Comment for conflict and health don't let sexual and reproductive health in humanitarian and fragile settings become a casualty of aid cuts and crisis fatigue

In 2025, 300 million people require humanitarian assistance, with sexual and reproductive health (SRH) crises driving 60% of preventable maternal deaths in conflict-affected countries. Despite the proven life-saving impact of the Minimum Initial Service Package (MISP) for SRH in Crisis Situations, official development assistance for SRH declined by 27% between 2022 and 2023, threatening implementation in fragile settings. Analysis of MISP Readiness Assessments across 64 countries (2021-2024) reveals critical gaps: while 95% have national emergency policies, only 40% of these integrate essential MISP services. With four in five countries at risk of missing 2030 maternal mortality targets, urgent action is imperative. Countries must anchor MISP into national disaster frameworks, establish dedicated SRH emergency funding, mandate MISP training for frontline providers, and integrate preparedness into health system strengthening. Reaffirming political and financial commitment to MISP is imperative to prevent preventable deaths and safeguard SRH as a core component of humanitarian and health system resilience.