Care with dignity in humanitarian crises: ensuring sexual and reproductive health and rights of displaced populations.

Each year, the number of people affected by humanitarian emergencies continues to increase, and the contexts become more complex, requiring thoughtful, intentional innovation and the creation of an evidence base that informs programme design, implementation and practice. In 2015, the numbers of people forcibly displaced from their homes hit a record high, with a 75% increase in two decades, rising from 37.3 million in 1996 to 65.3 million by the end of 2015. This translates to 24 persons being displaced from their homes every minute of every day in 2015, as a result of persecution, conflict, generalised violence or human rights violations. This trend is expected to continue. In addition, there were 19.2 million new displacements associated with natural disasters in 113 countries. The right to sexual and reproductive health (SRH) is an indispensable part of the right to health and is dependent upon a number of factors that include availability and accessibility to quality evidence-based services. While entire populations benefit from access to SRH services and rights, women and adolescent girls face a host of particular vulnerabilities. It is estimated that around 26 million women and girls of reproductive age are living in emergency situations around the world and face increased threats to their sexual and reproductive health and rights (SRHR), requiring access to quality services. While services such as food aid, shelter, water and sanitation, security and basic health services are crucial in the early stages of a humanitarian crisis, the provision of reproductive health services has been recognised as an additional priority early in an emergency. Commendable progress has been made to make SRHR services available since the mid-90s, when a landmark report highlighted the lack of comprehensive SRH care among populations in crises. This state of affairs triggered the 1995 formation of the Inter-agency Working Group on Reproductive Health in Crises (IAWG), a network of organisations dedicated to addressing the gaps in the provision of SRH services to communities affected by conflict and disaster. For more than two decades, organisations and individuals affiliated to IAWG have made concerted efforts to advance reproductive health through advocacy, research, standard setting and guidance development. To this end, major strides have been made, although much more remains to be done. In 2008, Reproductive Health Matters (RHM) dedicated a journal issue to the theme of conflict and crises, a well-timed issue that shed light on the devastating implications of conflict and crises on women and girls, highlighted ongoing response efforts and identified the unmet SRHR needs of populations in these fragile settings. Nearly 10 years later, with record numbers of people facing crises and displacement, it is once again time to draw attention to advances made, share best practices and discuss challenges in service implementation in crises and protracted humanitarian settings. A global evaluation conducted from 2012 to 2014 revealed that while considerable advances have been made, some of the concerns raised and gaps identified in RHM’s 2008 issue still ring true today. Building on previous work, the articles published in this journal issue cover a range of complex and sensitive topics such as safe abortion care, gender-based violence, sexual violence against men and sex work among refugees. Studies also address quality improvement and training of health workers with the aim of improving practice and care for better maternal and newborn health outcomes. EDITORIAL