–Rachel Girmus
In 2009, the UN Refugee Agency reported that 21.8 million worldwide are “persons of concern;” these include refugees, internally displaced persons, and stateless persons, spread over 140 countries. Of these, 80% are women and children who fled their home countries due to conflict and human rights violations. Women are disproportionately affected by every stage of conflict–as conflict begins, as they are forced to flee their communities, and during periods of seemingly interminable exile in camps. During these stages, women lose the protection of their families, on whom they are dependent for physical and economic security. They often become the victims of violent unprotected sex that results in unwanted pregnancy and contraction of disease, while humanitarian services offered in camps do not adequately meet their reproductive needs. Women and adolescent girls are particularly vulnerable to sexual violence in the form of rape during wars of nationalism or ethnicity. Because their bodies are interpreted as symbols of the collective motherland or culture, they are likely to become targets due to citizenry, religion, ethnicity, race or class. The use of rape as a weapon of warfare effectively terrorizes a society’s women and humiliates its men, causing whole communities to flee their territories in search of safety. During the disorganization of flight, women may also become separated from the protection of male family members, leaving them vulnerable to assault, robbery, harassment, and sexual violence by strangers they meet along the way, including army and militia units, police, pirates, highwaymen, border guards, peacekeepers, humanitarian aid providers, and other male refugees. Once settled within refugee camps, security may be lax leading to further assualts on women by other refugees or the security police themselves as recent reports on Haitian refugee camps document. In addition, women who are separated from male partners often bear the burden of providing for their families and may be forced to exchange sex for food and protection. Even when male partners are present, the stress of dislocation and the lack of economic opportunities lead to documented increases of domestic violence and marital rape. Frequent unprotected sex, moreover, poses significant risks to the one fourth of refugee women who are of reproductive age; most obviously, unwanted pregnancy and contraction of sexually transmitted infections. Adolescent girls are at particular risk of unprotected sex, early pregnancy and exploitation by older males in camp settings. While humanitarian organizations provide many important services to refugees, they sometimes fail to provide adequate gender and culture- appropriate ones because they don’t ask refugee women what they need. For example, despite the prevalence of forced and coerced sex, which is usually unprotected, services for women in the camps tend to focus only on basic family planning and antenatal care and those services are limited in comparison to the numbers of women who need them. As a result, many women have no option but abortion when faced with unwanted pregnancy. As a result, unsafe abortion is responsible for between 25-50% of all maternal deaths in refugee camps. Even though the majority of pregnancies and infections are not the fault of the women themselves, they risk death by trying to gain some semblance of control over their lives. Why are these reproductive services so woefully inadequate? The surprisingly straightforward answer: women refugees are not consulted about their own health needs. At the most basic level, addressing women’s needs effectively in refugee settings requires the inclusion of refugee women in the planning of programs and their implementation. Such an approach has the potential to create both gender and culturally sensitive outreach. The United Nations High Commission on Refugees even agrees that “programmes that are not planned in consultation with the beneficiaries, nor implemented with their participation, cannot be effective.” Assumptions and generalizations by aid organizations about how to serve female refugee populations do not work. There are myriad documented cases of interventions undertaken by relief organizations with the best intentions that ultimately ended in failure because the attempted speed of the response prevented any gender and culture sensitivity during implementation. Cases include instances of food and shelter distribution in the camps being under the sole control of men, resulting in malnutrition and mortality in female-headed households; counterproductive female income generation programs that alienate men; and male-dominated health service provision and lack of female health workers, which lowers women’s access to healthcare. To address issues of reproductive health, women should be involved in needs assessments and all stages of health care services including their planning, provision and implementation. It is the responsibility of agencies that work with refugee populations, including non-govermental organizations, reproductive health organizations, and government health officials to inform themselves of refugee women’s reproductive needs, as cultural taboos may prevent them from being openly voiced. Contextual understanding of the restrictive, overwhelming circumstances of camp life under which the women live is crucial. For example, one simple way to prevent sexual violence against refugee women is their inclusion in the distribution of necessities so they will not be forced into transactional sex to provide for themselves. Many women are under societal pressure to hide the fact that their pregnancies are the result of rape or transactional sex. By discussing reproductive health in culturally appropriate ways and settings, aid organizations could better understand that the challenges of daily life and social repression may be prohibitive to a woman’s self advocacy, but her silence does not indicate her lack of need for certain services like safe abortion. No one knows what refugee women need more than the women themselves. Any ‘top-down,’ generalized programs by humanitarian organizations that do not welcome the knowledge of the beneficiaries themselves risk becoming nothing but ‘feel-good’ operations. There is a massive need for effective reproductive health care in refugee settings. The only way to bring tangible benefits is to involve the women in the planning and delivery of services in more than a token way. Rachel Girmus is a graduate student in her last semester of the MA in International Studies program at East Carolina University. She is pursuing a Graduate Certificate in Economic Development, and is interested in foreign languages and literatures, social justice, development and Africa. Rachel Girmus In 2009, the UN Refugee Agency reported that 21.8 million worldwide are “persons of concern;” these include refugees, internally displaced persons, and stateless persons, spread over 140 countries. Of these, 80% are women and children who fled their home countries due to conflict and human rights violations. Women are disproportionately affected by every stage of conflict–as conflict begins, as they are forced to flee their communities, and during periods of seemingly interminable exile in camps. During these stages, women lose the protection of their families, on whom they are dependent for physical and economic security. They often become the victims of violent unprotected sex that results in unwanted pregnancy and contraction of disease, while humanitarian services offered in camps do not adequately meet their reproductive needs. Women and adolescent girls are particularly vulnerable to sexual violence in the form of rape during wars of nationalism or ethnicity. Because their bodies are interpreted as symbols of the collective motherland or culture, they are likely to become targets due to citizenry, religion, ethnicity, race or class. The use of rape as a weapon of warfare effectively terrorizes a society’s women and humiliates its men, causing whole communities to flee their territories in search of safety. During the disorganization of flight, women may also become separated from the protection of male family members, leaving them vulnerable to assault, robbery, harassment, and sexual violence by strangers they meet along the way, including army and militia units, police, pirates, highwaymen, border guards, peacekeepers, humanitarian aid providers, and other male refugees. Once settled within refugee camps, security may be lax leading to further assualts on women by other refugees or the security police themselves as recent reports on Haitian refugee camps document. In addition, women who are separated from male partners often bear the burden of providing for their families and may be forced to exchange sex for food and protection. Even when male partners are present, the stress of dislocation and the lack of economic opportunities lead to documented increases of domestic violence and marital rape. Frequent unprotected sex, moreover, poses significant risks to the one fourth of refugee women who are of reproductive age; most obviously, unwanted pregnancy and contraction of sexually transmitted infections. Adolescent girls are at particular risk of unprotected sex, early pregnancy and exploitation by older males in camp settings. While humanitarian organizations provide many important services to refugees, they sometimes fail to provide adequate gender and culture- appropriate ones because they don’t ask refugee women what they need. For example, despite the prevalence of forced and coerced sex, which is usually unprotected, services for women in the camps tend to focus only on basic family planning and antenatal care and those services are limited in comparison to the numbers of women who need them. As a result, many women have no option but abortion when faced with unwanted pregnancy. As a result, unsafe abortion is responsible for between 25-50% of all maternal deaths in refugee camps. Even though the majority of pregnancies and infections are not the fault of the women themselves, they risk death by trying to gain some semblance of control over their lives. Why are these reproductive services so woefully inadequate? The surprisingly straightforward answer: women refugees are not consulted about their own health needs. At the most basic level, addressing women’s needs effectively in refugee settings requires the inclusion of refugee women in the planning of programs and their implementation. Such an approach has the potential to create both gender and culturally sensitive outreach. The United Nations High Commission on Refugees even agrees that “programmes that are not planned in consultation with the beneficiaries, nor implemented with their participation, cannot be effective.” Assumptions and generalizations by aid organizations about how to serve female refugee populations do not work. There are myriad documented cases of interventions undertaken by relief organizations with the best intentions that ultimately ended in failure because the attempted speed of the response prevented any gender and culture sensitivity during implementation. Cases include instances of food and shelter distribution in the camps being under the sole control of men, resulting in malnutrition and mortality in female-headed households; counterproductive female income generation programs that alienate men; and male-dominated health service provision and lack of female health workers, which lowers women’s access to healthcare. To address issues of reproductive health, women should be involved in needs assessments and all stages of health care services including their planning, provision and implementation. It is the responsibility of agencies that work with refugee populations, including non-govermental organizations, reproductive health organizations, and government health officials to inform themselves of refugee women’s reproductive needs, as cultural taboos may prevent them from being openly voiced. Contextual understanding of the restrictive, overwhelming circumstances of camp life under which the women live is crucial. For example, one simple way to prevent sexual violence against refugee women is their inclusion in the distribution of necessities so they will not be forced into transactional sex to provide for themselves. Many women are under societal pressure to hide the fact that their pregnancies are the result of rape or transactional sex. By discussing reproductive health in culturally appropriate ways and settings, aid organizations could better understand that the challenges of daily life and social repression may be prohibitive to a woman’s self advocacy, but her silence does not indicate her lack of need for certain services like safe abortion. No one knows what refugee women need more than the women themselves. Any ‘top-down,’ generalized programs by humanitarian organizations that do not welcome the knowledge of the beneficiaries themselves risk becoming nothing but ‘feel-good’ operations. There is a massive need for effective reproductive health care in refugee settings. The only way to bring tangible benefits is to involve the women in the planning and delivery of services in more than a token way.
Rachel Girmus is a graduate student in her last semester of the MA in International Studies program at East Carolina University. She is pursuing a Graduate Certificate in Economic Development, and is interested in foreign languages and literatures, social justice, development and Africa.