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¨ Out of every 10 refugees and displaced persons in the world, 8 are women and children.
Refugees are people who cross the border of their country into another country, because they fear for their safety at home. Displaced people are people who are forced to leave their homes but remain in their own country. Many refugees and displaced people are victims of a group that has gained power and is prejudiced against the ethnic group, religion, nationality, or political views of others. If this group controls basic resources like food and water, people must leave their homes to survive.
Women and children make up more than 80% of refugees and displaced people. This is because men have often died fighting or been forced to leave their families. Like all refugees and displaced people, women need to be protected from forced return to their homes. They also need laws that give them economic and social rights, so they can get basic resources like food, shelter, clothing, and health care. As women, they need special protection from armed attacks, and from sexual and physical abuse.
This chapter will focus on some of the health problems that refugee and displaced women face. Most importantly, this chapter looks at the role these women can play in their new communities.
The route to a new place to settle is often very difficult. Families may be separated during their travel (flight). Younger children or older relatives may die of hunger or disease on the way. Women and girls may be attacked by pirates, border guards, army units, and male refugees. All these losses and dangers can make a woman emotionally and physically exhausted even before she arrives at a new home.
Once settled, a woman may face a situation very different from her old home. Often women from small communities find themselves in large, crowded camps that are organized differently from a traditional village or town. Or they may live in cities, often trying to avoid capture by government authorities. Some refugees are thousands of miles away in countries that have allowed refugees to enter and settle there permanently. In addition, a woman often faces some of these difficulties:
· living among people who do not like her being there or do not speak her language.
· not knowing whether she can return home soon or must stay away for years.
· needing papers showing her refugee status.
· adjusting to new family relationships.
· living in danger if a war is nearby.
¨ Having identity documents from either the United Nations or the authorities in the country of refuge can give refugees some protection against being forced to leave (deported).
Living in a refugee camp and being recognized as a refugee by a new government or the United Nations may give women some protection. But displaced women do not have these protections and are even more at risk.
In many communities, women are responsible for providing most of their families' basic needs: they grow most of the food, prepare it, collect water, manage the home, keep the living space clean, and try to maintain the family's health. Away from the home, refugee and displaced women must suddenly depend on outside help to meet basic needs. Often this help is not adequate. Some displaced women may not have any outside help, so meeting basic needs is even more of a problem.
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¨ Malnutrition is one of the leading causes of death for refugee and displaced women.
Many refugees and displaced women do not have enough food to eat before they flee or during their journey. When they arrive at a new settlement, there still may not be enough food. Or there may not be enough different kinds of food to provide a nutritious diet.
You may be able to improve your diet if you:
· get involved in food distribution. Food should be given directly to women, because men may not be as familiar with the family's needs. Also, women are more likely to feed their families with the food they receive than trade it for weapons or alcohol.
· demand that women get the same amount of food as men and eat at the same time.· fight for extra food for pregnant women, women who are breastfeeding, and women who are malnourished or sick.
· make sure that women have cooking pots and utensils.
· share cooking tasks with other women. Even if food is prepared in a central place, women can stay involved. This will give them some control over their family's diet.
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Emergency Food Distribution Even in emergency situations, food distribution should involve women. This honors the important role women have had in food management. In Kenya, for example, Oxfam has tried to strengthen traditional social roles by distributing food directly to women. Food is distributed in an open place, overseen by an elected committee of elders. Women are encouraged to give their opinions about what is being done. This kind of food distribution will continue until the local food supply improves. |
Refugee and displaced women often have limited water and cooking fuel. Sometimes water and fuel must be collected away from the camp in an unsafe area. Or the water may be unclean and will make people sick if they drink it. All these problems make women's lives more difficult, because they are responsible for washing and cooking for themselves and their families.
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These things can help:
· Learn how to purify your water.· Ask organizations that provide support and aid for containers that are not too heavy to carry water
· Ask those in charge to patrol places where water and fuel are collected, to make sure they remain safe and women can get to them. When you go for water or fuel, go with other people.
¨ Sexual violence is a violation of human rights.
Rope and sexual violence are common when people are displaced. This happens because:
· guards, government authorities, and workers may demand sexual favors in exchange for food, protection, legal papers, and other help.· if the area is too crowded, women may be forced to stay with strangers, or even with people who have been enemies. Women who are forced to stay among strangers are in greater danger.
· male refugees, who have lost opportunities they had at home, often become angry and bored. These problems are made worse when men see women taking on new responsibilities. Since men may have weapons with them, they may act violently toward women. This is more common if the men use alcohol or drugs.
· people in a nearby community may attack.
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There are many ways to prevent attacks:
· Women should try to stay with family and friends. Single women and girls without adults looking after them should stay in a safe place that is separate from men.· Men without much to do should be encouraged to begin activities like skills training, sports, or cultural activities.
· Women should be directly in charge of distributing basic resources, like food, water, and fuel, so they do not have to negotiate for their basic needs.
¨ You may risk attack if you have to go a long distance for food, water, fuel, or to use sanitation facilities.
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· The camp should be arranged so that latrines and other facilities for basic needs are close by and well lit. Women should also demand more protection at night, including women guards.· Try to arrange meetings for men and women to discuss preventing sexual violence. Make sure everyone understands the dangers. Protection against violence can be included in other programs, such as health and nutrition meetings.
· Ask for education about alcohol and drug misuse.
If you are attacked:
· Request a physical exam right away from a woman health worker. You may be able to prevent pregnancy and sexually transmitted diseases (STDs) by taking medicine. If you might be pregnant, be sure to discuss ALL your options - abortion, adoption, or keeping the baby - with a health worker.· If it seems safe to do so, report the attack. Officials will be required to investigate. Remember that you do not have to answer any questions you do not want to, especially about your past sexual history.
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· Talk over what happened with a trained mental health worker. This will help you realize you are not to blame for the attack and that many other people have overcome such experiences. If no mental health worker is available, see the chapter on "Mental Health."· In some cultures, rape is seen as a woman's failure to guard her virginity or her dignity in marriage. If your family is angry at you or ashamed that this happened, they may need counseling also.
· If you can, you may want to move to a safer place, away from your attacker. Request that your family or friends come also, if you want them with you.
Refugee and displaced women often find it very difficult to get proper health care. Health workers may have difficulty reaching displaced persons in dangerous or faraway areas. Or, if services are available, health workers may not know the language of the women they help or the cultural beliefs and practices that affect health care.
In addition to these general problems, women's specific health needs are often overlooked. These needs include:
· care during pregnancy and birth. Women need regular care before giving birth (prenatal care) and traditional birth attendants (TBAs) who understand a woman's traditional birthing practices.
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· family planning. In many refugee communities, the birth rate is very high. Part of the reason for this is that agencies often do not provide family planning information or supplies. Also, crowded refugee camps offer little privacy to use these methods, or secure, personal space to keep things.
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· supplies for monthly bleeding.· information about and treatment for STDs.
· health workers trained to detect serious health problems of women, like pelvic infections and cervical cancer.
· safe abortion. This is often unavailable, especially if the agencies providing health care are against it
· extra calcium, iron, folk acid, iodine, and vitamin C in the diet, especially for pregnant or breastfeeding women.
· being cared for by women health workers. Some women cannot be examined by men because cultural beliefs forbid it.
Ways to improve women's health
You may be able to improve health services by becoming a link between health services and your refugee community. Help staff understand the traditions and needs of your people. You can also request some of the following changes:
· If the clinic is far away, ask for it to be open more hours at least one day a week. Ask for women health workers to be available on that day, especially if the women in your community cannot be examined by men.· If the health workers do not speak your language or understand your birthing practices, ask to have a birth attendant or midwife from your community explain these practices to those at the health center.
· Ask for classes for adolescent girls and women on family planning, STDs, prenatal care and birth, and nutrition. Remind health center staff that women need a private area for discussing STDs.
· Request extra feedings for pregnant and breastfeeding women. If there is not enough food available for a healthy diet, these women should receive vitamin pills.
· Request that health workers receive training in treating the special health needs of women.
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Becoming a health worker Many camps train refugee women to be health workers, community health workers (CHWs). TBAs, and health educators, since they can speak the language of the other women and help improve the health of the whole camp. In Camp Kakuma in northern Kenya, for example, southern Sudanese refugee women are very involved in health care. Many TBAs have been given more training and birthing kits, and other women are now CHWs and health educators. They are being trained in a way that will allow them to work in both the southern Sudan and in Kenya when they leave the camp. Sara Elija, a refugee from the Sudan, says that her new role as a TBA trainer has given her hope for work when she is no longer a refugee.
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¨ A woman must be able to cope with sudden and forced change in order to help her family survive.
Refugee and displaced women face many of the difficulties listed below, which can cause mental health problems or make them worse. Mental health problems include feeling extreme sadness or not feeling anything at all (depression), feeling nervous or worried (anxiety), or feeling unable to get over horrible things that happened in the past (severe reactions to trauma).
· Loss of home. Because home is the one place where a woman often has some authority, losing her home may be especially painful.· Loss of support from family and community. As her family's caregiver, a woman must provide security for her children, and support her partner and parents. If her husband and older sons have died in fighting or joined military forces, she must also become head of the family. All these responsibilities can make her feel afraid and alone. This can happen even when other adults in the family are with her, because often they cannot support her as they did before.
· Witnessing or being a victim of violence.
· Loss of independence and useful work. Although a woman still has the important job of caring for her family, in other ways her life may be more limited now. For example, before leaving her home, a woman might have been responsible for growing crops, weaving, sewing, and baking bread. If she can no longer do these things, she may feel useless and sad.
· Crowded living. Without space, it is much harder for a woman to cope with the extra demands of caring for her family.
· Difficulty mourning or grieving. Refugee and displaced women may have lost family members before reaching their new home, but have been unable to carry out traditional burial or mourning ceremonies. Once in a place of refuge, it may still be impossible to bury or mourn in traditional ways. In many places, women are responsible for carrying out these ceremonies, which are important in order to grieve and accept the death of a loved one.
For information about the signs of mental health problems like depression, anxiety, and severe reactions to trauma, see the chapter on "Mental Health."
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The best way to help overcome mental health problems and to prevent them from becoming worse is to talk with other women about feelings, worries, and concerns. Here are some suggestions for encouraging the women you know to listen to and support each other:
· Organize activities that let women spend time together, such as nutrition or literacy classes, or child care and religious activities. Make extra efforts to include women who seem afraid or uninterested in getting involved. Often these women are the ones who most need to participate and talk with others.
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A group of Guatemalan refugee women who felt a deep loss when they left their land worked together to plant vegetables and flowers. This helped them feel close to the earth, to begin to feel like a community again, and to provide some food for their families.
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· Organize a support group.· Work with other women to find ways to grieve and mourn. You may be able to adapt some of your traditional rituals to your new situation. If you cannot, at least plan some time to grieve as a group.
· Become a mental health worker. You can organize a group of friends to talk with women who may not ask for help but who are suffering from mental health problems. Find out if your community has trained mental health workers or religious workers trained in counseling who can also help.
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The destruction of homes, families, and communities is very traumatic. Sometimes refugees and displaced women become so affected by these terrible experiences that they cannot work, eat, and sleep in a normal way for a long time. Women need special support and understanding to help them recover and to begin to trust other people again. For more information on how to help people recovering from trauma. For more information on helping a woman who has been raped. |
Women should be involved whenever plans or decisions are made that affect refugees and displaced people. Women should also be encouraged to become leaders in their new communities. This builds self-esteem, reduces feelings of loneliness and depression, encourages self-sufficiency, promotes safety for women, and helps those providing services to avoid mistakes.
¨ When programs are developed without consulting the women who will be affected by them, the programs are less effective.
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Here are some ways women can take leadership:
· Participate in planning the way your settlement is arranged - for example, where the latrines, gardens, and water are located.· Organize separate meetings for women and men about safety, basic needs, nutrition, and community involvement.
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· Encourage women to talk about how they feel about their situation. Elect a leader who can talk to those who run the camp.
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· Help with public information campaigns.· Organize nutrition and health worker training programs.
· Organize child care centers. Child care is an important way to help women participate in activities where they can talk with others.
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· Organize schools for children. Women are concerned about their children even in difficult times. The United Nations says that all refugee children have the right to an education, but few programs are available. Classes are sometimes overcrowded or there may be a shortage of teachers.· Help organize reading classes, skills training, music, and sports for women and men.
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When we arrived in Honduras we were weak from hiding in the hills and walking long distances to reach safety. There were many sick and malnourished children and old people with us. There was nothing here for us, so the women all worked together to organize nutrition centers. Then we got the local parish to bring us some extra food for the centers and we began to plant vegetables and raise chickens, goats, and rabbits to add to the food we prepared at the centers. Our projects have grown and now we are also able to give every family in the refugee camp a few eggs, a little bit of meat, and some vegetables at least once a month. We needed to repair our clothing and shoes, so we organized workshops and convinced the agencies to bring us a few sewing machines and tools. Some of the women had worked as seamstresses and an older man knew how to make shoes and they taught others their skills. We are proud of what we have achieved here - we have shown that women can do more than cook The agencies trained us to become health and nutrition workers and to raise livestock. We have learned to add, subtract, and plan our expenses so that we can manage these projects ourselves. Because of our experience with these projects, many women are now leaders in the camp and when we return to our country we will be able to run community projects and businesses. - Aleyda, a Salvadoran refugee in Colomoncagua, Honduras |
Refugee and displaced women often find it hard to get enough work to support their families. They may lack skills needed to work in their new home or find it difficult to get a work permit. But even in these situations there is often some work women can do.
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¨ Refugee and displaced women need choices, so they will not be forced to sell sex to survive and support their families.
For example, some refugee women do domestic work in people's homes or work as health workers in organizations that provide aid. Sometimes these organizations also give women money to start projects in traditional women's activities, like handicrafts. But since it can be hard to support a family with these activities, women should also try to find out about larger projects - like planting trees or building shelters - that pay more. Or, if women are given plots of land, they can grow food for their families or to sell. And if a woman has training, she may be able to work in a trade or small business.
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