Illustration of a woman talking to a female physician

It’s been two years since the Russian aggression against Ukraine began. By October 2022, seven months into the war, over eight million people had fled.

Upon arriving in an unknown country in the EU, many face barriers – especially women and girls who have been exposed to conflict-related sexual violence.

EIGE Director Carlien Scheele says:

Displacement already comes with physical and emotional tolls.  And on top of that, on their journey towards safety and stability, and what many of us don’t realise, people can become victims of gender-based violence. And this is mostly hitting many women and girls.

To make matters even more complex, they face barriers in accessing sexual and reproductive rights in host countries.

At EU and Member State level, more specialised support and access is needed.

Barriers to sexual and reproductive healthcare rights

The Temporary Protection Directive (TPD) went into swift action in early March 2022. This was the first time this instrument was used.

It provided immediate support to millions fleeing Ukraine in the EU in terms of housing, work permits, social welfare and healthcare.

Today EIGE is publishing a study on Women fleeing the war: Access to sexual and reproductive healthcare in the European Union under the Temporary Protection Directive.

The study is based on a questionnaire across 26 Member States and follow-up interviews held in four Member States: Czechia, Germany, Poland and Slovakia.

It looked into six healthcare services including: emergency contraception, sexually transmitted infection (STI) prevention and treatment, obstetric and gynecological care, psychological counselling, and safe abortion and post-abortion care.

These services are considered a bare medical minimum that victims must receive. Access, affordability and availability are key. The WHO sets clear timelines for each service, for example emergency contraception and STI prevention services need to be available as soon as possible, but not later than 72 hours after the assault.

EIGE identified several gaps in the healthcare aspect of the TPD. Key findings include: 

  • In 13 out of the 26 Member States surveyed only selected sexual and reproductive healthcare services are free of charge. 
  • Half of the Member States provide emergency contraception to minors without restrictions.
  • Only half of the Member States have established rape crisis centres. 
  • Only seven Member States assign mandatory female professionals providing sexual and reproductive healthcare services – upon request only. 
  • Interviews conducted in selected countries highlight secondary consequences of restrictive legislation on sexual and reproductive rights. 
  • This leads to challenges in identifying health providers or delays in receiving necessary care. 
  • In the most extreme cases, women and girls fleeing the war need to travel abroad or back to conflict-zone to obtain this service.
  • Women and girls face language barriers hampering their ability to meet needs.   

Victim-centred and trauma-informed

Carlien adds:

There is no doubt that the limited access to sexual and reproductive healthcare worsens the traumatic experience for victims.

“The needs of victims must be at the heart of the response. Even though EIGE finds that most Member States have referral systems in place, the coordination between the police, healthcare, and social care sectors must be strengthened by introducing national guidelines of responsibilities to ensure a holistic support system.”

Leah Hoctor, Senior Director at the Center for Reproductive Rights, who have also conducted research on barriers to sexual and reproductive healthcare services for women fleeing the war adds that: 

“Refugees from Ukraine still face significant barriers to sexual and reproductive healthcare in many parts of the EU, taking a significant toll on their health and compounding the trauma many endured before leaving Ukraine." 

"EU institutions and member states need to urgently address these barriers to ensure that the EU’s promise of safety and security for refugees from Ukraine is realized for all women from Ukraine.”

Strengthening future protection

Moving forward, the experience in applying the TPD should lead to permanent solutions for victims.

That means EU Institutions need to:

  • Implement the Istanbul Convention and adopt the proposed Directive on combating violence against women and domestic violence. A provisional agreement for the Directive was reached on 6 February 2024. 
  • Provide clear guidelines and support Member States on the correct implementation of EU rules on temporary protection and victims’ rights. 
  • Build on existing international guidelines on how healthcare providers should respond to sexual violence.

That means Member States need to:

  • Make provisions for temporary protected unaccompanied minors to ensure that their age or lack of parental consent does not limit their access to services.
  • Ensure services are affordable, timely, and geographically accessible. 
  • Establish accessible rape crisis centres.

Essential healthcare services must be strengthened for victims of conflict-related sexual violence. That’s why we need to commit to putting protective measures in place for women and girls fleeing the war in Ukraine – and from any war.

Women fleeing the war: Access to sexual and reproductive healthcare in the EU under the Temporary Protection Directive