Across Asia and the Pacific, frontline health workers—midwives, doctors, and community responders—persistently rush toward danger and hardship to save the lives of mothers, newborns, and vulnerable communities in floodwaters, conflict zones, and displacement camps. Their work unfolds in contexts of scarce resources and constant security threats, where every delivery, every emergency response, and every health check can be a matter of life or death. In Myanmar and neighboring regions, millions of women and girls remain displaced, with the Rohingya crisis marking eight years since the mass exodus to Cox’s Bazar, now the world’s largest refugee settlement. The same period has seen funding shocks reverberate through health systems, disrupt essential reproductive services, and heighten risks for those most in need. Against this backdrop, assaults on health facilities and personnel, sharp funding gaps, and the intensifying pressures of climate-driven disasters demand a reevaluation of how humanitarian action is organized, funded, and delivered—placing a premium on protecting health workers, sustaining local leadership, and keeping life-saving care within reach for women and girls when it is needed most.
Frontline health workers in crisis zones: the heart of humanitarian response
In every crisis—whether a flood-ravaged rural province or a city shattered by conflict—midwives, doctors, nurses, and community responders become the first on the scene and the last to depart. Their duties extend far beyond clinical care. They coordinate with local community leaders, identify pregnant women who need urgent obstetric attention, and mobilize essential supplies even when roads are compromised, clinics are shuttered, or mobile health teams have been suspended. The work demands relentless improvisation—finding alternative delivery routes, setting up temporary birthing spaces in shelters, and maintaining sterile conditions in makeshift facilities under threat of violence or subsequent flooding. The dedication of these workers often goes unseen, yet their decisions can determine whether a mother, her baby, or a survivor of gender-based violence survives the next hours or days.
Across settings—from rural villages to displacement camps—the spectrum of services delivered by frontline responders remains broad and vital. They provide antenatal care that can detect complications early, ensure safe deliveries, and distribute life-saving medications and supplies. They also deliver postnatal care, support family planning, and connect women with psychosocial services that address trauma and fear. In humanitarian operating environments, the success of these interventions hinges on stable funding, predictable supply chains, and protection from attack. When healthcare workers are targeted or forced to operate with limited protections, the entire delivery system destabilizes, jeopardizing maternal health outcomes and widening the gap in coverage for reproductive health services. The resilience of these workers is anchored not only in clinical acumen but in their deep ties to the communities they serve—the same communities they stay with through the aftermath of disasters and the long process of rebuilding.
The global panorama reveals a troubling pattern: as crises multiply and escalate, the burden on frontline health workers intensifies. They routinely navigate volatile security landscapes, respond to sudden shifts in population movements, and adapt to constraints imposed by funding cycles and political instability. Their work is inherently preventive and life-preserving, yet it is frequently underfunded and undervalued. The result is a vicious cycle: resource scarcity constrains the ability to pre-position life-saving supplies, to train and retain skilled birth attendants, and to ensure safe working conditions for those on the front lines. This dynamic is starkly evident in Asia and the Pacific, where millions of people face recurrent emergencies driven by floods, earthquakes, and ongoing conflicts. Local responders—often women themselves—play a decisive role because they understand the realities of the communities they serve, beyond what external aid actors can perceive from afar. Local leadership thus becomes a cornerstone of effective humanitarian action, one that can accelerate response times, tailor interventions to cultural and linguistic contexts, and foster trust—the currency of effective health delivery in volatile settings.
In this environment, the mission of UNFPA and its partners becomes a critical thread. By supporting frontline workers, the organization seeks to strengthen health systems at the point of delivery, especially for women and girls who bear the greatest burden when services falter. The work involves equipping midwives with clean delivery kits and essential supplies, sustaining mobile health teams that can reach remote or flood-affected communities, and shielding health workers from harm through protective measures and advocacy. The goal is not merely to respond to crises as they unfold but to build capacity that endures, enabling communities to rebound more quickly and to withstand future shocks with fewer losses. Yet the effectiveness of these efforts rests on the availability of stable, long-term funding that can be anticipated and planned for, rather than ad hoc, short-term funding that peaks during emergencies and dwindles in quiet periods.
The broader takeaway from the frontline experience is that humanitarian health interventions must be comprehensive, flexible, and locally grounded. They must integrate maternal and reproductive health into emergency response plans, ensure continuity of essential services even when other aspects of health care are disrupted, and protect women and girls from exploitation, violence, and discrimination in the most challenging environments. The resilience of health systems in crises hinges on the people who deliver care—those who carry the banner of health as a universal human right even when resources are scarce and dangers loom large. The stories of midwives like Soudaly—vivid reminders of the courage and commitment of frontline workers—underscore the importance of sustaining support for local responders who understand the realities on the ground and act first to safeguard life.
Myanmar and regional displacement: the ongoing refugee challenge
Myanmar’s turmoil and the resulting humanitarian crisis have produced a vast and complex landscape of displacement. Millions of women and girls remain displaced, not only within the country’s borders but also across neighboring states, where protracted displacement creates a continuum of needs that persist over years. The crisis in Myanmar is not isolated; it resonates through the region, affecting health systems, refugee settlements, and host communities that shoulder the burden of sustained humanitarian assistance. The reverberations are felt across borders and across generations, as displaced populations face barriers to accessing reproductive health services, maternal care, and protection against gender-based violence.
A stark milestone marks the Rohingya crisis: eight years since the mass exodus from Myanmar to Cox’s Bazar, Bangladesh. This settlement has grown into the world’s largest refugee camp complex, a place where humanitarians continue to work around the clock to protect the rights and dignity of those who have fled persecution, violence, and insecurity. The sheer scale of the settlement amplifies the demand for health services, shelter, clean water, nutrition, and protection mechanisms that are attuned to the specific risks faced by women and girls in displacement. In such contexts, reproductive health is often one of the first casualties when funding is uncertain or services are disrupted. The consequences for pregnant women, new mothers, and survivors of gender-based violence are profound, underscoring the imperative to maintain continuous, culturally sensitive, and gender-responsive care in settings where displacement persists and local capacities are stretched to their limits.
The regional dimension adds layers of complexity to the humanitarian response. Neighboring countries may face pressure on their own health systems as refugee populations seek care across borders, leading to competition for scarce resources and, at times, tensions in service delivery. International agencies, local organizations, and community actors must collaborate to ensure that displaced populations have equitable access to obstetric care, postnatal services, family planning, and essential medications. The Myanmar situation also highlights the importance of protection in displacement settings: safe spaces for women and girls, access to psychosocial support, and mechanisms to report and address gender-based violence. As crises endure, the role of local leadership and partners becomes even more vital, ensuring that health responses remain grounded in the realities, languages, and cultural contexts of the communities they serve. The ongoing commitment to protecting rights and dignity in Myanmar and across the region is essential for the health and resilience of both displaced populations and host communities.
The funding climate: UNFPA’s funding cuts and the downstream effects
Six months after global funding adjustments affecting UNFPA, the consequences have become increasingly visible in the daily operations of health services that millions rely on. The lack of stable, predictable funding has immediate and tangible effects on health delivery. Maternal health clinics are closing at a time when access to obstetric care could be a matter of life and death. Mobile health teams—often the only point of contact for remote or disaster-affected populations—are being suspended, interrupting continuity of care for pregnant women and new mothers who need routine monitoring and timely interventions. The delays in delivering essential reproductive health supplies—from contraceptives to prenatal vitamins and safe delivery equipment—create a cascading risk: women may miss crucial medications, risk unintended pregnancies, or face complications during childbirth that could have been prevented with timely care.
The ripple effects of funding shortfalls extend beyond clinical services. Supply chains become fragile, storage conditions are compromised, and trained personnel may be reassigned or laid off as budgets tighten. When health systems lose the capacity to pre-position life-saving items and equipment in disaster-prone areas, response times slow, and the window to prevent complications narrows. The human cost of these interruptions is borne most heavily by women and girls, for whom reproductive health and maternal care are essential lifelines during emergencies. The losses accumulate not only in the immediate health outcomes but also in the longer-term implications for family planning, mental health support, and protection against gender-based violence. In sum, the funding gap translates into reduced access to critical services, higher vulnerability for pregnant women in crisis zones, and increased risk of preventable deaths among mothers and infants.
Beyond the clinical implications, funding challenges undermine the broader strategic aim of building resilient health systems in crisis-prone regions. When predictable, multi-year funding is unavailable, investments in capacity-building, workforce retention, and pre-positioning of supplies are deprioritized or postponed. This results in a vicious cycle: weaker health infrastructure increases vulnerability to future shocks, making crises more severe and protracted, thereby demanding even larger and more sustained humanitarian investments that, in turn, remain uncertain. The net effect is a distortion of humanitarian priorities, where immediate short-term needs overshadow the crucial long-term investments necessary to prevent and mitigate future crises. The humanitarian community, including UNFPA and its partners, has emphasized that predictable funding is not a luxury but a practical necessity for protecting mothers, newborns, and frontline health workers in an era characterized by rising climate-related and conflict-driven emergencies. The stakes are high: when funding dries up, lives are on the line, and the gains achieved through years of health system strengthening can rapidly erode.
In this context, advocates argue that funding must be designed to sustain essential services during crises and to enable rapid scale-up when emergencies intensify. This means ensuring that maternal health clinics remain operational, that mobile outreach can resume quickly after disruptions, and that supply chains can be reconstituted so that health workers can deliver care without delay. It also means investing in the protection of health workers, including risk mitigation, security training, and policy measures that keep health facilities out of armed conflict zones as safe zones where care is provided. The objective is clear: to preserve life-saving health services for women and girls even in challenging funding landscapes, thereby maintaining the integrity of reproductive health care as a fundamental humanitarian principle.
Attacks on healthcare and the imperative to uphold humanitarian law
A distressing trend over recent years is the rise in attacks on healthcare—an ominous signal that the protection of health workers and facilities is not guaranteed in all conflict contexts. Last year marked the deadliest period on record for aid workers, with the vast majority of those killed being national staff who operate at the core of local health responses. Globally, more than 1,600 attacks on health care workers were documented, with devastating consequences that include the loss of more than 900 patients and health workers and hundreds of injuries. The geography of these incidents extends across countries, including Iran, Myanmar, and Pakistan, underscoring a widespread challenge to safeguarding humanitarian operations. The brutality of such attacks transcends the immediate harm; it constitutes a violation of international humanitarian law, which explicitly prohibits deliberate attacks on health facilities, workers, and patients. Yet impunity remains a pervasive problem, eroding the norms that should shield health services in times of war and disaster.
The impact of these violations on women and girls is particularly severe. When healthcare services are targeted or disrupted, access to obstetric care—a lifeline for pregnant women—diminishes dramatically, turning childbirth into an emergency with potentially fatal consequences. Survivors of gender-based violence lose access to emergency contraception, post-rape treatment, psychosocial support, and referral pathways that connect them to the necessary care. In many conflicts, sexual violence is weaponized, magnifying trauma and health risks for women and girls and leaving communities with long-lasting psychological scars. The health and protection facilities that should offer sanctuary become battlegrounds, where the consequences are measured not only in immediate injuries but in the erosion of dignity and the disruption of fundamental rights. The human toll of attacks on healthcare compounds the suffering caused by displacement, loss of livelihoods, and the erosion of social protections, reinforcing the necessity for robust enforcement of humanitarian protections.
The international community has repeatedly affirmed that healthcare must remain a core humanitarian principle—accessible, impartial, and protected from political and military calculations. This requires not only condemnation of attacks but concrete actions: embedding healthcare protections in national legislation and military rules of engagement, integrating health considerations into peace and security planning, and ensuring that perpetrators are held accountable through appropriate judicial mechanisms. Strengthening accountability entails documenting and reporting abuses, supporting investigations, and applying consequences to those responsible for harming health workers and patients. Without accountability, the risk of repetition remains high, threatening the viability of humanitarian responses and the health outcomes of millions who depend on aid during emergencies. The urgency is not just moral but practical: protecting health services sustains communities, preserves essential life-saving care, and upholds the integrity of international humanitarian law, which remains a shared standard for the protection of civilians in conflict and crisis.
The gendered toll: women and girls in conflict and displacement
When healthcare services are targeted or disrupted in crises, the consequences disproportionately affect women and girls. Pregnant women find themselves stripped of access to vital obstetric care, transforming what should be a routine medical event into a high-stakes emergency with potential life-threatening outcomes. The continuity of safe deliveries, antenatal surveillance, and postnatal follow-up can unravel within days of service disruption, increasing risks to the health of both mother and child. In the wake of disruption, survivors of gender-based violence lose access to essential support services, including emergency contraception, post-rape medical care, psychosocial counseling, and linkages to protective mechanisms and legal recourse. The disruption of these services not only affects immediate physical health but also has enduring implications for mental health, social stability, and the safety of women and girls within their families and communities.
In many conflict-affected settings, the deliberate instrumentalization of sexual violence compounds the trauma faced by women and girls. Sexual violence is used as a weapon to intimidate communities, erode social cohesion, and extend the psychological and physiological harm across generations. In such contexts, women’s health facilities and protection services become focal points of risk, and girls face heightened vulnerability to exploitation, child marriage, and abuse. The cumulative effect is a pervasive erosion of dignity and agency, undermining the ability of women and girls to participate fully in their communities or to pursue education, work, and personal development—all of which are essential for longer-term resilience. This gendered dimension of health and protection demands a holistic, rights-based approach to humanitarian responses that prioritizes women’s safety, delivers tailored reproductive health services, and ensures that protection measures are integrated into every level of planning and implementation.
Displacement in Asia and the Pacific amplifies these gendered vulnerabilities. Floods, earthquakes, and conflict displace households, forcing women and girls into situations where access to healthcare, safe spaces, and social support networks may be severely constrained. The mental health toll—trauma, anxiety, grief, and the fear for personal safety—adds another layer of complexity to reproductive health needs. In such environments, local health workers and women-led organizations play a pivotal role in delivering gender-responsive services that are culturally appropriate, accessible in local languages, and designed to meet the specific needs of survivors of violence and abuse. The emphasis on women’s health and protection is not a peripheral concern but a central pillar of humanitarian action, essential for preserving dignity and enabling communities to recover and thrive even amid ongoing crises.
Climate change further intensifies these challenges by increasing the frequency and severity of disasters that force displacement and disrupt health systems. As communities are uprooted, the most vulnerable—often women and girls—bear the brunt of these upheavals. The resulting mental health strain and loss of dignity contribute to long-term adverse outcomes, including missed opportunities for education and economic participation, heightened risk of unsafe childbirth, and reduced access to preventive care and family planning. Consequently, a comprehensive response must integrate gender-sensitive programming, ensure the continuity of maternal and reproductive health services, and address the full spectrum of women’s health needs in emergency contexts.
A case study from Lao PDR: resilience in the face of floodwaters
In a flood-affected rural province of Lao PDR, the story of Soudaly, a midwife, captures both the immediate danger and the commitment of frontline responders. She waded through waist-deep water to reach a temporary shelter housing displaced families, carrying a backpack packed with clean delivery kits. Her urgent awareness that three pregnant women were due within the upcoming days exemplifies the rapid decision-making needed in crisis settings. The sentiment she expressed—anticipating that waiting for the water to recede would be too late for some mothers—highlights a truth shared by countless local health workers: in emergencies, timing is critical, and decisive action is essential to prevent preventable complications in childbirth. Soudaly’s experience underscores the quiet heroism of thousands of local responders who act quickly and decisively when disaster strikes, often with limited resources and in conditions of elevated risk. Their instinct to move first—to prioritize the health of expectant mothers—demonstrates how local knowledge, courage, and community ties are central to effective lifesaving care in flood-prone and disaster-affected areas.
This case study serves as a microcosm of the broader emergency landscape in Asia and the Pacific, where rural health workers face a recurring cycle of exposure to hazards—floods, landslides, and infrastructure damage—that challenge the delivery of essential maternal and reproductive health services. The Lao PDR example also reflects the broader principle of locally led, community-based responses that UNFPA emphasizes: when local health workers are empowered with the necessary resources and protective measures, they can maintain continuity of care, adapt quickly to shifting needs, and sustain trust within communities during crises. The story of Soudaly is more than a single anecdote; it embodies the operational reality of humanitarian health work on the ground, where courage, rapid response, and a deep understanding of local contexts coalesce to protect the health and dignity of women and families in the most challenging circumstances.
UNFPA’s commitment, localisation, and the funding imperative
In 2024, UNFPA stood in solidarity with local health workers, volunteers, and community responders as part of a broader strategy to strengthen locally led, inclusive humanitarian responses across Asia and the Pacific. The organization supported 46 emergencies across 16 countries in the region, a testament to its ongoing commitment to reach millions of women and girls with essential health services. A core element of this approach is partnership with national and women-led organizations, reinforcing locally led mechanisms that reflect the realities on the ground and empower communities to shape their own health priorities. Local leadership is central to the efficacy of humanitarian interventions, ensuring that responses are culturally appropriate, linguistically accessible, and grounded in the lived experiences of those most affected.
Nevertheless, localisation without adequate resources risks becoming an empty promise. The fundamental condition for sustainable, locally led responses is predictable, multi-year funding. Such funding enables health systems to build resilience, support and protect midwives and frontline workers, pre-position life-saving supplies, and implement protective measures that reduce the risk to health personnel in conflict zones and disaster settings. It also supports the development of local supply chains, training programs, and governance structures that can sustain health outcomes beyond the immediate relief phase. The argument for stable funding is both practical and principled: it is the most efficient investment to stabilize health outcomes, protect essential health infrastructure, and prevent future crises by building the resilience of the health system at the community level.
In practical terms, sustained funding translates into a more reliable pipeline of reproductive health supplies, better-equipped frontline teams, and more robust protection for health workers. It allows for pre-positioning of delivery kits, emergency obstetric equipment, vaccines where appropriate, and contraceptives, ensuring that when a crisis unfolds, there is minimal delay in delivering critical care. It also supports psychosocial services, gender-based violence prevention and response programs, and safe spaces that help protect women and girls in displacement settings. By anchoring humanitarian action in locally led initiatives, UNFPA and its partners aim to shift power to those who know best how to navigate local realities, language barriers, cultural norms, and the complex social dynamics that influence health outcomes in crisis contexts.
The overarching message from UNFPA is clear: the scale and complexity of today’s emergencies demand a new paradigm of humanitarian action. Health workers and facilities must be protected as core humanitarian assets, international humanitarian law must be upheld, and resources must be directed toward strengthening local solutions. Attacks on healthcare must stop, and the responsibility for safeguarding health services rests with governments and donors alike. Investing in local responses is not merely a matter of equity; it is a pragmatic approach to achieving faster, more credible, and more sustainable health outcomes for women and girls who endure the greatest risks during crises. The call to action is unambiguous: mobilize the political will, secure sustained funding, and implement protective measures that enable health workers to deliver life-saving care with safety and dignity.
A new humanitarian paradigm: protecting health workers and local leadership
The protracted and increasingly complex humanitarian emergencies seen in Asia and the Pacific require a reimagined model of action that centers on the protection of health workers, the upholding of international humanitarian law, and the prioritization of locally led solutions. The imperative to protect healthcare as a core humanitarian principle is non-negotiable. This means not only recognizing health services as sanctuaries in conflict, but actively integrating health protections into national legislation, military rules of engagement, and broader governance frameworks that guide how security forces interact with humanitarian activities. It also implies accountability mechanisms that deter and punish those who attack or obstruct health facilities, workers, and patients.
For governments and donors, the responsibility is to bridge the gap between humanitarian need and resource allocation. The rising demand for health and reproductive services in crisis contexts—especially for women and girls—must be matched with commensurate funding, logistical support, and political commitment. The new paradigm emphasizes long-term resilience: building robust health systems that can withstand shocks, sustain essential services during emergencies, and recover quickly after crises subside. It also prioritizes local leadership and community ownership, ensuring that health programs reflect the voices and experiences of those most affected by crises. This approach recognizes that communities, when empowered and resourced, can design, implement, and monitor health interventions that are more effective, culturally appropriate, and trusted by the populations they serve.
The urgency to act is underscored by the human stakes in crisis settings: when healthcare is disrupted, women bear the heaviest burden, and the consequences extend far beyond the clinic or hospital. The call is for a collective commitment to protect life-saving healthcare, safeguard the rights and dignity of those displaced or affected by conflict, and invest in the infrastructures, training, and protections that allow health workers to perform their duties safely and with continuity. This is not simply a moral obligation; it is a strategic imperative that underpins stability, dignity, and resilience in societies facing frequent emergencies. The humanitarian community must speak up and advocate loudly for sustained resources, safer operating environments for health workers, and policies that reinforce the protection and effectiveness of life-saving health services in all crisis contexts.
On World Humanitarian Day, voices across the humanitarian spectrum—midwives delivering in floodwater, health workers delivering care amid conflict, and youth volunteers delivering supplies to remote communities—are invited to stand together in solidarity. The goal is to translate courage into concrete political will, protective policies, and reliable funding that serve as the backbone of life-saving health services for women and girls. The call is for a sustained, principled, and locally anchored response that can save lives now and prevent future crises from eroding the hard-won gains in maternal health, reproductive rights, and the protection of health workers in crises.
Conclusion
In a world where crises persist and intensify, the frontline health workers who deliver maternal and reproductive health services—midwives, doctors, and community responders—remain the most vital line of defense for women and girls in conflict, disaster, and displacement settings. Myanmar’s displacement challenge, the Rohingya crisis in Cox’s Bazar, and the broader regional pressures underscore the scale and urgency of safeguarding health services for those most at risk. The interaction of funding cuts, rising attacks on healthcare, and gendered health impacts reveals a fragile system that requires steadfast commitment, predictable multi-year funding, and a holistic, locally led approach to humanitarian action. Local health workers, women-led organizations, and community responders embody resilience and leadership that can transform crisis response into durable health gains. They remind the world that protecting health care is a fundamental humanitarian principle and that investing in local solutions is the most effective strategy to build stable health systems, prevent suffering, and secure the dignity of women and girls in times of crisis.
As we observe World Humanitarian Day, the courage of frontline responders—whether they are wading through floodwaters to reach expectant mothers, delivering care amid conflict, or bringing supplies to remote communities—offers a powerful imperative: translate courage into sustained political will, robust protection, and long-term funding. Only through comprehensive support for health workers, adherence to humanitarian law, and a commitment to locally led health responses can we ensure that mothers, families, and communities survive, recover, and thrive in the face of ongoing and future emergencies.
