O
ur world is in the midst of a paroxysm of violence, instability and upheaval not seen since the end of the Second World War. Over the past two decades, disasters, including ones related to extreme weather events, have affected billions of people. Today, crises, such as mass movements of people in response to extreme as poverty and unstable societies, are increasingly visible. Whole regions of the world seem to be in turmoil, and in a more connected world, even people in the stable zones feel more insecure than they once did. Many crises linger for decades, with no real solutions in sight. Refugees are living away from home for 20 years on average, with no access to durable solutions and sustainable livelihoods. In some cases, crises have persisted over generations (Milner and Loescher, 2011). Each crisis, whether a war, a deadly epidemic, earthquake or flood, brings unique challenges to the health, safety, livelihoods and rights of individuals, families and communities.
Pregnant women will only use services that are fast and within easy reach of transit hubs near border crossings, says Bojan Jovanovski, who heads the Association for Health Education and Research, or HERA, in the capital, Skopje.
Lidija Jovcevska Photo © UNFPA/Nake Batev
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CHAPTER 1
Today’s conflicts, devastation from disasters, instability, and environmental and economic vulnerability have triggered an unprecedented demand for humanitarian action from governments, civil society and international organizations. Floods and storms: most frequent natural disasters
The number of natural disasters tripled between 1980 and 2000, followed by a slight decline, but still double the number today than what was recorded 25 years ago, according to data from the Centre for Research on Epidemiology of Disasters. In most years, there are between one and three large-scale disasters that cause a level of death far greater than other events. In most decades, there are also one or two disasters so large and shocking to public consciousness they are labeled mega-disasters. For each person who dies in a disaster, there are hundreds more who are affected by it and require
HERA deploys its only mobile health clinic to the border with Greece, a few hundred metres from Gevgelijia, one day a week to provide free, quick, basic gynaecological services for refugees and migrants. UNFPA, the United Nations Population Fund, helps cover the clinic’s operating expenses. Lidija Jovcevska is an obstetriciangynaecologist based in Kumanovo. She volunteers one day a week for the mobile clinic. The five or six women she sees in a day mostly want to know whether their foetuses are healthy. She uses an ultrasound machine to reassure most expectant mothers but also lets them know about any potential complications. Some women who have traveled for days and sometimes months also ask for vitamin supplements to increase the
A FRAG I LE WO RLD
chances they will deliver healthy babies. Vaginal and urinary tract infections are common. Jovcevska prescribes antibiotics and other medications. On occasion, there is a serious problem requiring attention at a hospital. Jovcevska refers these cases to the nearby hospital, which can handle emergencies as well as deliveries. Jovcevska says the risks of traveling under such extreme conditions while pregnant are high. “It is unclear to me, as a mother of two myself, how they can even contemplate such a trip,” she says, while acknowledging the desperation that many of these women feel. “One woman I saw today told me, ‘It’s all right if I die on the way.’”