Sexual and reproductive health inequities
Nearly 25 years since sexual and reproductive health (SRH) was recognised as a fundamental human right, significant inequities in its fulfilment still exist. Global gaps prevail amongst the most marginalised, such as refugees. SRH interventions in humanitarian settings are failing to meet refugees’ needs, amongst others due to the lack of robust data. In the European region, studies are mostly limited to Turkey, adolescents are not accounted for, and demand-side factors are insufficiently examined. To date, not a single situation analysis of any European camp has been conducted.
Understanding refugees’ needs
Traditionally, individual preferences of financial donors, like NGOs, were the primary drivers of SRH interventions in humanitarian settings. However, planning for comprehensive services and tailored healthcare is only possible if needs, capacities, values and aspirations of the population are understood. In line with increased efforts to conduct people-centred research and decolonise healthcare programming, health needs assessments serve as a valuable tool. They ensure a systematic approach is deployed by which inclusive understanding of priorities is gained.
A new beginning?
Moria Reception and Identification Centre (RIC), situated on the island of Lesbos, was Europe’s largest formal refugee camp before being destroyed by fires in September 2020. The newly constructed Closed Controlled Access Centre (CCAC) Mavrovouni replaced the notorious Moria after its destruction. Here, one in four residents is a woman of reproductive age.
Refugee women as co-researchers
Actively involving refugees as partners and collaborators in the research process has the potential to improve research relevance, quality and impact. This study ensures meaningful engagement of refugees through their role as co-researchers. The convergent mixed-methods design helps identify refugees’ needs in two ways: (A) by gathering insights from the refugees themselves (demand-side) through: a quantitative household survey among women, focus group discussions with innovative participatory approaches such as community mapping and photovoice, and participatory ethnographic evaluation and research (PEER) interviews; and (B) by examining the perspectives of service providers (supply-side) through: assessments of primary and secondary sexual and reproductive health services, and in-depth interviews with key informants such as local and international non-governmental programme leads, SRH focal points, influential workers, government officials and community representatives. Quantitative and qualitative data are merged for deeper understanding. Stakeholder dissemination workshops result in co-created recommendations.
Empowerment by democratising healthcare
Ultimately, this research project seeks to promote healthcare democratisation and to empower the refugee community to shape their own health. Outcomes will facilitate planning for quality services, improve inter-agency collaboration, bridge the dissonance between academia and the humanitarian sector, encourage transition across the humanitarian-development nexus, and answer the Sustainable Development Goal promise to ‘leave no one behind’.
We have a sincere hope that this project will serve as an exemplar to similar efforts in other contexts.