Refugee Women

REFUGEES AT RISK

"The most difficult thing for women is collecting firewood. We walk a long way to get it and we have only our backs to bring it on. How much can a woman carry on her back?

Most of the women in this camp complain about backaches and severe back pain. There are many miscarriages... you see many breastfeeding and pregnant mothers (collecting firewood). Some women take their babies with them."

While all refugee women need not be classified as "vulnerable", those planning and implementing emergency assistance need to take into account women who may be disadvantaged or have special needs, namely female heads of households and isolated women. Efforts must be made not only to ensure mat these women benefit from and have equal access to the assistance provided but also provide for their physical safety.

Actions which may help solve or prevent such problems include:

· involving women in the planning and implementation of assistance (e.g. consulting with refugee women, use of female workers and interpreters)

· monitoring closely the distribution of aid and services, and their results

· setting up child care centres/services

· mobilizing help and support of friends, neighbours, relatives

· decentralization of health, nutrition and other services, or the use of mobile units to provide such services

· helping set up cottage industries and organizing vocational training

· providing sheltered accommodation for unaccompanied young women

In an emergency refugee women are frequently the victims of physical and sexual abuse, rape and abduction. This is particularly true of border areas, along escape routes and in camps. Unaccompanied women are also faced with pressure to provide sexual favours in return for protection, food and shelter. As they are unlikely to come forward to report this kind of problem, prevention of such abuse depends on the vigilance of the emergency assistance workers. The setting up of security patrols and the provision of protected shelters for isolated women are measures which can be taken. However, it is also important to mobilize the refugee community, through the "natural community leaders" so that they can deal with the problem appropriately from within.

Women and girls who have recently suffered rape, torture or other violence may be in a state of shock. Such cases require coordinated medical treatment, counselling *, and material and legal assistance.

^* Not all such victims will benefit from counselling. When family or friends can help, emotional support or counselling by an outsider is often not wanted or needed. Informal contacts can be used to let victims know that support is available if needed. Use discretion, particularly when dealing with cases of rape. Avoid any steps that could result in the woman being publicly labeled as a "rape victim" or staff as "rape counsellors".

In most cases, people who have suffered extreme trauma will, in a matter of days or weeks, be able to carry out daily tasks and will have begun to come to terms with their experience. Some who have difficulty in making progress in this psychological healing may benefit from therapy with a professionally trained psychologist or social worker, preferably of the same cultural background.

When assisting a victim, it is important not to overlook the needs of the family, or a fiancho may also be dealing with what has happened. Individual and family counselling by someone with appropriate professional training may be needed to prevent or resolve resulting marital or family conflicts. The traumatizing experience of rape may sometimes make it difficult for a mother to continue breastfeeding if she was already, or to breastfeed the baby that may be the result of rape. These difficulties may need to be specifically addressed during counselling.

Protection of women in refugee situations against various forms of abuse is a vital function of anyone planning and implementing an emergency relief operation.

The strength and capacity of women must be tapped in planning and executing programmes. They should be involved in the following activities:

· distribution of food
· camp policy committees (representation should be in proportion to their numbers)
· literacy programmes
· vocational training programmes
· health care activities, such as maternal and child care, family planning, oral rehydration, and other health needs.

There are other aspects which need to be ensured such as:

· access by women refugees to women protection officers and health personnel

· female-headed households should have the same access to assistance as male-headed households

· pregnant and lactating women should receive additional dietary assistance.

Breastfeeding in Emergencies^*

^* Source: Reproductive Health in Refugee Situations, An Inter-agency Field Manual, UNHCR, 1995

Breastfeeding is particularly important in emergency situations because of the increased risk of diarrhoea and other infections, and because the bonding, warmth and care which breastfeeding provides is crucial to both mothers and children. In these situations it may be the only sustainable element of food security for infants and young children. The risks associated with bottle feeding and breast milk substitutes are dramatically increased due to poor hygiene, crowding and limited water and fuel. These risks usually outweigh any potential risk of HIV transmission via breastfeeding. Women also need validation of their own competence. Breastfeeding is one of their important traditional roles that can be sustained during a stressful situation. Successful breastfeeding can contribute to the restoration or enhancement of a woman's self-esteem, which is critical to her ability to care for herself and her family.

Optimal Feeding Practices in Emergencies

· Initiation of breastfeeding within one hour of birth

· Importance of implementing the "Ten steps to successful breastfeeding" (1989 Joint WHO/UNICEF statement, protecting, promoting and supporting breastfeeding)

· Frequent, on-demand feeding (including night feeds)

· Exclusive breastfeeding during the first 6 months provides 98% contraceptive protection, providing menses has not returned, and no other food is given to the baby

· Supplementation of breast milk with appropriate weaning foods starting at six months of age

· Sustained breastfeeding well into the second year of life or beyond

· Breastfeeding during illness with increased frequency; and increased breastfeeding and feeding frequency after illness for catch up growth

· 2400 kcal/person/day of a culturally appropriate food are recommended as a minimum requirement for lactating women. This may require the distribution of supplementary food to lactating women when the general diet available to the refugee population is not adequate.

Counteracting Common Misconceptions about Breastfeeding in Emergencies

1. Women under stress cannot breastfeed
2. Malnourished women don't produce enough milk
3. Breast milk substitutes are a necessary response to an emergency
4. General promotion of breastfeeding is enough

1. Women under stress CAN breastfeed successfully: Milk release (let down) is affected by stress; milk production is quite stable. The treatment for poor milk release and for low production is increased suckling and social support. Research shows that lactating women have a lower response to stress, so helping women to breastfeed may help them relieve stress. The most effective helper for a breastfeeding woman is another breastfeeding woman.

2. Malnourished women DO produce enough milk: It is extremely important to distinguish between true cases of insufficient milk production (very rare) and mistaken perceptions. Milk production remains relatively unaffected in quantity and quality except in extremely malnourished women. The solution to helping malnourished women and infants is to FEED THE MOTHER, and let her feed the infant. By feeding her, you are helping both the mother and child and protecting the health of both. Giving supplements to infants can decrease milk production by decreasing suckling. The treatment for true milk insufficiency is increased suckling frequency and duration, ensuring sufficient food for the mother and reassurance from other breastfeeding women.

3. Usually Breast milk substitutes ARE NOT needed: Good guidelines exist on the use of breast milk substitutes and other milk products in emergencies. They include the WHO International Code of Marketing of Breast Milk Substitutes (May 1981), the UNHCR guidelines on the use of milk substitutes (July 1989), and the World Health Assembly resolution 47.5 (May 1994). Under the Code, donors must ensure that any child who receives a breast milk substitute is guaranteed a full supply as long as needed, usually about 6 months. Common elements of these guidelines are that breast milk substitutes are:

· not used as a sales inducement;

· used only for a limited target group of babies (for example orphans where wet nurses are not available);

· used under controlled conditions (therapeutic feeding, never in general distribution);

· accompanied by additional health care, diarrhoea treatment, water and fuel.

· feeding bottles and teats should not be provided by relief agencies except on the condition of strict supervision, and their use should otherwise be discouraged.

These guidelines should be disseminated and followed by all agencies working in emergencies.

4. Breastfeeding women NEED assistance - general promotion of breastfeeding is not enough: Most health practitioners have little knowledge of breastfeeding and lactation management. Women in displacement and emergency situations are at increased risk of breastfeeding problems. They need help, not just motivational messages. Health workers may need to be trained to give practical help concerning breastfeeding difficulties such as incorrect positioning, cracked nipples, engorgement. Maternal perception of the risk of "not having enough milk" is an important factor in early termination of breastfeeding. These perceptions may be intensified by the stress of emergency situations. The first concern should be ensuring optimal breastfeeding behaviours, which may require the selective feeding of lactating women. Policies and services which undermine optimal feeding, such as giving food supplements to infants under 6 months and using bottles for ORS delivery, should be avoided.

Improving the Physical Protection of Refugee Women*

^* Source: "Refugee Women", prepared by Susan Forbes Martin, Women & World Development Series, Zed Books Ltd, London, 1992

· Place international staff [including women] in border areas which refugee women must cross in order to enter countries of asylum as well as in reception centres, refugee camps and settlements;

· Improve the design of refugee and displaced persons camps to promote greater physical security. Special measures that should be implemented include security patrols; special accommodation, if needed, for single women, women heads of households and unaccompanied children; improved lighting; and physical barriers to the access of armed persons to camps;

· Provide gender-sensitive training for host country border guards, police, military units and others who come into contact with refugees and displaced persons;

· Ensure greater participation of refugee and displaced women in decisions affecting their security. Among the issues requiring greater input from refugee and displaced women are mechanisms to improve the reporting of physical and sexual protection problems;

· Employ female protection officers and social and community workers to identify and provide remedies for women and children who are the victims of physical abuse;

· Ensure that refugee women are not forced to stay for protracted periods of time in dosed refugee camps or detention centres where they are likely to be the victims of family and intra-communal violence;

· Provide emergency resettlement to refugee women who may be particularly exposed to abuse;

· Offer gender-sensitive counselling to refugee women who have been victims of abuse;

· Establish effective mechanisms for law enforcement to ensure that abusers are identified and prosecuted for their offence;

· Incorporate information on the situation, needs and rights of refugee women in all educational activities carried out in refugee programmes;

· Address protection concerns particular to refugee women in all other sectors of refugee programmes, such as health and nutrition programmes.

Check List

What actions have been taken to identify and assess the specific needs of vulnerable refugee women?

What measures have been introduced to protect and prevent sexual abuse of refugee women?

Do vulnerable refugee women benefit from the general emergency assistance?

How are the specific needs of vulnerable refugee women being addressed under the emergency programme?

Have the traditional support systems for vulnerable refugee women been identified and re-established?

Is there adequate support for optimal breastfeeding practices for mothers and infants?

Notes: