A few weeks ago, a harrowing image of a pregnant woman injured in the Russian bombing of a Ukrainian maternity and children’s hospital was doing rounds in the news and social media. Widely-circulated pictures showed the woman stroking her bloodied lower abdomen as rescuers carried her through the rubble on a stretcher following the airstrike on the hospital in Mariupol, which later killed her and her child. In addition to this being condemned as a war crime and an obvious violation of human rights by deliberately targeting a maternity and children’s hospital, the attack also highlights several risks to women and children in the Ukraine crisis.
Civilian casualties are one of the many huge costs of war. On the whole, noncombatants are killed in much greater numbers than combatants. The Office of the United Nations High Commissioner for Human Rights (OHCHR) recorded 4,232 civilian casualties in the country: 1,793 killed and 2,439 injured as of 9th April 2022.
The ongoing conflict in Ukraine has sparked massive displacement, forcing many Ukrainians to flee their homes to neighboring countries or other areas within the country. The vast majority of those fleeing are women and children.
Of the 10 million refugees, about 6.5 million are supposed to be internally displaced. Nearly 3.5 million people have crossed international borders. Roughly 1 million are children under the age of 18. Men between the ages of 18 and 60 are essentially not permitted to leave the country, given the needs of the Ukrainian war effort. Nearly 53% of internally displaced people are female. These numbers are expected to increase significantly as the conflict continues.
These statistics show that the health needs of people who are displaced, internally or those who have fled the country, represent the needs of women and children to a huge extent.
Women around the world already face limits on healthcare and reproductive rights and this access is further hindered during situations of conflicts and emergencies.
Among the current 4 million refugees who have left Ukraine, and roughly another 1 million internally displaced persons based on pre-war reports, around 120,000 displaced are estimated to be pregnant. Among these 18,000 are estimated to require emergency obstetric interventions.
During the conflict,women are disproportionately at risk of being cut off from all aspects of quality maternal health; throughout the entire cycle of care. On the most extreme level, women who were in the late stages of their pregnancies when the war in Ukraine started are now giving birth while displaced. Some of the women have even given birth in bomb shelters, where they may lack not only skilled birth attendance but even the basic supplies required to give birth safely.
Likewise, in situations of conflict and displacement, female refugees experience greater risk, trauma, and vulnerability than male refugees do. The war in Ukraine is putting women and girls at heightened risk of general violence against girls and women, including rape and other forms of sexual exploitation, increasing significantly. This is because they tend to end up in difficult and insecure living situations over long periods due to conflict.
According to a 2020 Amnesty International report, there was a severe increase in domestic violence in 2018 in the separatist areas of Ukraine; 76% in the eastern region of Donetsk and 158% in Luhansk. These types of statistics are not uncommon in situations of conflicts and emergencies.
Responding to the needs of those internally displaced and stranded within Ukraine must be a top priority right now. They must be represented in all decision-making platforms on conflict prevention, de-escalation, mitigation, and other processes in pursuit of peace and security. The inclusion of women themselves in the decision-making processes and humanitarian response is therefore essential to ensure that their rights are upheld.
The World Health Organization recommended prioritization for women and children in these situations as follows:
- Improving access to reproductive, maternal, newborn, child, and adolescent health services for internally displaced persons;
- Updating and organizing training with the inclusion of maternal and child health modules to increase the capacity of health care providers working in Mobile Emergency Primary Units by; and
- Strengthening services in emergency triage assessment and treatment of children.
These recommendations continue to apply in the current situation in Ukraine and should expand in correspondence to the size of the population affected by the conflict.
The situation in Ukraine is not unusual as every conflict sees these trends of disproportionate exposure to risks for girls, women, and children. As women and children continue to bear additional burdens of war, it is imperative to think about the role that age, gender, and health play in these conflict situations, and how best to respond to related needs.