A/HRC/39/26 woman’s and girl’s experiences, which transcend the crisis context, and ensure a continuum of care in terms of access to services. B. Key elements 1. Available, accessible, acceptable and quality comprehensive sexual and reproductive health care 40. As in other contexts, a human rights-based approach in humanitarian settings identifies who has rights (rights holders) and what freedoms and entitlements they have under international human rights law, as well as the obligations of those responsible for making sure rights holders enjoy their rights (duty bearers). It recognizes that sexual and reproductive health and rights are human rights, which must be upheld, even in humanitarian settings, and not matters of charity. In the context of humanitarian settings, the role of private actors is also pertinent, recognizing that the State, or occupying power, retains a duty to ensure that private actors do not engage in human rights violations. 35 It is important to note also that, under certain circumstances, in particular where an armed group with an identifiable political structure exercises significant control over territory and population, non-State actors are obliged to respect international human rights. 36 The present section explains the requirements of availability, accessibility, acceptability and quality, and how these human rights requirements may require further analysis in the context of humanitarian settings. 41. Humanitarian policies and programmes should ensure availability through a sufficient quantity and range of functioning sexual and reproductive health facilities, goods and services. This involves, for example, trained and skilled health-care staff, as well as comprehensive sexual and reproductive health services. Where crisis inhibits the ability of the State to provide comprehensive sexual and reproductive health services, the Minimum Initial Service Package, together with the core content of the right to sexual and reproductive health as articulated in general comment No. 22, is an important practice and starting point for determining which services should be prioritized. These services must be provided without discrimination, and involve the establishment and implementation of clear referral pathways and integrated approaches.37 Attention to ensuring that individuals and their communities are aware that these services are available and where they can be accessed is also critical. Humanitarian settings complicate the ability to ensure the availability of services, necessitating particular attention to interventions, which can maximize efficiencies such as task shifting, or user-initiated interventions for health care. 42. Furthermore, sexual and reproductive services, facilities and information provided by both the public and private sector must be physically and economically accessible to all affected individuals and communities, including host communities, with a particular emphasis on identifying and ensuring access for women and girls in the most vulnerable and marginalized situations. This means ensuring that such services, and the underlying determinants, such as safe and potable water and adequate sanitation facilities, are within safe physical reach, including for women and girls with disabilities. Accessibility is a major challenge in crisis situations as infrastructure breaks down and the ability of people to move, especially women and girls, is restricted as a result of insecurity and imposed movement restrictions. 38 For example, although important initiatives are under way to ensure maternal and child health, after decades of conflict in the Democratic Republic of the Congo, the health-care system is severely damaged, leaving many health facilities 35 36 37 38 See for example, United Nations Assistance Mission for Iraq (UNAMI)/OHCHR, report on the promotion and protection of rights of victims of sexual violence captured by ISIL/or in areas controlled by ISIL in Iraq (2017), para. 45. OHCHR, International legal protection of human rights in armed conflict (2011), pp. 23–37; and Committee on the Elimination of Discrimination against Women, general recommendation No. 30, para. 16. See also submission by UNFPA in the Democratic Republic of the Congo. See, on movement restrictions, in particular of pregnant women at checkpoints, A/HRC/10/35. Regarding a lack of access to services, see OHCHR, supra note 18, pp. 23 and 31. 11