(introduction...)

Key points

Vulnerable Groups, Minorities and Isolated Refugees

· Ensure that vulnerable groups benefit from assistance provided to other refugees, and if necessary take special measures to help these groups meet their basic needs.

· As much as possible, special assistance of benefit to vulnerable groups must be community based, focusing on building their capacity to meet their own needs.

· Assess the capacity of vulnerable groups to meet the day-to-day requirements of life; give priority for tracing and family reunification to individuals unlikely to survive without family or special support.

· Arrange for the systematic identification of refugees with special needs. Outreach services must be used to identify, reach and assess isolated individuals or groups.

Refugee Children

· There is no reason why refugee children should be denied the joy of childhood. Reactivate the sense of childhood.

· If special separate assistance activities for children are required, these should be carried out with the full participation of their families and communities, rather than addressing children in isolation.

· A child's mental health and psycho-social development is to a large extent dependent upon the restoration of daily routines and activities and the resumption of educational, recreational and cultural activities.

· In addition to medical and nutritional assessments, refugee children should be systematically screened to identify those at high risk from mental health or other psycho-social developmental problems.

Unaccompanied Children

· There should be one focal point (organization/agency) to set policy and coordinate the programme.

· Programmes should actively seek to prevent the separation of children from their families. No change in the situation of unaccompanied children which might prevent family reunion should be contemplated unless it is vital for the health and safety of the children.

· Unaccompanied children must be identified and registered as soon as possible. The first source of information is the refugees themselves and the community leaders.

· The primary consideration in any action or decision concerning unaccompanied minors is to promote the best interests of each child.

· Every effort must be made to find an appropriate solution as soon as possible. In most cases this will be family reunion, as a result of successful tracing.

· Material needs should be met to the level and, to the extent possible, in the manner available to other refugee children.

· A family-based approach should be adopted. The children remain in the refugee community with their own families, foster parents, or other family groupings (e.g. adolescents living independently) and siblings are kept together.

· Continuity of the arrangements and persons involved in the care of unaccompanied children is fundamental. This can be best achieved through a community-based approach, where the whole refugee community is involved and responsible for me care of its children.

· For each and every child ensure:

· immediate care and supervision is provided

· as much information as possible is gathered on his/her background and the circumstances of the separation from his/her family;

· medical, nutritional and psychological screening is carried out

· tracing efforts are initiated to find and reunite the child with his/her family wherever possible.

Refugee Women and Single-parent Families

· Set up mechanisms for the physical protection of women at border crossing points, in reception and transit centres and in camps.

· Set up procedures for assisting victims of sexual violence and other forms of physical abuse.

· Involve women in assessments and in planning and implementation of emergency assistance programmes.

· Ensure that female heads of households and isolated women without support have access to the assistance provided to the rest of me population.

· Ensure measures are taken to prevent family separation and the abandonment of children. Give priority to the families of male single-parents, especially those with infants or very young children.

The Elderly

· There is no fixed age at which it can be assumed that older refugees will need special assistance.

· Those without family support are more likely to need special assistance for their day-to-day survival.

· Plan and develop services for elderly refugees along with those for me general refugee population so that these services are integrated with the broader assistance programme.

· Community-based welfare services for the elderly should enhance their social functioning and ability to participate in the community as contributors and beneficiaries.

The Disabled

· Seek to prevent disabilities from arising through providing adequate nutrition, primary health care, immunization programmes, sanitation and by reducing health and safety hazards.

· Give priority to all cases in which the disability represents a serious obstacle to leading a normal life and achieving self-sufficiency.

· Screen all new arrivals, for those who need immediate assistance, and those who should be followed up later. Use outreach services to ensure that whole population is covered.

· The goal of rehabilitation is to restore the disabled to the community in an effort at re-integrating them into the mainstream of the community's activities.

· Families play a major role in helping (or preventing) disabled refugees to achieve social integration, hence the need for a family-based approach to assistance for this group.

Mental Health

· All refugees are potentially "at risk" in terms of their mental health. Provision for their psychological and emotional needs is of equal importance in assisting them not only to survive, but to attain self-sufficiency.

· Preventive measures will seek to re-establish, to the extent possible, normal family and community life, while actively pursuing durable solutions.

· A knowledge and understanding of how the population dealt with trauma, loss, grief and mental illness prior to exile is important.

· It is best for professional therapeutic assistance to be provided by someone of the same cultural background as the person needing help.

Vulnerable Groups, Minorities and Isolated Refugees

REFUGEES AT RISK

The strength of a chain is in its weakest link, and that of a community in how it cares for those who are most in need.

In emergencies it is important to ensure that the physically, mentally or socially disadvantaged are able to meet their basic needs. Thus in the planning and implementation of emergency assistance, vulnerable groups must be identified and monitored systematically to ensure that they are not further disadvantaged. If necessary, special measures should be taken to meet their particular needs.

Assessment is Necessary: Not everyone in these groups will necessarily need special assistance. Many are able to care for themselves or are helped by family members, relatives, friends, neighbours, etc. It must be assessed which refugees lack support and need special assistance to meet their basic needs.

Within a refugee population of any significant size there will almost certainly be some individuals and families who do require special assistance. Consequently, the question is not whether to assist the disadvantaged groups but what should be done for whom.

Screening: As soon as possible identify those who require immediate attention (e.g. unaccompanied children, the sick and malnourished, victims of violence, severely handicapped individuals who lack support) and those who should be followed up later (e.g. single-parent families, unaccompanied women, elderly persons, disabled individuals who need rehabilitation).

When lists are available showing family groups and the age and sex of each person, identify single-parent families and unaccompanied people who may need assistance.

Assistance: Measures to benefit such groups of refugees should inter-alia ensure the following:

· basic daily needs for food, clothing and shelter

· special medical care (as in the case of the elderly, the disabled and the traumatized)

· special diet for the elderly, malnourished children, nursing mothers and pregnant women - if medically indicated

· transportation for the sick, the elderly and the disabled

· foster care for unaccompanied children.

Community-based Assessment: Those within a large refugee population who need special assistance can be identified through a combined effort of refugee leaders and trained refugee community workers. This avoids the barriers of culture and language faced by outsiders.

Planning Considerations: when planning assistance for refugees with special needs, give particular attention to:

· self-support as a long-term goal

· community integration

It is generally best for refugees with special needs to use the same services as other refugees. When specialized services are necessary, they can be community based.

· consultation with refugees

(It is important to hold consultations with the refugee community to find out how those with special needs would have been cared for in their home country and to gather opinions on how their needs can best be met under present circumstances.)

Family-based Care: As far as possible, assist refugees who have special needs through their families. For unaccompanied refugees, foster families (for the disabled, elderly or chronically ill adults, as well as children) can often be arranged. Family care has the advantages of:

· providing continuing personal attention
· being culturally appropriate
· helping social integration
· being less dependent on outside resources than institutional care.

Institutional Care: For the those who have no family support and are unable or have difficulty looking after them, consideration is often given to placing them in an institution or creating a special centre for their care. Although this can be appropriate in certain circumstances, first consider alternative possibilities:

· family reunification
· assistance in their homes for the elderly and disabled
· foster families
· religious centres established by the refugees themselves, if this is their tradition.

Groups at Risk

Community-based Approach

Community-based mechanisms for identification, registration, care and follow up

· Committees within the community of interested persons to identify, follow up the needs of these groups.

· Involvement of families and friends in this process as well as those with a special interest.

· Involve every group in the community to ensure that no one is forgotten (men, women, youths, girls, children): promote interaction between the groups (e.g. young people and the elderly) to rebuild community solidarity.

· Identify local institutions which have facilities for care and treatment, such as clinics, schools, hospitals, recreational facilities.

· Strengthen these institutions through training, investment of resources, awareness creation and support to personnel, attendance at joint meetings and recognition of work done.

· Enable those at risk to speak up and make their needs known. Encourage persons with similar problems to form support groups. Give these groups a voice in programme planning and implementation.

· Discuss with the community the overall goals of the programme, as well as constraints (e.g. finance, duration of support, personnel). Focus on the long-term sustainability of the programme and the need for self-help and self-reliance.

· Develop activities which will eventually result in supplementary support, financial or in kind, for example: agricultural activities, skills training, education.^*

^* Common policies on the payment of wages and/or incentives to refugees engaged in providing services to the community must be agreed and adopted from the outset by all the agencies/organizations involved in the programme. Possible incentives include: money, food for work, training, recognition in the form of uniforms, certificates, badges, public recognition by the community, status in me community, inclusion in the decision-making on community matters.

· These activities have the dual goals of

a) keeping people emotionally and psychologically alive and interested;
b) actively engaged in developing a better future for themselves.

This has a beneficial impact on their eventual preparation for repatriation and reintegration on their return home.

Ethnic Minorities and Other Isolated Refugees:

Every society has its social, religious, political or ethnic minorities whose access to services, even under normal conditions, is restricted. These groups of persons become particularly vulnerable in a refugee emergency, as assistance is likely to be channelled through the leaders of the majority groups. Furthermore, recent emergencies have demonstrated that persons from third countries, without links in the country of asylum, and without links in the larger refugee community, are also likely to be without access to assistance. Hence, efforts should be made by emergency service providers to identify isolated refugees and minority groups, to ensure that they have access to the same basic assistance provided to other refugees.

A good understanding of the socio-political composition of the refugee population may also help to prevent inadequate social engineering that would either further isolate minorities or bring antagonistic groups into confrontation.

In the distribution of assistance it is necessary to ensure that basic human needs are met for all.

Vulnerable Groups:

Persons identified to be in: · a life threatening situation · unable to help themselves · lack family and normal support structures. Groups commonly identified in most emergencies: · unaccompanied children · traumatized children · unaccompanied young women · isolated women · the physically disabled · the psychologically disabled · unaccompanied elderly · heads of households (male or female) without support · victims of torture and violence · social or ethnic minorities and other isolated refugees

Remember ! The refugees most in need are often the least likely to come forward to make their needs known. Make sure that the most disadvantaged refugees are not overlooked.

Check List

Is there anyone in the family, or do you know anyone who has an illness or injury that needs treatment?

Is anyone having trouble taking care of himself or herself?

Is anyone having trouble getting enough food, water or cooking fuel?

Is there anyone who does not have the things needed for daily living, such as cooking utensils, cooking fuel, enough clothes, enough blankets?

Do you know anyone who does not have an adequate place to live or has difficulty putting up his/her tent or in building a hut?

Do you know of any children who are separated from their parents?

Do you know anyone who has difficulty in carrying out day-to-day activities because he cannot walk, cannot use his arms, cannot see or hear, cannot speak or is old and has no support?

Do you know anyone who has problems and is acting differently from usual?

Do you know anyone who sometimes has seizures?

Do you know anyone who is having a difficult time because he/she cannot locate a missing family member?

Are there single-parent households headed by men, with children below the age of five? Who is looking after these children?

Is the single parent able to cope with the situation? If not, is there anyone from the community who can help?

Do the needs and resources assessments include variables that allow the identification of sub-groups?

What safeguards have been introduced to ensure access of minority groups to basic assistance?

Are transit centres and camps designed in a way that can promote the interest of various groups with minimum conflict or rivalry?

Refugee Children

REFUGEES AT RISK

"...we were doing well (until) the war started. All of a sudden everything changed, there were too many people dying. A lot of families were trying to escape, but we held on till the last minute. I decided it was time to move when my father and uncle were killed. We left one night and left everything we owned behind, and just fled for our lives. I have ten children, and luckily all of them were home that night... We walked for weeks, walking all night and hiding during the day." *

* Source: Case studies reported in K. Hancock, "Refugee Women and Children in Somalia, their social and psychological needs", UNICEF, Mogadiscio, 1988. (Also passages quoted on pages 62, 68 and 80.)

All children have special physical, psychological and social needs that must be met for them to grow and develop normally. For this reason refugee children are particularly vulnerable in an emergency and should be among the first to receive protection and assistance.

The needs of refugee children should be identified and documented as early as possible by qualified and experienced child welfare personnel. A regular review should be carried out to ensure that their requirements are being met. If practicable, assessment should be made on an individual basis, as the age, personality, health, family and cultural background will effect a particular child's needs and the identification of appropriate solutions. The opinion of a child on his/her own needs should be obtained and given weight in keeping with the child's maturity and judgement. In large refugee populations, where individual assessment is not possible, such methods as surveys, meetings and interviews with children and key informants can be used.

Community-based Approach: If special, separate assistance activities for children are required, these should be carried out with the full participation of their families and communities, rather than addressing children in isolation. The effectiveness of assessment and responses can be significantly increased if the refugee community itself is actively involved.

Emphasis on Psycho-social Aspects of Child Development: Most relief agencies working with refugees have, until recently, focused on the physical survival of the refugee child by reducing infant mortality. This has had top priority in UNHCR emergency assistance practice for a number of years through its supplementary and intensive feeding programmes. However, it is becoming more and more apparent that physical survival is not enough in order for the refugee child to grow up and become a responsible member of society. The psycho-social aspects of child development must also be included in assistance programmes for refugee children.

A child's mental health is directly affected by the level of well-being of the family and community. Apart from the harm which may be caused to normal development by the disruption and insecurity inherent in refugee situations, additional problems may arise when children suffer or witness violence, abuse, torture or the loss of family members. In this respect unaccompanied children are particularly at risk.

Access to Services: Refugee children generally should have access to the same or similar mental health services as nationals. Moreover those who suffer mental disorders or extreme mental distress as a result of their experiences, or their situation as refugees, are entitled to benefit from mental health services and treatment, even where such services may not be available to nationals.

Preventive Measures: Not only treatment should be available but measures that help prevent mental health problems should also be adopted. In general, this will include action to pursue durable solutions and to re-establish normal family and community life. Such community-oriented measures can have important benefits at the family level, as well as enabling children to develop and learn cultural values in a normal fashion. A child's mental health and psycho-social development is to a large extent dependent upon the restoration of daily routines and activities and the resumption of educational, recreational and cultural activities.

Trauma: Because of the possible damaging effects of trauma, refugee children should be systematically screened (through schools, clinics or feeding centres) to identify those at high risk from mental health or other psycho-social developmental problems. Some children will require specialized services or treatment.

Community-Based Treatment. Treatment services should be planned and provided in a culturally appropriate manner with the involvement of the refugee community and qualified personnel. In some situations, traditional healers have proven effective in treating mental disorders among refugee children. Unless it is necessary to prevent abuse or neglect, a child should not be separated from his family and community for treatment.

Services that address such special difficulties as trauma related to witnessing or being a victim of torture, violence or sexual assault require the involvement of a qualified mental health professional with a background in working with children. Preferably such a professional would be of the same ethnic background as the refugees or at least have good cross-cultural skills. His/her role could be either to provide treatment directly or to guide and support members of the family or community to do so.

Education:

Every child has a right to education.

Although priorities in the emergency phase may mean that the full elaboration and implementation of an education programme is not possible, the setting up educational activities will make a significant contribution to the well-being of the whole community. Teachers and other educated refugees should be identified and encouraged to participate. Even with inadequate supplies, establishing the discipline of schooling through regular classes and organized activities for the children is important. Simply gathering the children together for a set period each day and keeping them occupied is a valuable first step.

The choice of curriculum is debatable. In practice it is considered advisable to continue with a curriculum which is familiar to both the pupils and their teachers. This will help to bridge any gaps and, by re-establishing familiar patterns, palliate to some extent feelings of being uprooted. At a later stage, when the situation is more settled, children may be introduced to the language and curriculum of the country of asylum.

Games, sports, play and other recreational activities are important for the psycho-social well-being of the children as well as for their recovery from trauma. The opportunity to play is extremely important: playing is a basic activity which gives the child the possibility to process negative experiences and begin to come to terms with them.

Teacher training, should include the psycho-social aspects of the education process. Teachers must have an understanding of the effects of trauma (e.g. disturbed behaviour, psychosomatic problems, learning difficulties) and be able to plan therapeutic activities (e.g. structured games, drama, drawing, peace education) to help the children work through their experiences.

Figure

Emotional and Psychological Needs of Children Children need: · Emotional security and stability. · Individual and sustained care of at least one adult, preferably someone of a similar linguistic and cultural background. · Continuity in existing relationships with other adults and children. · Continuity in societal relationships, education, cultural and religious practices. · Specific help to overcome particular, individual problems. · Unaccompanied children, in particular, need environments which provide as many stabilizing factors as possible and minimize possibilities for additional stress. Continuity of community and cultural ties is all the more important in the absence of family. · The stable nurturing care of an adult is especially Important for infants and young children.

Check List

Are families supported in making their own decisions, controlling their lives and disciplining children?

Are there any (opportunities for) special activities to meet social needs of children?

Are there culturally appropriate facilities to identify and assist traumatized children?

Is there adequate support for mothers to fulfill their mothering role (stimulation) for apathetic babies/children and mothers?

What kind of challenges do refugee children face in everyday life in terms of stimulation or danger?

What is being done to improve the psycho-social environment of refugee children - a) schooling, b) organized play activities, c) support for families in special need?

Have teachers or other educated refugees been identified/recruited?

Are learning activities organized for children on a regular basis?

Notes:

Unaccompanied Children

REFUGEES AT RISK

In a refugee situation, unaccompanied children should be the "first among the first" to receive protection and care.

The physical security and well-being of such children may be at serious risk.

Preparedness: The presence of unaccompanied children should be anticipated in all refugee situations. The number of children in this category may represent 2-5% of the total population. In most cases a special programme will need to be set up for unaccompanied children. In the case of mass influxes it is especially important to designate as soon as possible an agency with the necessary child welfare expertise to be responsible for the immediate and longer-term care of unaccompanied children. A system of identification and registration needs to be set up from the outset to ensure that the basic survival needs (shelter, food, water, clothing and health care) are met. Mechanisms for prevention, care, tracing, and family reunification will also need to be planned.

Assisting Unaccompanied Children: General Objectives 1. prevention of separation 2. saving lives 3. meeting immediate needs 4. identification 5. tracing 6. family reunification 7. interim management 8. long-term care if tracing unsuccessful

Preventing Separation: Programmes should actively seek to prevent the separation of children from their families. Actual and probable causes need to be identified and preventive action taken. Mothers in ill health, single-parent families and families with disabled members for example may need extra support to ensure that basic needs are met In general, the refugees should be encouraged to keep their children with them. This message should be communicated dearly from the outset.

Parents may "abandon" their children if they think that their children will receive better care in a residential centre for unaccompanied children. Such centres therefore should be created only as a last resort with strict criteria for admission and on how long the child will stay before being placed with a foster family.

Causes of Separation: There are many circumstances prior to, during, and after their flight into exile under which refugee children are separated from their families. Different causes of separation have different implications for the care of the child and the potential for family reunion. Action to assist such children must take this into account.

Against parents' will, a child may be:

Lost

Accidentally separated from other family members, e.g. during population movements (spontaneous or organized).

Children are sometimes lost in emergencies:

a) due to inadequate or inaccurate hospital records or tagging, and the movement of patients between institutions; and

b) when taken away from apparently dangerous situations by service personnel or volunteers seeking to protect or arrange medical treatment without first finding and informing parents.

Abducted

Deliberately taken away from parents by other adults/organizations

Run away

Choosing to leave and live apart from their parents without parental consent

Orphaned

Both parents (or legal guardian) and dose adult relatives in "extended" families having died.

With parents' consent, a child may be:

Abandoned

Deserted by parents who have no intention of subsequent reunion (this can include "unwanted" babies)

Entrusted

Placed voluntarily in me care of another adult, or institution, by parents who intend to reclaim him/her eventually.

A child may be entrusted or even abandoned when parents believe that his chances of survival will be improved by being with other people, or when facilities and services are established for unaccompanied children which are significantly better than those otherwise available.

Independent

Living apart from parents (alone or with others) with parental consent.

In conflict situations, children may also be:

Conscripted

Enlisted in fighting units with or without their parents' consent, or their own.

Principles for Immediate Care

Guiding Principle: To promote the best interests of each child. The unique needs and situation of each individual must be considered.

· One focal point (organization/agency) to set policy and coordinate programme.

· A community-based approach. The children are kept in the refugee community. The community at large is involved and responsible for its children.

· A family-based approach. The children are to remain in the refugee community with their own families, foster parents, or other family groupings (e.g. adolescents living independently). Siblings are kept together.

· No adoption.

· No evacuation except when necessary to protect the health and safety of children generally and therefore not organized specifically for unaccompanied children.

· No residential centres (only as a last resort). If necessary temporary shelters can be arranged within the community to meet the most urgent needs for protection and care while awaiting placement with an appropriate family.

· Assistance to unaccompanied children to be at same level as for rest of the refugee population.

· Support to vulnerable families to help meet basic needs and prevent separation.

· Give priority to infants, children under 10 years, the sick and malnourished, child soldiers.

· Disabled children should be included in normal patterns of activities.

· Material assistance to foster families should, if given, be based on an assessment of vulnerability and not as a general incentive to fostering. Assistance can also take the form of community support (e.g. neighbours helping with daily tasks, child minding, moral support from community/social workers monitoring the family, etc).

· All children to be documented as soon as possible to facilitate tracing.

· Tracing to begin immediately (as soon as the child has been identified as unaccompanied).

· No family reunification without verification.

· Foster families should be encouraged to repatriate with children in their care.

· Repatriate groups together (e.g. adolescents living independently, siblings).

· Action should not be taken without consideration of the long-term implications for the child.

Priority Activities^*

^* adapted from "Assisting in emergencies. A resource handbook for UNICEF field staff", UNICEF, 1986), p. 399.

1. Set up mechanisms for the identification and registration of unaccompanied children:

· communication network including key people (who are resourceful, accepted by everyone in community, with access to all groups of persons, particularly women, and having knowledge of refugee and local languages)

· lost and found posts within refugee community and on routes of population movement

· outreach to locate unaccompanied children within the community (house-to-house visiting, hospitals and clinics, feeding centres)

· standardization of registration procedures

2. If children are not being cared for by a family, arrange to provide shelter, food and medical care for unaccompanied children, in simple community-level "emergency care" centres (small family-sized units within the refugee community) pending placement with foster families:

· basic standards of care should be the same as for rest of the community.
· group children in a culturally appropriate manner.
· establish links with food distribution centres to ensure cards for rations.
· establish a referral system with the health and nutrition sectors.
· ensure minimum registration (if not already completed).

3. Provide support, where necessary, to families already caring for unaccompanied children to enable them to continue to do so.

4. Initiate tracing immediately through community channels/communication network.

5. Find and screen families in the community willing to foster unaccompanied children:

· find out which adults would normally care for children separated from their parents

· find out what are the traditional methods for caring for unaccompanied children

· establish criteria for foster families (e.g. no exploitation, no sexual abuse, no military recruitment, equality of treatment with other children)

· consult with refugee community for other criteria (e.g. known by neighbours to have a good character; does not have disputes within the family or with neighbours)

· identify women who are breastfeeding and would be willing to act as wet-nurses.

6. Set up mechanisms for placement of children in interim care (foster families, independent living for adolescents, residential centres if these absolutely cannot be avoided) appropriate to his/her needs:

· document the placement and subsequent movements
· fostering agreements
· draw up standards for protection and care in centres
· follow up/monitoring by social/community workers.

7. For each and every child ensure that:

· immediate care and supervision is provided

· as much information as possible is gathered on his/her background and the circumstances of the separation from his/her family;

· medical and psychological screening

· tracing efforts are initiated to find and reunite the child with his/her family wherever possible.

Simultaneous Action is Needed to:

· prevent further separations

· confirm and publicize policies and provisions for unaccompanied children including responsibilities for protecting their interests and supervising arrangements for their care

· mobilize available child welfare expertise and train other workers/volunteers

· remove barriers (e.g. administrative, political) to family reunion where necessary and possible.

Identification: Unaccompanied children must be identified as soon as possible. The first source of information is the refugees themselves and the community leaders. Active efforts to identify unaccompanied children should be made, through a process of registration, house-to-house visiting, creation of lost and found posts. Places should be designated/established where:

· parents who have lost children can register enquiries

· members of all communities can report unaccompanied children for whom they are caring

· young unaccompanied children can be brought by people who find them but are unable to care for them

· older unaccompanied children can present themselves.

Unaccompanied children are also likely to be found in hospitals and clinics, feeding centres and orphanages.

Registration and Documentation: Time lost before interviewing the child is also information lost; particularly about the circumstances of a family separation which has taken place recently. As soon as identified, unaccompanied children should be specially registered. (During general registration exercises, unaccompanied children should be registered separately but cross-referenced to the family with whom they are staying.) The information required will depend on the circumstances. At a minimum note the child's name and location.

Circumstances permitting, the following steps must be taken as soon as possible:

· ask the child if he/she knows where the family is with whom he/she has been living (parents may be temporarily absent of the child may be sent by a parent merely to receive extra food)

· if possible, go with the child to the place where he/she was found and attempt to negotiate the continuation of assistance by the previous care-giver

· interview of the adult care-taker, and older siblings if any

· record made of all information available concerning the child's circumstances (including exactly where and when the child was found) from those who either brought the child forward, or with whom the child was found (this is especially important for infants and very young children)

· give the child a coded identification bracelet (enter the code/reference on the registration form immediately)

· make sure that appropriate care arrangements have been taken for the child

· have the child photographed with a small board on which at least his assigned reference number is clearly marked. Use a camera and film from which subsequent copies can be made for tracing purposes. If feasible, also take an "instant" picture to put into the file immediately.

The identification and registration process must be carried out carefully in order to avoid caretaker families abandoning children, or hiding children for fear that they may be taken away.

Legal Status: Legal responsibility for unaccompanied children rests with the government of the country of asylum. UNHCR however has the obligation to ensure that the High Commissioner's policies are enforced.

A legal guardian should be appointed to act in loco parentis for the unaccompanied child. In situations where refugee status is individually determined, special procedures must be instituted to safeguard the rights and best interests of the child (for details see "Refugee Children, Guidelines on Protection and Care", UNHCR, Geneva, 1994, pp. 100-101).

Tracing: As soon as unaccompanied children are identified, efforts must start to trace their parents or families, and ensure family reunion. One agency/organization should act as focal point for tracing activities to ensure common aims and procedures. Where feasible, tracing should be coordinated with the International Committee of the Red Cross (ICRC).

Even for unaccompanied children who report that their parents are dead efforts should be made to trace family members. In such cases it is possible that at least one parent is still alive. There is also the possibility of locating other family members or adults who may have more information about the parents, or who may be willing to care for the child.

The enquiring party, as well as the child, should be informed of progress made in tracing efforts. However, the asking of questions and the circulation of information must not endanger the child or the family. The potential benefits of tracing must always be weighed against the risks that the process could impose on the child and the family. The political context or the otherwise potentially dangerous circumstances of the situation should not be underestimated in the overall effort to reunite children with their families.

Verification: When the parents/family of a child have been traced and a child is claimed, the claim must be verified. Before bringing the adults and children together, photographs, descriptions, accounts of events and family composition need to be compared.

Family Reunion: The assistance and support of a social worker should be made available to facilitate the child's re-integration into me family. The length and causes of separation will be key factors in this process. Each case must be carefully assessed to determine what is in the best interests of the child. If family members are located in the country of origin and it is not possible for the child to rejoin them, the child should be assisted to maintain communication with them. In some situations the ICRC will be able to help with this.

THE TRACING PROCESS

Identification based in community Documentation information from child information from community Tracing immediate community in other camps in other parts of the country international Family Reunification If the activity starts early enough, inter-country tracing may not be necessary.

Organizing Care: Where there are considerable numbers of unaccompanied children, the establishment by UNHCR of a special unit for their care is recommended. The assistance of the appropriate national authority, UNICEF and qualified NGOs should be sought.

The best child care workers are likely to be respected adults within the refugee community, for example older parents with child-rearing experience. Child care workers must be properly supervised, and supported with training programmes. Unaccompanied young women can be recruited as assistant child-care workers, thus giving them useful work as well as some measure of security.

Where outside assistance is required, the criterion must be competence to manage the specialized services needed. Any organization involved by UNHCR in the care of unaccompanied children must be in agreement with the principles and policies of the Office and not have conflicting objectives, such as adoption, resettlement or religious conversion.

Programmes for the care of unaccompanied children must be carefully co-ordinated with all involved to ensure common aims and standards.

One of the most important principles of the care of any child is that relationships must be stable. Unaccompanied children will develop very close bonds with other children and adults. Development and maintenance of a strong bond with the person looking after the child is of crucial. Thus continuity of the arrangements and personnel involved in their care is fundamental.

Family-based Care: Foster care in the emergency phase is considered as care by a family outside the normal culturally accepted family structures, on an interim basis, pending family tracing and reunification. The care of unaccompanied children should be undertaken, as far as possible, by persons of the same ethnic and social background as the children in order to ensure cultural and linguistic continuity. Refugee foster families therefore should be preferred to local families. If possible, in anticipation of voluntary repatriation (families are encouraged to repatriate with the foster child in their care), the foster family should also come from the same area of origin and intended area of return as me child. Every effort should be made to place the child (or children in the case of siblings) with an appropriate and caring foster family within the refugee community. Compatibility of the child with the foster family should be kept in mind when making placements. Ethnic differences should be borne in mind, but should not become an issue when placing children of mixed marriages. However, staff should be ready to respond to problem case together with the Protection Officer. Careful account should also be taken of cultural attitudes towards fostering. For instance, in some cultures the family may take in a child, but only as a servant.

Before placing children in foster care, the following conditions must be fully satisfied:

· The community where the foster families reside must be sufficiently secure and stable to ensure that the child and family can live in safety and that regular monitoring of the child is possible.

· Before a child is placed with a family, the organization responsible for the care of the child screens the family with regard to their willingness and capacity to provide an adequate level of care and nurture for the child; information about the prospective foster family should be gathered through reliable community networks, religious associations.

· The child is registered (using the ICRC documentation form) before any placement is made.

· The foster placement is formalised with a written agreement (UNHCR form, annex 9), signed by the head of the foster family, agreeing to provide care for the child as a member of the family under the supervision of the organization responsible for the child and to return the child on request of that organization in the event that this is determined to be in the child's best interests (i.e. for family reunion, or if care is judged to be inadequate).

· The written agreement also states what assistance, if any, the foster family is to receive.

· The organization responsible for the child monitors the child's well-being at least every two weeks. The follow-up must be strict and should include monitoring of health and nutritional status of the child. The organization must have sufficient resources to provide regular and competent medical check-ups of the children. Psychological well-being should be monitored regularly by a social worker.

Where an unaccompanied child is living voluntarily with a family or an adult not related to her/him and the child's needs are being met adequately, the relationship should be respected. It merits repeating, however that unaccompanied children living with other families should still be identified and documented, and the quality of their care arrangements should be assessed. This process must be done carefully in order to avoid disrupting the care relationship or encouraging care-taker families to abandon or hide the presence of such children." Special attention should be given to situations in which children are found to be abused, exploited or neglected, and appropriate alternative arrangements made for them. (source: Refugee Children, Guidelines on Protection and Care, UNHCR, Geneva, 1994)

Adolescents

Arrangements for adolescents should be made on a case-by-case basis, seeking the solution that provides most stability. Most adolescents will probably choose the option of living in groups. Unless they are related it is advisable to separate boys and girls. These groups should be followed up by the community monitoring system. It is further advisable that they choose an adult who will take responsibility for them in addition to the community monitoring system.

Infants

Feeding is an important aspect of caring for unaccompanied infants and young children. Exclusive breastfeeding remains the safest and most adequate way of feeding young infants under 6 months of age even if they are separated from their own mother. Continued breastfeeding after 6 months is an important source of high quality nutrients in times when the diet is marginal. Breastfeeding also continues to protect the child from disease.

Where a child's own mother is not available an infant can be fed by a surrogate mother. This is called wet-nursing. A wet-nurse can be a mother who is breastfeeding her own child. She may also be a mother who has just lost her own child. Or, she may be a woman who is not breast-feeding, but who is ready to let the infant suckle at her breast, and establish a milk supply. This is called relactation.

Care should be taken in the selection of a wet-nurse. If possible, she should be screened for HIV. However, where screening is not possible, the risk of feeding the infant with infant formula should be weighed against the risk of the infant acquiring HIV by a potentially infected woman. Where it is unlikely that infant formula can be prepared hygienically and safely, and where the prevalence of HIV is low, breastfeeding will normally be the preferred mode of infant feeding.

Care within the Community: Every community has its own mechanisms (regulated by its beliefs, social values, customs, traditions and preferences) which determine how problems are solved. A community-based approach seeks to enhance and improve existing "coping mechanisms" which may include: family relationships, mutual assistance among neighbours, local social and economic organizations, community leaders, religious institutions/practices/leaders.

Apart from the families fostering children, the refugee community at large needs to be involved and made responsible for its children. The refugee community network (communication/dissemination of messages and information) will be vital to identification and tracing efforts. Refugees can be trained as community workers for outreach activities (searching for and identifying unaccompanied children, supervising and mediating with the foster families). Training and orientation of teachers should also be undertaken. The wider community also has a role to play in monitoring the well-being of unaccompanied children. Fully integrated into the community, the children will benefit from programmes and activities organized for all refugee children (e.g. schooling, games, sports, religious practices).

Residential Care Fostering in refugee families is the preferred option. Residential care should only be considered as a last resort. Where special residential centres are required, small units of five to eight children are preferable with the numbers of house-parents being determined in the light of the ages and particular needs of the children. These centres should be integrated in the refugee community but must be carefully supervised. Large centres should be avoided. Apart from the likelihood that individual attention will suffer in large centres which cannot provide adequately for the child's developmental needs, experience has shown that there is a tendency to provide special services unavailable elsewhere. This can actually attract children who are not unaccompanied. Siblings should live together. In certain circumstances unaccompanied children may have been living together as a group and have close emotional bonds with the group. It may be in the interests of the children to preserve such groupings, or relationships within them, where possible, while at the same time establishing a substitute parent relationship. Standards for such centres need to be drawn up covering all aspects of protection and care to be provided

Tracing Methods

The method(s) chosen will depend on the nature of the refugee situation. Some methods that have been used include:

Spontaneous Tracing

Parents actively go out and search for their children. This can be extremely effective in the immediate weeks following separation, especially when separation occurs locally.

Red Cross Messages

Spontaneous tracing is facilitated by parents or children sending messages via the ICRC to places where they think their children/parents are.

Case-by-Case Tracing

NGOs, other agencies, including governments go out to do tracing for individual children. This method is time consuming, labour intensive and demanding of transport.

Photo-tracing

This has produced excellent results in some contexts. One of the simplest and most effective methods has proved to be the posting of photographs which contain the child's reference number, on special bulletin boards, for example in community centres, for public view. Also, data sheets, including photographs, can be reproduced, bound into volumes and circulated among the refugees. Certain NGOs have acquired considerable experience in implementing such programmes.

Computer Matching

Tracing requests are completed by parents or relatives. These are entered into a database and checked against children registered. Where a match is found and verified, reunification can be arranged.

Media Tracing

Use of television, radio and newspapers to advertise tracing programmes, and to advertise information about particular children.

Baby Tracing

Mothers who have lost babies have been transported to centres to try to identify their babies. Photo-tracing is also used for this group.

Mass Tracing

Using the information base of all children separated from their families, whether in the country of origin or exile, lists are produced by local area of origin. These lists together with photographs are read out/displayed at public meetings, gathering places, etc.

Family Mediation

Families sometimes abandon their children in the expectation that they will receive better care. When such children are identified community workers must mediate with the family to persuade them to take the child back into the family.

Check List

Have all unaccompanied children been identified, registered and documented? Have families who are missing children registered details of the child?

Are there single-parent households headed by men with children below the age of five years of age? Who is looking after these children?

Are other single-parents able to cope with the situation? If not, is there anyone in the community able to help?

Are there culturally appropriate facilities to identify and assist traumatized children?

Have steps been taken to ensure appropriate care arrangements for unaccompanied children?

Which adults would normally care for children separated from their parents?

What are the traditional methods of caring for unaccompanied children?

If the traditional patterns have been disrupted, what do the community and religious leaders, educators, and child care workers or local groups have to say about how such children should be handled?

Are there, or could there be, qualified groups or individuals within the community prepared to care for the children?

Are there any concerned adults caring for children who are not their own? If this is the case, can such care be maintained and supported? Have the children been registered and documented? Has a foster agreement been signed?

What is being done to improve the psycho-social environment of refugee children: (a) schooling; (b) organized play; (c) support of families in special need?

What measures have been taken to identify unaccompanied children? (Outreach, registration offices, lost and found posts, feeding centres, hospitals, etc.)

What mechanism has been put in place for tracing family members of unaccompanied children?

What steps have been taken to preserve the confidentiality of the information provided by the child?

If family members have been traced, have their claims been verified (by photographs, comparison of descriptions and accounts of events)?

What measures have been taken to support and facilitate the child's re-integration into his family?

If family members have been located, but it is not possible for the child to join them, is the child being assisted to maintain communication with them?

Notes:

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:

Single-Parent Households

REFUGEES AT RISK

"I was very dependent on my husband, and all of a sudden he was gone and I had to flee, come to a new place not knowing a soul and be responsible for nine children. The oldest was ten. I can't tell you the hell I went through during that period."

Because of the dangers and hardships inherent in many refugee situations, it is quite common for a significant proportion of refugee families to be headed by a single parent, often by a woman.

Causes: Events that lead to a high proportion of single parent families in some refugee situations include:

· the deaths of family members
· separation during the events that lead the refugees to flee
· the departure of men to look for work or for other purposes.

Problems: This group is likely to experience difficulties including:

· lack of mobility due to child-minding responsibilities
· lack of time to earn an income due to domestic responsibilities
· difficulty in achieving self-support
· difficulty with access to assistance and in arranging for a reasonable place to live
· concern with physical security.
· the likelihood of family disintegration among single-parent families headed by men.

Prevention and Solutions: The following action can help prevent or resolve such problems:

· organizing co-operative child care among families

· establishing child care centres

· mobilizing friends, neighbours, relatives to help with child care

· establishing breastfeeding mother support groups

· decentralization of health, nutrition and other services to locations dose to where refugees are living, or the use of mobile units to provide these services

· helping set up cottage industries

· vocational training to enable the head or some other member of the family to gain employment

· helping refugee women to set up mutual support groups

Often accustomed to maintaining a low social profile and depending on a father or husband, women are in a particularly difficult position when they suddenly become the family head. If they are not assertive, they may find themselves at the end of the queue for the allocation of food, shelter and other basic items. To improve their access to assistance:

· include refugee women in the planning and implementation of assistance
· monitor closely the distribution of aid and services provided, and their results.

Setting up residential centres for unaccompanied women and women heads of households can provide physical security as well as opportunities for cooperative child care, income-producing activities, skills training and other services.

Single-Parent Families Headed by Men: These households face a greater likelihood of breaking up than those headed by women. Because child-rearing in many societies is largely the responsibility of women, a father who finds himself the sole parent may feel unable to keep his family together. Steps that can help keep such families together may include:

· arranging for child care

· arranging for practical help and encouragement from neighbours, religious leaders, community leaders, refugee community workers.

· providing training in parenthood skills and responsibilities

· counselling fathers to help them accept their role as single parents.

Check List

What special problems is the single-parent household facing?

Are there any friends, relatives and/or neighbours who can be mobilized to assist the family, to solve problems? If not, what alternative support system can be set up in their favour?

Can the family provide information to trace missing family members?

What has happened to the husband/wife who is not present?

Do the children and parent seem to be: healthy - adequately fed - adequately dressed?

What skills and possibilities does the parent or any older child have to work and support the family? Are they aware of, and able to use, appropriate services and/or training opportunities?

If anyone has been sick: When? Were they treated by a doctor? What was the illness? Is anyone still taking or need medicines?

Have the children been fully immunized (in line with local EPI)?

If parent is a mother, is she pregnant? If so, does she attend a clinic? Does she receive/need any special health care which is available?

If there is an infant or young child in the household, how is he/she fed?

If there is a mother, is she able to breastfeed?

Is adequate support available to ensure optimal feeding practices?

Notes:

The Elderly

REFUGEES AT RISK

In the harsh circumstances surrounding life as a refugee, the elderly often do not survive for long. Yet, the presence of the elderly in the population is vital to the community, as they represent continuity with the past and act as a stabilizing force. Their care and protection is a priority...

The extent to which a particular person is affected by the aging process is influenced by physical health, family and social support, living conditions, economic situation, cultural background, psychological and emotional well-being. Consequently there is no fixed age at which it can be assumed that older refugees will need special assistance.

As with other groups with special needs, the elderly may or may not require help in meeting their basic needs. Those without family support however, are more likely to need special assistance for their day-to-day survival. This is a priority in an emergency and should be assessed on an individual basis. If assistance is needed, it must be offered in such a way that older refugees are able to maintain their dignity and a sense of self-worth.

Plan and develop services for elderly refugees along with those for the general refugee population so that these services are integrated with the broader assistance programme.

As a rule, the family or kinship group takes care of the elderly who have a well-defined role in the community. In refugee situations however, the support network is likely to be disrupted. To counter this trend, it is important that social service interventions are introduced which are community based and which will enhance the social functioning and ability of the elderly to participate in the refugee community as contributors and beneficiaries.

In an emergency, the following measures should be undertaken:

· Medical screening and assistance

· Older refugees can generally be assisted more effectively within their own communities. Use community resources to this end. Try to arrange for informal help with day-to-day tasks (e.g. collection of water and fuel, the preparation of food) through family members, relations, neighbours, religious or social groups.

· Identification of foster families where necessary. The family should be helped to look after its elderly member.

· Involvement of elderly refugees in community activities. Providing services to their community can help older refugees achieve social integration and reduce feelings of dependence.

Possibilities include:

- providing child care

- passing on traditional knowledge and teaching skills to young refugees (thereby ensuring cultural continuity for the community at a time of crisis)

- making clothing or other items for other refugees

- preparing meals for home-bound refugees.

· Look for organizations in the community, or volunteers who can provide in-home assistance which will enable older refugees to stay in their own homes

· Only when there is no other possibility should institutional care be considered.

· If such care is required, try to place refugees with other members of the same cultural and national group.

The elderly who are still physically fit should be involved in planning and implementing community programmes. Most refugee communities have great respect for their older members. This cultural norm, amongst others, must be reinforced and used as a means to keep the community together and thus retain its identity.

Check List

Have vulnerable elderly refugees been systematically identified? And by what criteria?

Have efforts been made to trace family members of isolated elderly refugees?

Do the elderly refugees benefit from the general assistance? (food, clothes, shelter, water, health care)

Do they need any additional assistance for their daily survival?

What skills, services can they provide to community?

Are there friends, neighbours, relatives, religious or social groups who can provide informal help?

Do they have difficulty with day-to-day tasks? Which ones?

The Disabled

REFUGEES AT RISK

When dealing with the disabled, capitalize on their strengths... Do not focus or dwell too much on weaknesses.

The disabled in any society are at a disadvantage. In a refugee situation where even the able-bodied are in a struggle for survival, the disabled have less chance than the rest, and it is not uncommon to see the disabled abandoned by those who had previously cared for them. Thus, in a refugee emergency, it is important that special attention be given to this group and priority given to all cases in which the disability represents a serious obstacle to leading a normal life and achieving self-sufficiency.

Some of the major disabilities are due to:

· malnutrition
· vitamin deficiencies
· polio
· cerebral palsy
· leprosy
· epilepsy
· bums
· injuries due to accidents
· injuries related to armed conflict
· torture
· other severe trauma
· mental retardation and mental illness
· severe ear and eye infections.

Prevention: Preventive measures may have a greater overall impact on disabilities and handicaps than rehabilitation training. Preventive action begins with the earliest assistance and remains a continuing concern. While community services staff would not be responsible for their implementation, they can play an important role in encouraging refugee participation in carrying out measures which can prevent the incidence or worsening of impairments.

For example:

· adequate nutrition
· ready access to clean water
· adequate shelter
· adequate sanitation
· access to medical treatment
· adequate clothing and necessary
· control of pests that spread disease material items
· mother and child clinics
· exclusive breastfeeding for about 4-6 months and continued breastfeeding for up to 2 years or beyond
· vaccinations for measles, poliomyelitis
· safe working conditions and other diseases, as appropriate
· fire prevention and fire fighting measures
· elevated fire placed to prevent bums to children
· public health education children
· preventive mental health measures
· living arrangements that provide adequate physical security

Identification and Assessment: Before action can be taken for treatment and rehabilitation, disabled refugees must be identified and their needs assessed. When workers are in place before refugees arrive, a good way to identify disabled refugees is to screen all new arrivals, for those who need immediate assistance and those who should be followed up later. A combination of house-to-house visits and information from refugee leaders can be used to identify disabled individuals once refugees are settled. In both cases trained refugee community workers can play a major role.

Some disabled refugees will have impairments that are likely to become worse if proper medical care is not provided. Once handicapped and disabled refugees have been identified, it is strongly advised that they be medically screened as soon as possible. (See UNHCR Disabled/Medically-at-Risk form, annex no. 5).

Remember, "Our greatest need is to be needed." The disabled are also a part of the community. Their strengths can be an asset if used skillfully and sensitively. Look beyond the broken body to the mind and soul, the remaining skills that lie dormant and need to be tapped.

Disabled and handicapped refugees sometimes require immediate help to meet the requirements of daily living. If the refugee is having difficulties in carrying out the following activities then an immediate response will be necessary:

· obtaining food, water, fuel
· preparing food
· eating food
· washing himself/herself
· dressing
· washing clothes
· cleaning his/her house
· preventing injuries to parts of his/her body that have no feeling
· moving around inside his/her house and immediate living area
· moving around outside his/her living area
· going to the toilet or latrine
· working
· going to school
· understanding what is said to him/her
· expressing thoughts, needs and feelings
· taking part in family activities
· taking part in community activities
· (See assessment form for a person who is disabled or chronically ill, annex no. 6).

Treatment: Local resources for treatment and rehabilitation should be used as far as possible. At times it may be necessary to help to develop these services for the local residents as well as for the refugees. These may include production of prosthetic aids which are simple, inexpensive, durable, easy to maintain and repair, yet able to help the disabled person to overcome his difficulties in carrying out daily activities.

All existing services (i.e. basic health units, clinics, hospitals, dispensaries, etc.) should be used to support community-based treatment and rehabilitation services for disabled refugees.

An effective referral network involving governmental agencies, NGOs, religious leaders, traditional healers and community outreach workers should be worked out to avoid duplication of programmes and ensure that services are available to all.

Refugees suffering from disabilities requiring surgical intervention(s) and/or specialised rehabilitation not available in the country of asylum but necessary to restore or prevent further loss of functions, and thereby gain partial or total independence should be given priority for assistance. A limited number of disabled refugees with extraordinary medical problems may therefore receive treatment through international medical referrals, normally within the region where they have asylum.

Rehabilitation: Rehabilitation is not the automatic result of medical treatment or physical therapy. It also means achieving the level of physical, mental and social functioning of which a disabled person is potentially capable. This can range from completely normal functioning for some, to doing such basic tasks as feeding and dressing for others. The goal of rehabilitation work is to restore the disabled to the community in an effort at re-integrating them into the mainstream of the community's activities. It is better therefore for the disabled to participate in the same social services and other programmes as me rest of the refugee community, rather than in separate programmes.

Disabled refugees can contribute to their communities when given the chance. Rehabilitation includes removing barriers to their full participation. Ensure equal access to:

· housing
· transportation
· social and health services
· education
· work opportunities
· cultural activities
· recreational activities
· social interaction
· information of concern to refugees.

Families play a major role in helping (or preventing) disabled refugees to achieve social integration. Programmes should therefore be designed to keep the disabled in the family rehabilitation and receive the necessary support Families must be encouraged to take part in and training to fulfill this responsibility.

Examples of the ways in which Community Services can aid Disabled Refugees

General social welfare services

· Identify disabled refugees.
· Assist them to meet any immediate needs.
· Link them with medical treatment, physical rehabilitation or other needed services.

Education and training

· Help individuals achieve their intellectual potential.
· Teach skills to achieve self-support.
· Promote social integration for children through participation in school.
· Give priority to the disabled when selecting students, as they may have more difficulty than others in achieving self-support.

Individual case guidance

· Help disabled refugees see their own potential and use available resources.

· Help them resolve personal and family problems that can impede integration or self-support.

· Guide them toward employment or other means of self-support.

Self-help projects

· Enable disabled refugees to produce items to use or sell.
· Help participants to develop a sense of their own capacity for self-support.
· Reduce feelings of dependence and helplessness.
· Increase feelings of self-worth.

Community activities

· Help disabled refugees to take part in cultural, religious and recreational activities.

Incidence of Disability in Refugee Populations

The incidence of disability in refugee populations tends to be lower than that in the country of origin, because the disabled are often left behind, die during the exodus or during the emergency phase.

Rate of Survival

Few disabled survive the rigors of the flight into exile. For the survivors who find asylum, immediate action needs to be taken to prevent a fatal deterioration of their condition.

Check List

Are there any medical and rehabilitation facilities? If so, do refugees have access to them? If not, what is the alternative solution?

Have you identified the number of disabled persons and the type of disabilities?

Among those refugees with disabilities identified, how many would require special services?

Are these disabilities caused by circumstances leading to refugee situations?

What do nationals with disabilities do for treatment and rehabilitation?

What measures have been introduced to prevent disabilities: immunization, supplementary feeding, distribution of vitamin A, mine-clearing exercise?

Notes:

Mental Health

REFUGEES AT RISK

"It is not the same when you are independent and responsible for your life and when you are dependent on someone else. You can never be satisfied with handouts. I am not the same, I am not happy to be dependent on someone when I know how wonderful it was to be independent."

"I am always depressed. I don't have any relatives or friends in the camp. I feel very lonely and I cry all the time. I am afraid I will lose my mind."

In an emergency, while the basic needs of food, water, shelter and health care of refugees are easily recognised, measured and understood, the deeper human needs (for security, a sense of belonging, coming to terms with loss, for mourning, and to feel in control of one's life) are often ignored or brushed aside as of no importance. It should not need to be emphasized that refugees do not live by bread alone, that provision for their psychological and emotional needs is of equal importance in assisting them to not only to survive, but to attain self-sufficiency. No emergency worker would wish, that in the process of providing material assistance, he increased their sense of helplessness, and deprived refugees of their self-respect and dignity as human beings. Unfortunately, emergency workers are often guilty of not being sensitive enough to these needs, of inflicting even greater hurt, and, in a way, adding insult to injury.

Responding to Mental Health Problems: In planning an effective mental health component of an emergency programme, all the refugees' experiences must be taken into consideration: what happened to them before, during and after their exodus. A knowledge and understanding of how the population dealt with trauma, loss, grief and mental illness prior to exile is also important.

Survivors of physical abuse or violence require co-ordinated medical care, counselling, protection, material and legal assistance.

Not all victims of violence will benefit from counselling however. 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 mat support is available if needed.

In most cases, people who have suffered extreme grief or 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 experiences. Many are able to do this on their own or with help from family or friends. Some who have difficulty making progress in this psychological healing may benefit from therapy with a professionally trained psychologist or social worker. If possible, it is best for professional therapeutic assistance to be provided by someone of the same cultural background as the person needing help.

When assisting a victim, it is important not to overlook the needs of his/her family in coming to terms with what has happened. As a result of feeling helpless to prevent the situation, these people may turn their anger on themselves, the victim, or others.

Preventive Measures: Measures to prevent mental health problems should also be considered. In general this will include action to pursue durable solutions and to re-establish, to the extent possible, normal family and community life.

As much as possible, refugees should have the opportunity to control their own lives. Freedom of movement and the right to employment or other forms of self-support are basic. In camps, refugee participation in planning and decision making, and the implementation, management and evaluation of all assistance measures should be as extensive as possible.

Ensuring access to information concerning their present situation, responsibilities, and rights to basic health, nutrition and other services has important secondary mental health benefits. The refugees' efforts to reestablish community social structures and institutions, normal cultural and religious life should also be supported. In camps, enabling refugees to build structures that provide places for them to gather informally, to hold meetings or to organize activities can also facilitate the re-establishment of a healthy community life.

Figure

What is perceived as normal human behaviour, including "normal reactions to stress", depends on perceptions which are determined by our physical appearance, health, personality, age, culture, religion, education, socio-economic status, and circumstances. Each individual has a different threshold of tolerance to stress.

Check List

Was violence or physical injury involved during flight?

Was he/she involved personally in the violence (e.g. torture, imprisonment, rape) in the place of origin?

Was he/she a witness to violence and were members of the family involved?

Could important rituals for burying the dead be carried out prior to flight, during flight and presently?

Is information on the situation in the country of origin and asylum status being shared? The hardest thing to live with is not knowing.

Is he/she consulted at all possible times on current/future plans?

Do the conditions under which the person is living allow for self-respect? Are there culturally appropriate measures to determine space and privacy?

Is self-reliance being facilitated? Are goals for self-reliance realistic?

Are cultural factors being respected, i.e. food habits, traditional child-rearing methods?

Has a mental health programme been incorporated into the basic health services provided to refugees at various levels?

Notes: