Majuro, THE MARSHALL ISLANDS – The Republic of Marshall Islands (RMI) Ministry of Health and Human Services (MOHHS) suddenly found itself on a high alert on 8 August 2022, when the first community transmission case of COVID-19 in the Capital city, Majuro, was recorded. Until then, RMI was one of the last nations in the world that were untouched by the Coronavirus. Within four days,  the State of Emergency was declared. 

The United Nations Population Fund (UNFPA) Director for the Pacific based in Fiji received a request from the RMI MOHHS, through the World Health Organization (WHO), to urgently assist RMI with its COVID-19 response by deploying a physician to the most populous island of the country, Ebeye. UNFPA consultant physician, Dr. Marie Lanwi-Paul, who was at that moment working in Majuro on another island, quickly travelled more than 400 kilometers to Ebeye.

RMI is a large-ocean state in the Central-Northern Pacific, with two chains of 29 low-lying coral atolls and five coral islands spread out over an exclusive economic zone of 2,000,000 square kilometers. While there are 50 functioning health centres across the country, this topography makes the delivery of basic services including maternal health services, a daunting task for the Government. UNFPA estimates that, out of the approximately 55,000 population of the Republic, over 20,000 are women of reproductive age, including some 6,000 adolescent girls (10-19 years old). At any given time, close to 1,300 women are pregnant in the country, all of whom require essential sexual and reproductive health (SRH) services.

In the four weeks after the first community transmission was detected in the capital city, more than 15,000 COVID-19 confirmed cases were reported to WHO, with 17 deaths. Upon arrival in Ebeye, UNFPA’s Dr. Marie joined the only Alternative Care Site (ACS) on the island and started looking after patients who showed COVID-19-related symptoms, as well as those with medical complaints other than COVID-19. “Because Dr. Marie came to the rescue, three of our specialist physicians were able UNFPA's Dr. Marie Lanwi- Paul assisting the COVID-19 response at the Alternative Care Site in Ebeye, Marshall Islands to return to their regular duties from the emergency COVID-19 response,” Dr. Cho-Cho Thein, the Ebeye public health director, and other medical staff, expressed appreciation to UNFPA Pacific.

Despite the pandemic, Ebeye managed to provide timely SRH services, along with other essential services.  Ante-natal care was provided to all high-risk mothers at a separate area within the ACS, to ensure their safety from the virus infection. Pregnant mothers were advised on how to recognize early serious signs of COVID-19 and seek further medical care if necessary.

Dr. Marie was also deployed to Santo Island, where she was able to identify those pregnant mothers who had not been screened for COVID-19 symptoms and provided them with the necessary treatment and medical advice. She also taught them about COVID-19 complications.

One of the concerns in RMI, from prior to the pandemic, has been a stagnating Adolescent Birth Rate (48 births per 1,000 adolescent girls aged 15-19, in 2017 according to MOHHS) and a decreasing Contraceptive Prevalence Rate (16% CPR of any method in 2017 from 37% in 2007). “Especially during a crisis like this, it is essential to ensure the continuity of reproductive, maternal, child and adolescent health services, including for family planning, gender-based violence care, HIV/STI treatment, and mental health and psychosocial support as well,” said UNFPA’s Dr. Marie Lanwi-Paul. At Santo Island, she also worked with health care providers to conduct an assessment of the health center to ensure the continuity of SRH services. One of the SRH nursing staff, Ms. Ana Koliniwai, recalled, “It was timely that we had received training from UNFPA Pacific Humanitarian Team just last year in 2021 about the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health (SRH) in Crisis Situations, because we were able to apply it this time during this COVID-19 pandemic.”

Under the leadership and management oversight of the MOHHS, RMI has been able to contain the pandemic, through COVID-19 risk mitigation and overall health systems strengthening measures. After receiving counselling and support from UNFPA's consultant physician Dr. Marie Lanwi-Paul, a 24-year old pregnant woman on Santo, Kwajalein atoll was able to access ante-natal services. “Thank you, UNFPA, for the much-needed support,” the Ministry’s Secretary, Mr. Jack Niedenthal appreciated Dr. Marie’s timely deployment and contributions. UNFPA’s assignment of Dr. Marie in the Marshall Islands has been made possible by the funding support received from the New Zealand’s Ministry of Foreign Affairs and Trade (MFAT) through the UN Pacific Strategy Fund.

Past epidemics have shown that a lack of access to essential health services due to the shutdown of services during the pandemic response can result in more deaths than the pandemic itself. Barring access to essential SRH services such as family planning, intrapartum care, antenatal care, emergency obstetric and newborn care, clinical care for sexual violence survivors, post-abortion care, and prevention and treatment for HIV and sexually transmitted infections can lead to a significant increase in morbidity and mortality.

Given a very high prevalence of violence with 69% of Marshallese women reporting physical or sexual violence in their lives, the continuity of GBV response services is also important, in addition to SRH services. Aside from the pandemic, climate change also exacerbates the risks and vulnerabilities that women, girls, and persons with disabilities face. UNFPA Pacific leads the Pacific GBV Sub Cluster to provide technical assistance and facilitate capacity development to prevent and respond to GBV in emergencies (GBViE), including the health sector response to GBV. UNFPA Pacific stands ready to assist RMI and other Pacific Island Countries and Territories with addressing these unique needs of women and girls for their sexual and reproductive health and reproductive rights, throughout the humanitarian-development continuum.