
So ideally, what we would want to see is that although you have a crisis occurring, the health system, the protections system, other systems can withstand some shocks and continue to provide services. Or if they are badly affected, that they can bounce back quickly and start providing services pretty soon after an emergency has occurred. So that preparation is really, really key.
00:23:31:11
Kristine
And that is and so it's training, capacity building. So just as an example of that here in Bangladesh, one of the things we do is we work with the government health system to make sure that they have good plans in place for emergencies like floods that happen in almost every year, where, for instance, if serious flooding happens, we can very quickly deploy midwives to emergency locations to help women who are giving birth.
00:23:57:11
Kristine
And so that kind of planning can really save a lot of lives. Tomoko also mentioned our very successful regional initiative to pre-position supplies. I've seen that firsthand, both in Nepal and Bangladesh. How much of a difference that makes. It means that when an emergency hits, we have the ability to provide essential supplies straight away, really on one of the first days after the emergency happens.
00:24:20:20
Kristine
And that has saved us a lot of valuable time. And then, you know, like I said before, if the needs of women and girls are not a priority, they will be at greater risk. So the advocacy work that we do is also really important. We do a lot of work both in Bangladesh and around the region, to highlight exactly how women and girls really are very critical during times of crisis.
00:24:48:00
Kristine
And we do that to try to ensure that the necessary resources are allocated and necessary plans are made so that we can be prepared and that we can be resilient.
00:24:56:18
HOST
It's so interesting how it's not just the technical side that's important, but also in terms of working together as a community, as a nation and as a region. So it's going to be very interesting to see how things progress. And I really like the next question that I want to ask. I think Tomoko first and then Kristine, because I want to hear from Kristine as well.
00:25:22:12
HOST
And that is what can our listeners do to be a part of the collective action? Tomoko, if we could, you know, kind of encourage more or are if you are talking to someone who whoever is listening to us right now, I'm sure they, they feel that they want to be a part of this movement. They want to do something. Tomoko, what can they do?
00:28:23:00
TOMOKO
Yeah, this is a great question. You know, collective action starts with awareness. So my hope is that the listeners of this podcast will walk away understanding that disasters and climate change are not gender neutral, whether it's armed conflict or a climate change induced natural disaster, women and girls bear the brunt.
00:26:14:12
TOMOKO
Women and girls affected by crises can be menstruating and will need access to menstrual products, access to clean water and soap to maintain their basic hygiene. They can be pregnant and will need access to antenatal care visits or emergency obstetric services, if they experience pregnancy related complications. They will need continued access to contraceptives to be able to choose whether, when and how many children to have.
00:26:43:08
TOMOKO
For a woman or girl coping with a crisis situation, access to contraceptives is an important part of protecting her own health and also the well-being of her family. This doesn't change during disasters. Women and girls who are at increased risk of gender based violence will need access to information and services to reduce their exposure to violence, and services for survivors of violence must be available to support their recovery.
00:27:11:04
TOMOKO
All of these needs of affected women and girls are very real and it has to remain a top priority. So my parting message for this podcast is that investing in sexual and reproductive health and gender based violence services in disaster response and climate action for women and girls is truly lifesaving.
00:27:33:14
HOST
Tomoko, thank you so much for sharing that. Kristine, I'm sure being on the ground and having experienced crises, emergencies, you know, for those who are on the outside looking into the situation and who are listening to us now, what can they do? Obviously, they feel that perhaps, maybe, they might not be able to do much if they're just listening to a podcast.
00:28:06:14
HOST
But what is your advice for our listeners to want to do more as a, you know, being a part of a collective action?
00:28:07:12
Kristine
Yeah, I think it's a great question. And I think Tomoko’s answer is so good. I think maybe what I would say is I would go back to something I said a little earlier, which is that when a crisis hits, the first responders are always the community.
00:28:21:06
Kristine
And I have been so impressed and so many times that I've been in an humanitarian crisis to see how, for example, youth networks just pull together and respond, how local women's groups support other women, how really just local people and local volunteers just have the ability to support each other.
00:28:45:07
Kristine
And because they are the first people on the ground and they are the first people to support each other, I think actually that's where most of us as regular people in our normal civilian lives can be very helpful in a disaster. So to be part of that community action, I think is really, really valuable. And those are the real heroes, I think, of humanitarian response.
00:29:08:01
HOST
Well, Kristine, Tomoko, thank you so much for shedding light on disastrous situations and how UNFPA is actually working not only during the disaster but also before the disaster to try and make sure that women and children have the right access and care that they need during such situations.
00:29:31:02
HOST
And I'm sure our conversation today has definitely inspired and also probably lit some sort of spark amongst our leaders and also our listeners who are with us today on our podcast to do something to be a part of the big collective act towards supporting better care for women and children during crises. Thank you so much, Tomoko. Thank you so much, Kristine.
00:29:52:08
TOMOKO / Kristine
Thank you. Thank you so much.
Host Conclusion
00:29:54:19
HOST
This has been the latest episode of “Hold on a Minute!” by UNFPA Asia-Pacific. It is clear from our talk today that in the face of disasters, we as a world community can come together to ensure lifesaving sexual and reproductive health services to women and girls, who are often overlooked. Together, we can provide the safety, rights, and dignity that they deserve.
00:30:20:13
HOST
For more insightful episodes of “Hold on a Minute!” by UNFPA Asia-Pacific, follow our podcast pages on Spotify, Facebook, YouTube, and Apple Podcast. Just search for UNFPA “Hold on a minute”.
See you in our next episode!
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