Menstrual Hygiene Management in Emergencies

Over 26 million girls and women are displaced around the world, many of whom struggle to manage their monthly menstruation safely, comfortably and with dignity.  In many emergency contexts, menstruating girls and women face inadequate access to toilets and water, and may lack the most basic materials needed for managing blood flow, such as menstrual products, underwear and soap. Privacy is often scarce, and when toilets are available, they often lack locks, functioning doors, lighting and separation by gender. In addition, strong menstrual taboos may restrict the movements and behaviors of adolescent girls and women, hindering their ability to attend school, wait in line for distributions, or go to the market.  

The GATE program supports a range of menstrual hygiene management (MHM) in emergencies projects around the world in partnership with cross-sectoral humanitarian partners, international agencies and researchers. Most notably, GATE has collaborated with the International Rescue Committee (IRC) for the implementation of two large-scale research and practice projects highlighted below.

The MHM in Emergencies Toolkit Project:

The MHM in Emergencies toolkit project was a 3-year initiative led by IRC and Columbia University, supported by Elhra's Research for Health in Humanitarian Crises. The aim of this project was to expand the evidence and guidance on MHM during emergencies. The project contributed to the evidence available on MHM in emergencies through a global desk review, interviews with global humanitarian response experts, and field assessments in two humanitarian emergencies (Myanmar and Lebanon). Key findings included:

  • Women and girls have insufficient access to safe and private toilet and washing facilities for MHM.
  • Displaced women and girls often alter their MHM practices due to economic and environmental limitations.
  • Humanitarian organizations have a narrow interpretation of an MHM response, with a tendency to focus on supplies, but seek to provide an improved MHM response.
  • Limited MHM guidance available and insufficient consultation conducted with beneficiaries about their MHM needs and the monitoring of MHM activities.
  • Limited coordination between sector.

The project also developed an MHM in emergencies toolkit in partnership with the global humanitarian response community.  The toolkit provides practical guidance and tools for planning, implementing and monitoring MHM programming. The toolkit was piloted in refugee camps in Tanzania in 2017, and then finalized. English, Arabic and French versions are available below. 

Global Scoping Project on effective practices for menstrual waste disposal, waste management & laundering for displaced populations:

The toolkit project identified gaps in the evidence and practical learning on how a humanitarian response can best support girls and women with menstrual waste disposal, waste management and laundering of used menstrual materials and underwear. In the absence of solutions, girls and women adopt coping mechanisms, such as burying used menstrual materials before dawn, making them vulnerable to attack, or disposing materials directly into toilets, thus clogging the pipes and rendering toilets unusable. When reusable pads or cloths are provided, laundering can prove challenging. There may be inadequate privacy for washing and drying, and strong cultural beliefs may create a strong need to hide the drying of menstrual materials, a significant challenge when living in crowded spaces. Laundering may be further hindered by poor access to soap, water and other supplies, resulting in materials being improperly washed.  

In response, IRC and GATE, with support from USAID’s Office for Foreign Disaster Assistance (OFDA), are working on a new initiative in collaboration with the global humanitarian response community that aims to document new approaches for addressing menstrual disposal, waste management, and laundering in a range of displacement contexts. The project began in August 2018, and includes assessments in 3-4 on-going emergencies, a desk review and a series of interviews with global humanitarian experts. Outcomes include the development of a compendium with improved guidance and publications that contribute to the evidence base. 

MHM in Emergencies Resources:


Sommer, M., Schmitt, M., Ogello, T., Mathenge, P., Mark, M., Clatworthy, D., Khandakji, S., Ratnayake, R. (2018). "Pilot testing and evaluation of a toolkit for menstrual hygiene management in emergencies in three refugee camps in Northwest Tanzania." Journal for International Humanitarian Action, 3(1), 6. 

Sommer, M., Schmitt, M. L., Clatworthy, D., Bramucci, G., Wheeler, E., & Ratnayake, R. (2016). “What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? A global review.Waterlines, 35(3), 245-264. 

Schmitt, M. L., Clatworthy, D., Ratnayake, R., Klaesener-Metzner, N., Roesch, E., Wheeler, E., & Sommer, M. (2017). “Understanding the menstrual hygiene management challenges facing displaced girls and women: findings from qualitative assessments in Myanmar and Lebanon.” Conflict and Health, 11(1), 19.


Sommer, M. 'A Simple Way To Make Toilets Friendlier For Women in Refugee Camps.' (2019). NPR

Schmitt, M. 'Opinion: There's Nowhere Worse to Have Your Period Than A Refugee Camp.' (2019) Buzzfeed News. 

Sommer, M. “Why a monthly period is a especially hard for millions of women and girls around the world.” (2017). [Editorial] The Conversation.

Sommer, M. “The Syrian Refugee Struggle No One’s Talking About.” (2015). [Editorial] Ms. Magazine Blog. 


Marni Sommer, DrPH, MSN, RN
Principal Investigator
Associate Professor, Department of Sociomedical Sciences 


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