(introduction...)

COMMUNITY
SERVICES
GUIDELINES

Revised May 1996
Second Edition

Additional copies of these guidelines may be obtained from:

Senior Community Services Officer
Community Services Unit, PTSS
UNHCR
PO Box 2500
CH-1211 Geneva Dt 2

Any comments or questions in relation to this publication can be sent to the above address.

Design and Layout:
LN Crossing

Photographs:

UNHCR/B. Press,
UNHCR/Y. Hardy

This manual is a revision of the guidelines published in 1991 under the title "Social Services in Refugee Emergencies".

Foreword

Despite the hopes at the start of this decade, massive displacements of populations as a result of conflict, civil strife and atrocities continue. Displacement has been the objective of gross violations of human rights as well as a consequence of actions with other primary aims.

Much attention has been focused on improving emergency response to the needs of refugees. Whether for large groups or for individual victims of persecution, it is recognised that this response must go beyond the provision of material relief. The response must also address their social, human and emotional needs, and help to heal psychological wounds.

Helping people to help themselves and to help others in need is at the heart of the community services approach advocated herein. This support must start at the earliest possible opportunity and continue in a structured and well-planned manner, reaching and giving priority to those who need it most.

These revised manuals seek to strengthen community services by providing practical guidance to those closest to the refugees. The manuals cover refugee emergencies, assistance to disabled refugees, urban refugees and working with unaccompanied minors. They reflect experiences and lessons learnt since the preparation of the original version.

Comments and suggestions for improvements are most welcome and should be addressed to Community Services (TS00), UNHCR Headquarters, C.P. 2500, CH-1211 Geneva 2 depot., Geneva.

With best wishes for your work.

Nicholas Morris, Director
Division of Programmes & Operational Support
United Nations High Commissioner for Refugees

Basic Principles

Community Services activities are based on certain fundamental principles about human beings, they are:

1. The dignity and worth of individual human beings.

2. The capacity of persons to change no matter how desperate their situation.

3. Inherent desire of all human beings to belong to and contribute to a larger supportive community.

4. Every person has a right to live a full human life, and to improve his circumstances.

5. Persons are entitled to help when they are unable to help themselves.

6. Others have a duty to help those who are unable to help themselves.

7. The ultimate goal of Community Services is self-help.

(introduction...)

Key points

· Community services methods aim at involving refugees in assessment of their needs, planning activities and services and in the implementation and evaluation of programmes.

· The goals of community services are: to restore the refugees' humanity and dignity, to enable them to take decisions, to restore a sense of security, to create a sense of belonging and to rebuild a self-generating community.

· Community services are part of a larger whole, supporting and complementing other activities such as protection, health services and education.

· The focus of Community services is on providing services to individuals through the family and the community.

· Emergency response calls for a phased approach: 1) assessment, planning, developing guidelines on policies and procedures; 2) laying the foundation of the programme; 3) building up community services.

· Needs and resources change over time. Use a variety of sources for cross-checking and validating information.

· Consider how problems would have been resolved by refugees in the country of origin.

· Refugees most in need are often the least likely to make their needs known. Use outreach services to make sure they are not overlooked.

· Identify constraints that will limit action.

· The plan of action should be based on the findings of the needs and resources assessments and revised in accordance the evolution of situation.

· Establish a framework of policies and priorities and build consensus among groups involved (including refugees) on problems to be addressed, action to be taken and by whom, and on a timetable for specific activities.

· Many social welfare needs can best be met by resources that exist within the refugee community.

· The degree of security and stability achieved through providing protection and material assistance is enhanced by community services activities that provide for the emotional and psychological welfare of the refugees.

· Family reunification should be a priority.

· While participation and refugee involvement may sometimes retard the process of assistance, because of the intervening learning that takes place, in the long term it will ensure a self-help approach which is the goal of all assistance. Taking time to train refugees is well worth the effort and time required.

The Role of Community Services

EMERGENCY RESPONSE

The basis for community services:

A belief in people, in their strength, in their ability to change, in their desire to help each other, and in their capacity to solve problems

In an emergency, one should not forget that refugees are persons. The focus of community services interventions should therefore be to assist refugees to re-establish social structures, coping mechanisms and normality in day-to-day living. Basic needs must be met in the context of the refugees' culture as much as possible.

The refugee community should be the reference point for determining felt needs and in identifying priority groups and individuals. The means for meeting these needs should be worked out with the community through continuing dialogue, evaluation and by involving the refugees in planning and in the implementation of programmes and service delivery.

A Problem Solving Process: Community services methods aim at involving refugees in assessment of their needs, planning activities and services and in the implementation and evaluation of programmes. Their involvement in decision-making is vital.

The Goals of Community Services:

Individual - To restore the refugees' sense of being human, to enable them to take decisions, and to start living again in a self-respecting way.

Community -To restore a sense of security, create a sense of belonging and to rebuild a self-generating community.

Integrated Approach: Community services are part of a larger whole, supporting and complementing other activities such as protection, health services and education.

Focus: Community services activities are directed towards assisting individual refugees within the larger community. Community services thus focus on:

· the individual refugee
· the family
· the community

In refugee situations there are no ready made answers. Solutions have to be tailored to needs. Consequently, there is a need to have a very flexible and creative approach to such work. Involving refugees in solving their own problems is the best way to ensure that the problem is solved in the most satisfactory manner.

Timing: In an emergency, the transition from a stable existence to one of instability and uncertainty takes place over an incredibly short time. The old patterns and ways of living, the support systems, habits and routines are thrown into disarray. However, over a period of time, new patterns replace the old (see pp. 10-11). Therefore, if the subsequent patterns are to be positive, constructive, and have the seeds of self-generation, it is essential that inputs are made while change is taking place and the situation is fluid and dynamic. Later may be too late. Community services inputs should be made at the earliest, in the context of establishing appropriate procedures and systems, and involve refugees as partners in the process.

Emergency Response - A Phased Approach:

1. Assessment, Action Plan, Guidelines (2 weeks)

Involving the refugees in assessing their needs and planning is vital. Organizing meetings with refugees, including women, to discuss problems and ways in which the refugees themselves can solve them is a good way to start. These meetings should be documented and feed-back provided to help the refugees organize themselves. At the same time relevant resources need to be identified: within the community, as well as services and facilities provided by NGOs and the government.

Guidelines on policies and procedures will need to be worked out in order to ensure common aims and standards, and to avoid overlap and gaps in the provision of services/facilities.

2. Foundation of Community Services Programme

The following activities are carried out:

· setting up refugee committees (either including women, or separate women's committees)

· establish a regular meeting schedule with committees to develop a community service programme and to train people in community responsibility;

· identification/selection of implementing partners;

· training of UNHCR field staff

· revision of guidelines and action plan.

3. Building up Community Services

The third phase comprises the following:

· capacity building with implementing partner(s)

· identification and recruitment of refugee community workers

· training programme for community workers

· identification of vulnerable/special groups

· using registration information to build up a profile of population

· education programmes

· tracing

· special programmes.

Community Processes in Refugee Emergencies

Figure

Figure

Community Services Issues · Choice of leaders (who, how, criteria for "good" leaders) · Vulnerable groups - concept · Women in community work · Involvement of outside agencies (interference versus support) · Capacity Building · Idleness · Causes of mental breakdown · Community's perceptions of its own problems · Education of women · Power in community work · Goals of community work

Figure

Process based on:

· maintaining self-respect,
· encouraging self-help,
· support,
· restraint
· capacity building

Figure

Community processes are disrupted/prevented leading to:

· frustration
· anti-social behaviour
· corruption for survival
· apathy
· idleness

Crisis and Leadership Patterns

Needs and Resources Assessment

EMERGENCY RESPONSE

Questions needing answers:

Who are the refugees?
What are their priorities?
What can they do for themselves?
What could they do for themselves with some help?

In order to respond to refugees' needs we must understand what they lack to live a full human life. Needs vary from the very basic ones of food, doming and shelter, to the less tangible, the needs of self-esteem, to belong, to be loved and to be able to grow. While basic physical requirements are easily identified in an emergency, the deeper human needs, which are not so easily perceived, often do not receive the same attention. However, it is essential that the whole range of human needs is understood from the beginning, in order that planning for long-term durable solutions can be set in place. It should be borne in mind, however, that needs will change and a reassessment will have to be made so that new plans and goals can be put in place to ensure that assistance is provided in the most appropriate way. The diagram on the next page illustrates this cycle.

A needs assessment can take hours, days, or weeks depending on the urgency of the situation, the range of needs, problems and resources examined, the size of the population, the methods used to collect information, the ease or difficulty with which information can be obtained, the personnel available, the process of analysis. Response to a true emergency should not be delayed pending completion of a detailed needs assessment. Tailor the process to the degree of urgency or stability of the situation.

Sources of Information: Three sources of information which may be used for assessing needs are existing data, expert opinion and the refugees themselves. Use information from all three, for cross-checking and validating information (see box on page 20). An area for particular attention is the gathering of information on how certain problems would have been resolved by refugees in their country of origin.

Comparing Needs and Resources: Problems result when the resources available to a population are inadequate to meet the needs of the entire population; are not appropriate to certain needs; are not accessible to all who need them; are not culturally acceptable to some or all of the population concerned.

There is sometimes a tendency to focus more on outstanding needs and problems than on the resources available. This can lead to faulty analysis and inappropriate programmes.

Give attention to the following "resources":

· Government, agency and UNHCR assistance provided for basic needs
· Existing social service projects
· The range of skills the refugees themselves possess
· Traditional "coping mechanisms" of the refugee population
· Tools, equipment and other items that the refugees already have
· Technical assistance available from:

- Government departments
- NGOs
- UNHCR Community Services and Education Officers
- Other UN bodies

· Potential funding for projects from UNHCR or other sources
· Local organizations and religious bodies

Solving the Social Problems of Refugees is a Cyclical Process:

Refugee needs and resources change over time. Assessments must be made periodically to determine whether priorities should be shifted.

Sources of Information 1. Existing Data Before starting a survey, see what statistical information is already available. Sources include: registration forms, medical statistics on types of illnesses, causes of death, nutritional status, etc. Advantages This information is relatively easy and inexpensive to obtain. Statistics can indicate which part of a refugee population is affected by a problem. Disadvantages Find out how and when existing statistics were developed. They are of limited value if: they are out of date, they were not collected properly or do not cover all the areas to be assessed. Statistics based on services requested may under-estimate the extent of a problem. Often the most needy refugees are unable to get to the place where services are. 2. Expert Opinion The groups listed below may be able to give direct information on refugee problems or provide background on how these problems develop and how they can be solved. · Staff who have been working directly with the refugees concerned. Government officials responsible for refugee matters. · Refugee leaders. · Teachers in local schools. · Workers in local voluntary organizations. · Social welfare experts from a local university, government welfare office or UN system. Advantages This information can be gathered easily and quickly. First-hand experience can be particularly valuable. Case examples help clarify how problems develop. They also add a human dimension to statistics. Disadvantages There is always the possibility that one person's view may be biased or inaccurate. Experience with a limited number of cases may not justify general assumptions about the actual extent of a problem. 3. General Refugee Population When refugee problems are assessed, it is essential to get information from the people most directly concerned. Information can be obtained from refugees through specially-called meetings, a general survey, social case histories or informal contacts. Advantages The obvious advantage of information from refugees is that they have first-hand experience of the problem. Disadvantages Meetings may not represent the views of the population as a whole. Surveys are usually time-consuming and expensive and do not produce valid results unless they are properly done. Informal contacts present a limited and possibly biased view.

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Analysing the Situation

The following questions suggest the kind of analysis that begins during the collection of information on needs, resources and problems. The answers will provide a framework for action.

Determining Severity and Extent:

How extreme are the problems?
What part of the population do they affect?

Identifying Root Causes:

What is the reason for the problem?
Why is a need not being met properly?

Understanding Inter-Relationships:

Does a particular problem result or lead to any others? Are the resources currently being used having the desired effect? If not, why?
Would a proposed solution be likely to have any side-effects? Would these be positive or negative?

Identifying Barriers:

What prevents the refugees from solving the problem on their own?

Researching Previous Efforts:

Have others tried to resolve the same problem elsewhere in the country? In other countries?
What worked and what did not?

Selecting Points of Intervention:

Should attention be given to the causes of a problem, barriers to a solution or the effects? Should each be addressed?

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Check List

What is the demographic composition of the population? Percentage of men, women and children?

What are the ethnic, linguistic and cultural characteristics of the refugee population.

What is the average family size and the typical household arrangements?

What are their traditional and normal life-styles?

What resources have they brought with them?

Are they able to survive and support themselves, at least in the beginning?

Are cultural factors being respected or taken into account in the planning of assistance?

How are basic needs being met (by outside aid, local population, local government, NGOs) and how is this given?

Are basic needs being met?

What are the refugees doing to help themselves? Are traditional coping mechanisms reactivated? If not, for what reasons?

How can dependency be avoided? Are all opportunities for self-help being facilitated?

Is the condition of the refugees better or worse than that of the host population? What is different? Why? What can be done to avoid conflict?

What resources are on hand and en route from all sources?

What unmet needs exist?

What further problems/needs might be anticipated?

What are the priorities as seen by the refugees themselves?

Which are the priority target groups and how might the priority needs be met?

What criteria should be used for allocation and distribution of services and assistance? Are they flexible enough to allow the inclusion of late-comers immediately?

How long did the flight take?

Have arrangements for self-help groups been established?

Have community leaders, workers, health professionals, TBAs and teachers been identified and mobilized?

Notes:

Planning Action

EMERGENCY RESPONSE

Based on the findings of a needs assessment, decisions are made about concrete action. Who should do what, when and how is decided by the people involved in the refugee situation, and the needs assessment findings provide the starting point for their decisions.

Who to Involve: Refugees must participate in decisions on how to respond to the problems identified.

Others involved include:

· government officials responsible for refugee matters
· UNHCR programming and social services staff
· staff of agencies involved in refugee assistance
· any technical experts needed.

Review and Clarify Policies: The first step is to decide what policies will guide a response to the needs identified. This defines the boundaries for developing specific plans. Key issues are likely to include:

· what durable solution(s) are possible in the foreseeable future

· what is the general timetable for assistance

· whether there are limitations on who can carry out services

· whether there will be a priority for maximum refugee participation and self-management of services

· whether the government, UNHCR or some other body will co-ordinate the activities of all groups assisting refugees.

A solution to a problem may lie in changing policies that affect refugees. These may be embodied in government laws or regulations and guidelines for assistance. Refugees may also be able to solve their own problems if certain restrictions are removed. This may involve international protection rather than assistance. Changes in assistance policies may also help.

Establish Priorities: Limited resources, personnel and time make it essential to set clear priorities for action. If the refugees' own priorities have not become clear through the needs assessment (e.g. survey results), further refugee participation is needed at this point.

When deciding which problems or needs are most urgent, also consider whether an effective response is possible. If a problem appears so stubborn or overwhelming that it will absorb all the resources available with only marginal results, it may be better to focus on situations where progress seems more likely.

When priorities are set establish a reasonable balance between rural and urban areas. It is easy to concentrate on urban areas simply because urban refugees are generally in a better position to press for assistance. Providing more assistance in urban than in rural areas may leave serious rural problems unattended and encourage refugees to migrate to urban centres.

Once the framework of policies and priorities has been established, working groups can focus on specific problems. Consider the following when deciding how to solve the priority problems. Many working in social services assume that the solution to a social problem will require the development or expansion of a social services project. This may or may not be the best answer. Look at alternatives. Consider ways in which the problem can be prevented or the cause addressed directly. This is preferable to helping people cope with the consequences of a problem.

Relate the problem and possible action to the local non-refugee population. If both experience the same problem (e.g. a need for medical care), perhaps a joint project can be developed. This might also improve local acceptance of the refugee population. Consider also that disproportionate assistance to refugees can cause resentment by the local population. Consider whether there are constraints that will limit action. These may include local laws or regulations, limited resources, environmental factors.

ESTABLISHING PRIORITIES

Minimizing the gap in priorities between the two builds trust, credibility, efficiency and accuracy of outputs.

Developing a plan of action includes building a consensus among the groups involved. Seek agreement that:

· certain problems exist
· something must be done, at least in priority areas
· what this action should be
· what the timetable should be for specific activities.

Integrating Services: Before working group plans are implemented, review them all together to:

· avoid duplication
· ensure that action planned is in keeping with policies and priorities
· identify areas where co-ordination is needed among sectors.

Deciding on Roles: Once action has been agreed upon, the groups involved must decide on who will do what.

If it is agreed that a new project should be established, clear understanding is needed about who will:

· develop the proposal (project submission)
· provide funding
· implement the project
· provide technical assistance
· monitor the project
· evaluate the project.

The Principles of Assistance:

· Assistance is a service not a right.

· It should be sufficient for subsistence.

· Assistance is time bound.

· It is an interim measure pending durable solutions.

· Assistance is provided in accordance with assessed needs.

· It is community based.

· The credibility of assistance measures depends on uniformity, impartiality, transparency and clear procedures.

· The inherent dignity and worth of the recipient should in no way be undermined by the manner in which assistance is disbursed.

Figure

Check List

Have policies, standards and guidelines been established and agreed upon?

Have problems been identified (with participation of refugees) and priorities established?

What can refugees contribute to the planning process?

What are the immediate and long-term objectives?

How is the expected outcome to be evaluated/measured?

What is the timetable for the proposed action?

What will be the impact on the local population of proposed action?

Have constraints that will limit action been identified (laws, policies, resources, environmental factors, etc.)?

How are activities of various organizations/groups involved being coordinated?

Notes:

Community Building

EMERGENCY RESPONSE

The skill of working with communities is very much a state of mind, a constant sense of enquiry, imagination, and an ability to continue learning -from even the most humble source or fleeting thought: an alertness to dreams and to the minute details of reality.

One of the most important actions that can be taken to help reduce the shock and stress for the community as a whole is to provide security and stability as quickly as possible. This can be done materially (by providing food, water, shelter, clothing, basic household items, preventive and curative health care), by ensuring protection, by keeping the refugees informed and by involving them from the beginning in the organization of all aspects of their new lives.

Community-based Approach: Experience suggests that even in an emergency many social welfare needs can best be met by resources that exist within the community. A social welfare programme should thus be designed to mobilize these resources through the establishment of community-based services.

Every community has its own mechanisms (regulated by the its beliefs, social values, customs, traditions and preferences) which determine how problems are solved. Thus a social welfare programme should also seek to enhance and improve the existing "coping mechanisms" which may include: family relationships, mutual assistance among neighbours, local social and economic organizations, community leaders, religious institutions/practices/leaders, traditional ceremonies and festivals, traditional healers.

Family Reunion: The family is the basic social unit in almost all societies. It plays a key role in meeting basic needs and solving me problems of individuals. Strengthening families will improve the ability of refugees to take care of themselves. Activities to facilitate family reunification therefore should be a priority.

Tracing

The ICRC (International Committee of the Red Cross) which has both experience and expertise in this area should be asked to advise on tracing. (See Tracing Form Parts A & B, annex no. 1).

The possibilities for ensuring communication between those separated/and for tracing and reunion, will vary greatly with each emergency. Individual tracing may take a long time and will only really be possible once the emergency is stabilized and the refugees are registered; it may involve the country of origin. However, immediate action is often possible, for example to reunite members of an extended family or village who fled at different times or by different means, and are thus in different locations in the country of asylum.

Procedures for the reunion of refugees separated within the country of asylum should be agreed with the authorities and implemented as soon as practicable. For example, lists of names with photographs posted on the community notice boards in the different locations may provide a simple and effective tracing mechanism. The tracing arrangements must be widely promulgated; a central contact point in each site is likely to be needed. Tracing is a delicate task, and has to be organized by people who have the necessary experience and skills. It of course requires the involvement of refugees themselves, who will play a key role in any tracing service.

Preventing Family Separation

Where large numbers of refugees are involved, efforts must be made to keep families intact and to reduce the pressures mat cause them to separate (see next page).

Re-establishing Cultural Patterns: Refugees should be encouraged to re-establish cultural patterns that will help them to adjust to their new situation. Outside assistance with this should only be in response to what the refugees, themselves, see as important. Appropriate action will vary widely among refugee groups. The following have proved useful in certain situations:

· helping refugees establish cultural or religious centres
· organizing refugee self-help committees
· promoting cooperation between traditional healers and outside health staff
· establishing a team of refugee community workers
· supporting literacy programmes in the first language of the refugees.

Re-establishing religious and other institutions that maintain cultural norms may help prevent anti-social behaviour and resulting security problems among refugees.

Information: Uncertain about their present and future well-being, refugees need information to guide them. They are, for example, often unaware of services available to them. Information is the responsibility of UNHCR and its implementing partners.

Issues of concern will vary in importance according to the situation and will changer over time. In an emergency these may include:

· assistance and services available
· government policies and regulations concerning refugees
· opportunities for employment, services, education.

When facts are not available from official sources, rumours fill the void. This can lead refugees into inappropriate action or inaction. A lack of information can, in the longer term, lead to severe stress, resulting in anxiety and depression, conflicts within families, abuse of alcohol/drugs, or other self-destructive or anti-social behaviour.

Refugees most in need are often those least likely to use available services. While other reasons, such as difficulty of access or cultural barriers, may be responsible, refugees may fail to use services because they are not aware they exist, do not know how to use them or have inaccurate information about them. Information can be passed on to refugees through:

· group orientation sessions
· community outreach services
· distributing material written in the language(s) of the refugees
· using refugee community workers
· providing information through a refugee committee or refugee leaders
· films, slides or other audio-visual media.

Some Causes of Family Separation

1. Organized movements of large numbers of refugees

Preventive action:

· Enlist refugee leaders to help with preparations for the movement,
· Announce the movement as far in advance as possible,
· Encourage family members to group together on vehicles.

2. Undermining of role of males and lack of opportunities for selfsupport leading men to leave families in search of income

Preventive action:

· Early attention to providing economic opportunities or other productive activities can reduce the number of men who leave their families.

3. Undermining of the role of mothers (through chronic ill health, malnourishment, physical or mental disability)

Preventive action:

· Special attention to protecting the health of mothers especially when resources are limited.

4. Highly visible residential centres for unaccompanied refugees (children, the elderly or disabled) can encourage some people to leave their families, expecting to receive better or specialized assistance

Preventive action:

· Providing care through families instead of centres avoids this problem.

5. Inability of families headed by a single parent (especially when the parent Is male) to cope

Preventive action:

· Providing special support to such families.

Refugee Participation: Community services providers can strengthen a programme of assistance by organizing constructive refugee participation. Refugees can be involved in needs and resources assessment, planning and implementing assistance measures and evaluating the results. The degree of participation will depend on the situation. Limiting factors may include:

· refugee limitations (technical skills, management experience, motivation, limited resources, restrictive policies, socio-cultural practices)

· reluctance of agency staff to give up control

· government concern about refugees controlling activities.

Possible Forms of Participation:

Self-help activities and mutual support groups. Self-help activities and mutual support groups often develop naturally or as a result of conscious refugee initiatives. Community workers seek to identify and support these as needed. Where they do not exist but could be useful, community workers, together with any technical specialists required, can help organize such activities.

These may include:

· Setting up of a refugee committee (selected by refugees) to provide a two-way information link between refugees and UNHCR/implementing partners.

· Established refugees assisting new arrivals with information, support and practical assistance with housing and other matters.

· Production of items for use in camps.

· Construction of community facilities.

· Care of needy individuals.

Refugee leadership

By accepted refugee leaders:

· representing the interests of the refugee community when dealing with government administrators and aid organizations.

· carrying out or supervising such basic tasks as distributing aid, assigning housing and settling disputes.

Requirements for Effective Refugee Participation:

1. Organization

Although there are exceptions, effective refugee participation usually requires some outside help in the initial stages of planning and organization. The role of the non-refugee organizer includes helping refugees to:

· identify their needs, resources and goals
· mobilize their own resources
· make use of available outside resources
· develop their own systems of leadership and operation

The organizer's role is quite different from that of a leader. The organizer's place is in the background, guiding and assisting only when necessary.

2. Official support

Before refugees are asked to participate in decision-making, make sure that the government authorities and administrators are willing to accept the results. If there are limits to what they will accept, these must be made clear to the refugees.

3. Realistic approach

In an emergency the desire for refugee participation must be weighed against the need to get things done quickly. Consequently broad refugee participation in planning during the emergency phase may not be worth the time. Large-scale community participation is difficult to sustain over time. A practical approach is to:

· involve the general refugee community in setting priorities and making key decisions

· arrange for representatives selected by the community to be responsible for implementation

· provide opportunities for continuing participation of those who are interested (e.g. open meetings).

4. Realistic Objectives

The objectives to be achieved through participation must be realistic in terms of the background and skills of the refugees, the resources available and environmental or policy limitations.

5. Maintaining Momentum

Effective participation does not just happen. It requires careful planning and continuing effort to maintain it.

6. Background Knowledge

An organizer must be familiar with the cultural, social, political and economic dynamics within the refugee group to be organized.

7. Decentralization

If participation is to have meaning, authority for making decisions and using resources must be given to participants. Refugees are unlikely to be interested in simply providing advice, particularly when it can be easily disregarded.

Community Building/Development Process

Definition:

Community development is an integrated development process aimed at improving the overall economic, social and cultural conditions of a community.

Figure

Old Chinese Verse by Lao Tse

Go in search of your people:
Love them;
Learn from them;
Plan with them;
Serve them;
Begin with what they have;
Build on what they know.
But of the best leaders when their task is
accomplished, their work is done, the people
all remark:

"We have done it ourselves."

Figure

Refugee participation in an assistance programme has costs to be recognised as well as benefits. In a specific situation, and especially in emergencies, these factors must be weighed against each other to decide what level and type of participation is justified.

Some potential benefits and costs of refugee participation

More realistic information for planning.
Services are more likely to address real needs.
The broader the scope of participation, the more likely project benefits will be distributed fairly.
More favourable community opinion of a project.
Additional labour, skills and other resources are made available.
Higher levels of commitment to achieving the goals agreed upon.
Effects are likely to be more long lasting.
Increased project effectiveness due to all the above.
Increased sense among participants of self-worth and of having control over their lives.
More time required to allow for involvement in planning and for training.
Additional costs due to increased staff time.
May have to consider different needs from those administrators see as priorities.
Loss of short-term efficiency when refugees are expected to perform unfamiliar tasks.
Lowering of professional standards when refugees assume technical roles with limited training.
May run a higher risk of failure if a project is directed by participants away from its original objectives, or if their technical performance is not adequate.
Loss of time spent directly on economic activities when time is required for planning and decision-making.

Figure

While participation and refugee involvement may sometimes retard the process of assistance, because of the intervening learning that takes place, in the long term it will ensure a self-help approach which is the goal of all assistance. Taking time to train refugees is well worth the effort and time required.

Example

Community Participation in Environmental Activities

WHY?

The arrival of a refugee influx greatly intensifies existing environmental problems in an area and their impact on the environment is quickly felt by the refugees themselves, particularly in harmful effects on the health of women, children and vulnerable groups.

Refugee and host community participation in environmental activities is a cornerstone of UNHCR's reformulated policy. Unless refugees are aware of their responsibility to conserve the local environment, preventive measures are unlikely to succeed. Participation in decision-making helps to create that awareness.

Fostering participation is the most cost-effective environmental measures which can be introduced in the emergency phase. With very little investment in money terms, the success of many technical measures can be greatly enhanced.

It is likely that encouraging refugee and host community participation in environmental decision-making will bring to the surface tensions and conflicts, in the short term. However, by opening up communication between refugees, host communities, host government authorities, local and international NGOs and UNHCR, on a range of environmental issues, the long-term escalation into violence of resource-management conflicts can be avoided or minimized. Similarly, political pressures faced by UNHCR over inappropriate environmental management can be defused if genuine sharing of responsibility occurs.

HOW?

The fundamental question to answer here is: who participates in whose activities? We should not simply invite refugees to contribute to their labour to UNHCR or implementing partner "projects", imposed upon them by foreign "experts". Refugee and local communities must be engaged in decision-making about local resource management. The crucial issue is ownership of and responsibility for the process of change.

If refugees and local people are enabled to join UNHCR as partners in decisions about the assessment of needs, the setting of environmental programme and activity objectives, the planning of activities, the allocation of resources, the process of implementation, monitoring and evaluation, then that participation will be meaningful and not token.

Genuine mutual respect must be fostered for the traditional environmental knowledge and coping mechanisms of both refugee and host communities and for the benefits of modern science. In managing the environment of refugee-affected areas, both are vital.

Local land tenure arrangements, including usufruct rights to common lands must be considered in consultations over the environment.

Incentives to participation must be handled with consistency and sensitivity.

Environmental issues must be placed high on whatever participatory mechanisms begin to emerge during the first days of the influx. If a committee structure develops, it may be possible to encourage the establishment of a local environmental task force, including representatives of refugee and local host communities, local government officials, local and international NGOs and UNHCR. Clearly it is necessary that such a task force be as representative of the full range of refugee and local community interests as possible. The environmental task force will be vital in helping create a consensus among all concerned over the objectives, planning, implementation, monitoring and evaluation of environmental activities.

WHAT?

After consultation with refugee and local community leaders and other sectoral specialists, the environmental specialist on the emergency team may recommend a combination of the following measures, among others, during the emergency phase, depending upon local geographic, climatic and economic conditions:

· tree marking

· tree planting, to prevent erosion and possibly later for fuelwood harvesting

· organized fuelwood distribution

· alternative energy sources (e.g. kerosene, solar, crop residues)

· promotion of environmentally friendly cooking practices, e.g. pre-soaking hard, dry foods, milling grains, cutting food into small portions, limiting the extent of the fire to family, communal and institutional cooking arrangements

· fuel efficient cooking devices, such as improved stoves, solar cookers

· sound waste disposal, e.g. recycling of wastes for compost, mulch and fertiliser

· water conservation measures

· sound sanitation practices

· sustainable shelter practices, e.g. minimizing pole requirements, improving mortar ix

· environmental awareness campaigns to increase acceptance and understanding of all the above measures.

Check List

Are refugees' efforts to re-establish community social structures and institutions being supported? Are there places where they can gather informally to hold meetings, etc.?

Do refugees have a means of communicating with family members from whom they have been separated?

Has a tracing service been set up? Have the refugees been informed about the service?

Have policies and procedures for reunion been agreed with the authorities?

Are refugees informed about: assistance and services available, government policies and regulations that affect them, opportunities for employment, education and other services?

Have community leaders, health professionals, TBAs, teachers, traditional healers, been identified/mobilized?

What are refugees doing to help themselves?

Have refugees been able to participate in planning and implementation of assistance?

Are traditional coping mechanisms reactivated?. If not, why not?

Have mutual and/or self-support groups been organized?

Is there a refugee committee? If not, can one be set up?

Have potential refugee community workers been identified, recruited, trained?

What action is being taken to prevent family separation?

What is the cultural, social, political and economic profile of the refugee community?

(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:

(introduction...)

Key points

· Involve refugees from the outset in the planning and coordination of repatriation.

· To facilitate the reintegration process, prepare refugees by providing information and counselling. This presupposes that agencies have accurate information about the conditions/services and facilities available in the country of origin, the changes that have taken place, and the impact that these may have on the returnees.

· Ensure community support by encouraging refugee communities/groups to repatriate together and by identifying potential support groups in the country of return.

· Identification of extremely vulnerable individuals should be undertaken at the time of registration to plan the assistance required during the movement and reintegration phases of the repatriation.

· Vulnerability in the camp setting will not necessarily translate into vulnerability in the home country. Upon return, vulnerability may be greater for social than medical cases (e.g. female single-headed households without family support).

· Encourage and support agencies working with vulnerable groups in the refugee setting to develop programmes in the country of origin and continue their work with the same population, thereby ensuring the continuity of services and facilities.

· In providing assistance, avoid making returnees a privileged group. Set goals and time limits for assistance and publicize these widely so as to dispel any unrealistic expectations of endless assistance.

The Role of Community Services

VOLUNTARY REPATRIATION

Repatriation is not always an easy process. There may be unforeseen problems, not only for the returnees, but also for those welcoming them home...

"My wife seems like a different person... Now she acts like she is the boss... She has a good job. She says she won't give up her job now. I feel as if she doesn't need me any more."

"My son behaves so strangely these days. He always wants to close his bedroom door - is he hiding something from us?"

Repatriation involves the voluntary return of refugees to their country of origin from which they had earlier fled for fear of persecution. It implies that since their departure there has been a change in the circumstances that caused their flight, thus permitting their return in safety and dignity. It is however necessary to recognize that, because of the complexity of human affairs and institutions (beliefs, expectations, prejudices, memories, desires), and despite changes in laws and governments, successful repatriation operations must encompass much more than the logistics of the return.

Preparedness:

Prior to departure. The voluntary nature of the return has to be established and therefore involves a community services and protection element on both sides of the border.

The Voluntary Repatriation Application Form (VRAF) duly filled in implies the willingness to return home. However, besides belonging to a particular country a returnee also belongs to a community, a family, and has feelings, hopes and expectations about returning home.

Assistance must be given to establish contact with his/her family prior to departure in order to avoid traumatic episodes on arrival (e.g. discovering that family members have died, and mat after all his/her return is meaningless, or expecting a hero's welcome, only to be rebuffed and rejected as yet another 'mouth to feed' by a family struggling to make ends meet). Information about the country should be given to the returnee before departure so that he is 'prepared' for his/her return.

Why Exiles Return Home

1. Life in exile intolerable
2. Home-sickness
3. Reforms in country of origin and change in government policy
4. To find out what is happening
5. Optimism about the situation in the country improving
6. Fear of being sent back by host country
7. Family circumstances
8. UNHCR's presence and security given thereby
9. Information about assistance given to returnees and possibilities for a new start
10. Change in government

Initial assistance should be given to enable the returnee to find his feet and a job and relationships to fall back upon. An initial period of six months should be enough, all things being equal.

The more vulnerable among the returnees may need special assistance. Their needs have to be carefully understood and addressed. It is necessary that the local residents and local institutions are involved at the earliest in the arrangements for the vulnerable.

Community leaders, volunteers, and other groups of persons should be involved in assisting the returnee in his integration. Returnees should be involved in community and group discussions regarding the problems faced by them in exile and the special problems they have faced and their special needs particularly for a deeper human understanding.

Preparing the Ground in the Country of Origin:

Collaboration with other agencies. It is very important that other agencies are involved in me process of reintegration. However, it is important to ensure that they are not prejudiced (or perceived to be so) against returnees. Where perceptions differ, policies need to be clarified, and agreed to by the agencies concerned before returnees are put into contact Lines of accountability and relationships have to be dearly understood by all. Similarly, procedures established for returnees (e.g medical examinations, scrutiny of bags for contraband items, etc.) should be dearly explained to the returnees prior to departure.

Assessment form. A record of individual returnees needs to be established and put in place for future assistance and follow up.

Post-Arrival - Understanding the Psychological Aspects of Counselling Returnees: Counselling of returnees entails a proper understanding and response to their feelings.

While some, because of family support, may have the possibility of making a better adjustment than others, there are returnees who have been traumatized and, as such, need special care. The long duration of their absence compounds the situation, making the process of integration difficult and often painful.

Consideration should be given the feelings that may be experienced by returnees:

· fear
· withdrawal
· anxiety
· inadequacy
· alienation
· shattered expectations
· suspicion
· loneliness

Some typical expectations of exiles include: a warm welcome from co-patriots, to find a niche in society, to find a job or means of livelihood, to start life where they last left off.

Common Problems and Difficulties Faced by Returnees: The main problems faced by returnees are likely to concern housing, health, employment, social reintegration and family separations (especially where spouses have formed new relationships in the absence of partners in exile).

Some other difficulties experienced may include:

· security problems vis-a-vis the government and others with whom they may have had difficulties before.

· no family to fall back on

· dual identity of an exile and a returnee

· maintaining neutrality in the given situation which has not changed much since they left

· confidentiality about their situation

· unemployment

· a system to integrate them not yet in place

· given wrong information in country of exile about situation in country of origin leading to inappropriate expectations

· differing loyalties within families

· no ready-made solutions

· false promises and disillusionment

· feeling strange in a place they once knew well

· confronting changes (prices are different, life has moved on without them).

Cross Cultural Problems: Changes in social structures that occur in the interim also make readaptation difficult. The longer the absence, the more difficult the adjustment.

Concept of Trust: The concept of trust underlies all efforts at repatriation. Where laws but not governments change, those who have suffered under the ruling regime find it difficult to believe in a change of heart on the part of those who were responsible for their hurts and exile. Thus it is essential that every measure is taken to ensure that bridges of trust and reconciliation are built up between people at every level.

Careful choice of staff and volunteers cannot be overemphasized. They will be the vital links in the overall plan and programme of action.

Survival Skills of Returnees: While some returnees may have the benefit of welcoming and understanding families, most have to fend for themselves. In the context of the types of problems outlined above, many have to resort to unconventional methods of survival.

Some of these may include theft, alcoholism, manipulation of the system, fraudulent behaviour and lies. Some may even return to exile, where they have a support system of friends who can be trusted.

Re-integration rituals and membership of self-help groups are more positive ways in which returnees survive

Strategies for Assisting Returnees:

Individual counselling: Comprises one-to-one case management, including an accurate assessment of the returnee's situation and orientation upon arrival.

Volunteers: Support: Entails the organization, on a one-to-one, activities for returnees. Be-friending - Create groups of people who befriend life of the community.

Group counselling and therapy: Assist groups of returnees who have the same problem, thereby enabling them to provide mutual support. The ideal would be to include early returnees who had already made the adjustment.

Community support and awareness: Create a support system within the larger community, because problems need to be put into the context of society as a whole, thus involving everyone.

Self-help groups: Allow returnees with similar interests to meet and help each other, with older returnees helping newcomers.

Networking: Set up a network of contacts (formal and informal) for assistance and exchange of information

Assessment of Needs: In order to help those in need, returnees' requirements must be assessed on an individual basis. This assessment must cover, inter-alia, the following: family situation, previous training, work experience, housing, health, etc. (See Social Services for Returnees Needs Assessment Form, annex no. 7.)

Counsellors: Often in a confused and confusing situation such as repatriation, counsellors and others expected to assist returnees experience 'burn out' and, as a result, are not able to be positive in their approach. Some feelings typical of this situation include:

· inadequacy
· irritation
· uncertainty
· confusion
· helplessness
· "fed up"

Accordingly support for both staff and volunteers should be provided in an organized way.

In addition to a knowledge of the returnee's background, counsellors require the following skills:

· ability to listen
· ability to give guidance
· tact
· creativity
· objectivity
· ability to work with groups
· empathy
· ability to handle aggression.

Vulnerable Returnees: In the case of the disabled, the elderly and unaccompanied minors, for whom short-term assistance would be inappropriate, additional assistance may be provided in the form of a one-time assistance grant from UNHCR.

However, in planning for the long term, provision should be made for assistance by governmental or non-governmental institutions. In this context a good referral network is vital.

Assistance - Short- and Long-Term Planning: The immediate assistance needed by returnees on arrival and shortly after return is determined by the situation and operates on a sliding scale. However, during this time (to be seen as a buffer period), the returnee is expected to find some means of earning a livelihood (i.e. finding a job, undertaking training in a trade or skill) and be self-supporting at the end of the period. The role of counsellors during this period is to provide guidance about opportunities, make appropriate referrals, tap resources for jobs and ensure that training opportunities are developed, if they are not already available. One-time grants for income-generation and other assistance must be carefully monitored to ensure long-term self-support.

The diagram below represents a plan of action based on a buffer period of six months. In other situations, a lump-sum payment upon arrival may relieve the organizers of the burden of assisting returnees and their families. However, it has been proved that an initial follow-up is good for both the returnee and the community.

INITIAL PERIOD OF SIX MONTHS

Planned Voluntary Repatriation
Identification of Extremely Vulnerable Individuals (EVIs) and Medical Screening:

Identification of extremely vulnerable individuals should be undertaken at the time of registration to plan the assistance required during the movement and reintegration phases of the repatriation. Medical cases would include:

· chronically ill with diseases that require continuation of long-term treatments (e.g. tuberculosis, leprosy, diabetes, etc).

· disabled/physically handicapped

· children who are moderately malnourished (between 70%-80% weight for height)

· pregnant women

· mentally ill.

Identification is carried out by a medical team working with the registration team. Care should be taken not to overlook those who might not be able to walk to the registration sites because of acute disease or physical disability.

Counselling should be provided regarding the arrangements made for assistance during the movement and the reintegration phase. Special emphasis should be put on seeking assistance and support from dose relatives and other refugees travelling to the same destination. Where support of dose relatives cannot be ensured for unaccompanied children, authorities in the country of origin should identify a reliable alternative support system.

Priority should be given to seeking family reunion on both sides of the border as a solution to EVI problems. Outside assistance should not replace support by the family. This is particularly important for refugees with mental health problems.

Updating Medical Records: Preventive and chronic disease medical records should be updated and sent with the returnees for continuation of the services in the country of origin. Preventive records include immunization, particularly measles, antenatal services, family planning and other MCH records.

Medical Screening and Escort: It is essential to ensure that refugees should not unduly suffer in the process of repatriation. In this regard, it is necessary to conduct screening in health and nutrition for all repatriants prior to their departure.

The objectives of the medical screening are to:

· ensure that repatriation of refugees with acute life threatening conditions will be postponed while they are undergoing treatment;

· make adequate provisions for attending to emergencies during the movement phase;

· prevent transmission of an internationally notifiable disease across the border;

· postpone pregnant women who might deliver on the way (as assessed by a qualified medical doctor/midwife);

· ensure that families with severely malnourished children (i.e. less than 70% weight/height) are not moved until the child recovers (> 75% weight/height);

· make a final check of the medical records and provide measles vaccine on the spot if required;

· provide medicines required for continuation of treatments of chronic diseases till access to similar services in the country of origin is assured.

A mobile medical escort (comprising medical doctor/TBA/Community Health Worker(s) as required) should accompany each convoy. Each medical escort should have a first aid kit in addition to medicines such as ORS, chloroquine, paracetamol, aluminium hydroxide, ampicillin, promethazine injection and egotamine injection (with the necessary needles and syringes).

Overall Procedures: In organizing mass returns of people, it is essential that every part of the community is involved in the process of reintegrating returning exiles. Clear procedures and the identification of focal points for different activities are an essential starting point.

Where travel is by road crossing points, and reception centres have to be identified, assistance during travel and special arrangements for vulnerable groups need to be organized. Protection en route of returnees, and of women in particular, needs to be ensured. Reception and care of the vulnerable upon arrival must be organized in co-ordination with implementing partners, host government and NGOs, as well as with volunteers.

The important point to remember is the time factor, which limits assistance to the initial buffer period. However the process of mobilizing local government and non-governmental resources should occur simultaneously, allowing them gradually to assume full responsibility for assisting returnees as citizens of their own country.

The flow chart on the following page is an attempt at identifying me various stages in the process and the breakdown of activities by sector.

The following case studies illustrate the importance of planning and preparation for all those involved in repatriation activities. Case 1 John has come back after five years of exile. He has not been in touch with his family since he left. His father, who was very upset by his son's departure, died while John was away. John arrived home without informing his family. His mother was shocked to see her son again as she had thought he was dead. Four days later she died of a heart attack. John is very disturbed as he feels that he killed both his mother and his father. He wonders why he came back. His sister, and only surviving relative, has been struck by paralysis and is bed-ridden. As his mother, who looked after her is now dead, there is no one to look after his sister. He wanders about alone and is seen sitting by himself. If anyone gives him money he uses it to drink at the local bar. Case 2 Joe has been away for 20 years. He had left his wife who was very young. He did not keep in touch. She was not sure whether he was dead or alive. In the meantime, she formed a relationship with another man and had his children. However, she did not many him. Informed of Joe's return, she was very excited. She asked friends for help and went to the airport in a car to meet him. The flight did not arrive as scheduled. When the flight eventually arrived, some of Joe's friends who had seen her there, told Joe that his wife had come to meet him. He had been very hesitant about his reception but was reassured that she still cared. He understood her need for another relationship in the interim and did not hold it against her. They met and were happy to be reunited.

Procedures for Reception of Returnees

Check List

Are you fully aware of the political/social/cultural aspects of the problem?

Have you identified people who can assist returnees on a one-to-one basis in the communities to which they will return?

Are the communities briefed to understand the psychological aspects of the returnees and their needs for acceptance and understanding?

What efforts have you made to bring about a larger community awareness?

What efforts have you made to brief the returnees in their country of exile about conditions they will experience in their country of origin?

Identify special needs that you perceive need to be addressed prior to the arrival of the returnees. E.g. assistance package, shelters for the homeless, medical care, food arrangements and clothing.

Identify the main attitudes that returnees are likely to have as well as their expectations from the receiving community.

Notes:

(introduction...)

Key points

· While operations and the provision of services may be undertaken by other bodies, UNHCR should have overriding responsibility for setting up clear policy guidelines and agreed standards, and ensuring their implementation.

· Community welfare programmes generally require a decentralized structure, allowing community workers to work regularly among the same refugees, getting to know and be known by them.

· An active community welfare service is likely to be the major referral unit, helping direct people with needs to available resources and identifying areas of need to which services may be directed.

· As part of the emergency response team, there must be at least one person with the time, training and experience to address the social aspects of a refugee emergency.

· In selecting an implementing agency, ensure that it has staff who have a good knowledge of the language and social and cultural practices of the refugees.

· The most effective way to provide community services in large refugee influxes is through refugee workers.

· Continuity of personnel whether from among the refugees or outside, is especially important for effective community welfare services, because of the fundamental part played in these services by human contact and trust.

· Community services should not be seen in isolation, but as a baseline support system and a bridge between the other various services and the beneficiaries.

Field Level Management and Administration

ORGANIZING SERVICES

Management in Emergencies:

Clear procedures
Clearly communicated
Simple
Supportive
Continuing evaluation and review
Openness to change
Responsiveness to needs
Supportive to initiatives
Growth producing
Clear goals which are shared

The organization of the social welfare programme must be considered as early as possible in a refugee emergency and the refugees themselves must be involved in developing the necessary services. A co-ordinated approach by all organizations concerned is essential. It should be remembered however, that while operations and the provision of services may be undertaken by other bodies (e.g. NGOs, governmental agencies, etc), UNHCR should have overriding responsibility for setting up clear policy guidelines and agreed standards, and ensuring their implementation.

Experience suggests that even in an emergency many social welfare needs can best be met by resources that exist within the community. A social welfare programme should thus be designed to draw on these resources through the establishment of community-based services.

The basic case-work (identification of individual or family problems, assessment of needs, development of solutions or referral) will necessarily take place at the individual, family or small group level Social welfare programmes therefore generally require a decentralized structure, allowing community workers to work regularly among the same refugees, getting to know and be known by them. Regular home visiting is necessary both for identifying the persons or groups with special needs and for monitoring the effectiveness of the response to these needs.

Up-to-date records and confidential individual dossiers should be kept, and a simple periodic reporting system instituted, focusing on the needs identified and services provided rather than giving just statistical data. It is important that case records are transferred with refugees when they are moved. Unnecessary repetition of basic interviewing is not only a waste of time, but can also be psychologically damaging.

Co-ordination is required between the social welfare services and other community-based services, particularly health care. Health workers can often identify social problems and health problems may initially be brought to the attention of social or community workers. Regular social welfare clinics at health or community centres may be a useful complement to home visiting. In general, an active social welfare service is likely to be the major referral unit, helping to direct people with needs to available resources and identifying areas of need to which services may be directed.

Personnel: As part of the emergency response team, there must be at least one person with the time, training and experience to address the social aspects of a refugee emergency. This could be a UNHCR Community Services Officer, an NGO Social Services Expert, a consultant or an official from the Ministry of Social and/or Community Services (See terms of reference for Community Services Officer (Focal Point), annex no. 8).

Community and social services should be built around a nucleus of trained professionals - possibly comprising local nationals whose cultural knowledge and understanding of the refugees will be important, and international personnel whose role may be limited principally to overall co-ordination, support, training and liaison with the authorities and other organizations concerned.

In selecting an implementing agency, ensure that it has staff who have a good knowledge of the language and social and cultural practices of the refugees. Sympathy with and understanding of the kinds of problems faced, and a knowledge of local preferences for their resolution will be instrumental in the successful delivery of services to the target population. On selection, training and a thorough briefing on the operations of community and social services response to refugees should be provided. (See Duties and Responsibilities of Community Services Agencies in an Emergency, annex no. 9).

Refugee Community Workers: Experience shows that the most effective way to provide community services in large refugee influxes is through refugee workers. Volunteers therefore should be encouraged, supported, given recognition and rewarded.

Training should also be provided, drawing on the knowledge of the community and outside expertise (from within the host country if possible, in social work, community development and public health).

Refugee community workers could be involved in the following activities:

· orienting newly-arrived refugees and screening them for problems
· community surveys
· distributing basic material items based on individual needs
· monitoring food distribution and use
· providing a broad range of social work services
· assisting refugees with special needs to support themselves through self-employment
· conducting public health education and monitoring
· assisting with nutritional assessment and surveillance.
· finding and following up medical cases
· tracing to achieve family reunification
· organizing and supervising recreational activities.

Selection: Before refugee staff are recruited, consult a broad spectrum of refugees in the community about the kinds of people who would be suitable. Such factors as the following may be important:

· age and sex
· previous work experience
· ability to read and write the refugee language
· ability to read and write, or at least speak a common language with agency staff
· educational background*
· social position^*

^* A higher level of education and/or social position may help or hinder a community worker, depending on the requirements of the job and on the way these characteristics will effect relationships with other refugees.

It is important for community workers to:

· be respected as honest and trustworthy by other refugees
· have good judgement
· be concerned about me needs of other refugees
· show initiative
· be able to communicate easily with the refugee target group
· listen well
· have an agreeable personality.

It is also important that those recruited intend to stay in the area for the foreseeable future. The more highly educated are often among the first to be resettled or to seek better opportunities elsewhere. (NB: Continuity of personnel, whether from among the refugees or outside, is especially important for effective social welfare services because of the fundamental part played in these services by human contact and trust.)

Refugees should, where possible, be involved in the selection of staff. Find people respected in the refugee community, explain what the initial work will be and involve these people in choosing workers. Thereafter the community workers could, possibly in consultation with the refugee leaders, take responsibility for finding and screening additional replacement staff as needed.

Where mere are various ethnic, religious, political or other sub-groups within the refugee community, it is important to see that these are adequately represented among the community workers selected.

Training: The type and amount of training will depend on the background of me workers in relation to the tasks to be undertaken. Training should be practical, concentrating on what workers will do on a day-to-day basis. Formal training should be kept to a minimum before community work actually begins.

Pre-service training needs to provide a general orientation to:

· the work to be done
· the social cultural and statistical characteristics of the refugee community
· the resources available
· the role of the sponsoring agency
· the roles of and relationships with other organizations, including UNHCR, and
· a functional ability in the skills initially required for the work
· a sense of confidence and legitimacy in taking on the community worker role
· procedures and guidelines to be observed.

Start community workers on basic tasks and progress to more difficult ones. Once they have some experience and gained more confidence, skills needed for more challenging work can be taught through in-service training sessions.

Find out whether there are any training programmes for nationals in which refugees can participate or which could provide a model for a similar programme for refugees.

Pair new refugee community workers with those who are more experienced. This has proved to be a successful in-service training method.

Set aside regular times for workers to come together to:

· discuss their experiences with the work
· identify and discuss how to resolve difficulties
· learn new skills.

Select training methods appropriate to:

· the skills to be learned
· the trainees
· the instructor
· the setting.

One way to start workers in the community is to help them do a survey of needs related to the work they will do. This may be broadly focused or specific to certain groups likely to have special needs.

A survey:

· involves workers in a structured activity they can easily handle
· makes them familiar with the community
· helps define work to be done and further training needed.

A distinction should be made between refugee para-social workers and volunteer refugee community workers. The para-social workers should be recruited as assistants and be paid for their services. Refugee volunteers would form a second line of community workers, from which potential para-social workers could be recruited for training. Volunteers could be reimbursed for incidentals, such as transport and given a lunch allowance when this is warranted. (NB. Agencies involved in providing emergency assistance to refugees should co-ordinate the type and level of remuneration to be paid to refugee workers in order to avoid competition.)

Community Services as Part of an Integrated Approach: Community Services should not be seen in isolation, but as a baseline support system and a bridge between the various other services and the beneficiaries (i.e. refugees, and in the case of repatriation, returnees). Social services personnel, by co-operating and co-ordinating with the other services, can complement and supplement their activities and ensure a positive response from the refugee community.

Qualities Expected of Community Services Staff Personal · Ability to genuinely accept persons who are different · Analytical abilities · Ability to get along with others · Knowledge of resources · Flexibility · Creativity · Maturity of outlook · Ability to bring people of different backgrounds together in a common cause · Communication skills · Listening skills · Ability to accept criticism · Pleasant personality · Honest and trustworthy · Committed to the cause · Sense of humor Preparedness 1. Understanding Previous Situation · political situation · demographic breakdown · habits/customs/traditions/religion 2. Country of Asylum · attitudes towards refugees · habits/customs/traditions/religion · economic conditions 3. Staff Preparedness · training/orientation · material resources · strategies for refugee involvement

Several different approaches have been used, often in combination, for assigning responsibilities to refugee community workers. Geographic areas: Workers can be assigned to certain specific areas to which they go every day. Part of the day may be spent making informal contacts in the community or following up specific cases. Part of the day the worker may keep "office hours" at a particular place. Experience suggests that it is better NOT to assign workers to the areas in which they live. This affords them some protection from pressures to show favouritism to those they know. It also reduces after-hours difficulties with authority and confidentiality. Functional: For some projects a division of labour among workers is appropriate. More than one worker can be assigned to the same area with each carrying out different, but complementary tasks. Teamwork: Some projects have had success using teams, such as one male and one female worker. Other characteristics or skills of workers can be matched to form effective teams. Special Assignments: Some projects require certain specialized skills or management abilities. Some workers can be assigned to special tasks that support the activities of those assigned to geographic areas. Assignments to Avoid: Refugee community workers may be more vulnerable in some situations than nationals or expatriates. It is best to avoid assignments that would place a worker in a sensitive position such as negotiating with authorities or between rival factions within the refugee community.

Check List

Have you identified or designated a focal point to deal with community social services?

Have you identified a local or locally-based international agency to provide community social services?

Does the agency possess skills and expertise to function on its own? Is extra training or briefing required?

What kind of resources can the agency mobilize? What input is required from UNHCR?

Determine funding possibilities and other resources, including refugee participation?

Notes:

Annex No. 1

Tracing Form
(Part A)

Ref. No._________________

I. Information about person(s) requesting services:

1. Name:______________________________________
Sex:___ Age:___ Religion: ________________________
2. Place of Birth: ________________________________
3. Ethnic origin/nationality: ______________________
4. Marital status: ________________________________
5. Present location: ______________________________
6. Permanent residence: __________________________
7. Contact address: ______________________________
8. Relationship to person being traced: ______________
9. Enquirer's signature: ___________________________
10. Date and place of enquiry: _____________________

II. Information about the person(s) to be traced:*

(* For unaccompanied children/minors, complete annex no. 2.)

11. Name:________________________________________________
Age: ___ Sex: ___ Religion:__________________________________
12. Father's name:_________________________________________
13. Mother's name:________________________________________
14. Place of birth:__________________________________________
15. Ethnic origin/nationality:________________________________
16. Marital status:_________________________________________
17. Profession:____________________________________________
18. Any distinguishing physical characteristics:_________________
19. Last location if known:__________________________________
20. Date of last contact:_____________________________________
21. Date and kind of last news: _______________________________
23. Circumstances of separation:______________________________
24. Family members accompanying the person to be traced:_________

1 Name__________________________________________________
Sex ___ Relationship _________ Date of birth___________________
2 Name__________________________________________________
Sex ___ Relationship _________ Date of birth___________________
3 Name__________________________________________________
Sex ___ Relationship _________ Date of birth___________________

29. Additional information: (Please give all information that may assist investigation, such as duration and address of former residences, business address or that of present employer...) _________________________________________________

30. Name and address of persons able to supply information: (family, friends, business relations, etc.)_______________________________________________

31. Action taken:_____________________________________________

32. Name of interviewer:______________________________________

Date: ___ Place:___________________________________________

Tracing Form
(Part B)

Ref. No._________________

1. Feedback:___________________________________________________
2. Follow-up action:_____________________________________________
3. Feedback:___________________________________________________
4. Follow-up action:_____________________________________________
5. Outcome of tracing:___________________________________________

Name of case worker:___________________________________________
Date: _____ Place:______________________________________________
Case closed: ________ Ongoing: __________________________________

Annex No. 2

Sample Form to Record Basic Information on Unaccompanied Child^*

(* adapted from "Unaccompanied Children in Emergencies", ISS, 1987)

1. Child: _________________________________ Registration No:_____
Family Name:________________________________________________
Given name/forename:________________________________________
Also known as:_______________________________________________
Date of Birth: __________ Place of Birth: __________________________
Age: ____ Sex: ___ Nationality:__________________________________
Religion: ________ Tribe/caste/ethnic origin: _____________________
Languages spoken:____________________________________________
Education/schools attended:____________________________________
Last permanent address:_______________________________________
Identifying features or marks:___________________________________
Personal belongings:___________________________________________

2. Accompanying brothers, sisters, other child relatives (names, sex, age, relationship):
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

3. Family members (include mother, father, brothers and sisters, grandparents, aunts, uncles, other relatives and household members):

Name:_______________________________________________________
Relationship: _____________ Age/Date of Birth:____________________
Address:_____________________________________________________
Present whereabouts:___________________________________________
_____________________________________________________________

Name:_______________________________________________________
Relationship: _____________ Age/Date of Birth:____________________
Address:_____________________________________________________
Present whereabouts:___________________________________________
_____________________________________________________________
If parents are dead, give date, place, and cause of death:______________

4. Guardian (with whom child lived/lives, if not parents):

Name:_______________________________________________________
Relationship (if any):___________________________________________
Address:_____________________________________________________

5. Circumstances when child was found/identified:__________________
When and where found (give dates, time and place):__________________
With whom was the child? (give names addresses and relationship to child):
_____________________________________________________________

6. Information concerning the child's separation from the family:_________
Date and place of separation:_______________________________________
Reason for separation:_____________________________________________
When and where did the child last see the parents or other family members?
______________________________________________________________
If the parents are presumed dead, why does the child believe this to be so?
_______________________________________________________________

7. Information about the child's life before separation (record places, people and important events the child remembers):
________________________________________________________________

8. What has happened to the child since separation?
________________________________________________________________
Where and with whom has the child lived, and for how long?
________________________________________________________________
Record places, people and events the child remembers:
________________________________________________________________

9. Description of the child's physical health and past medical history:
________________________________________________________________

10. Description of the child's present emotional state as well as relationships with other children and adults, daily care, and any specific needs which are not being met:
________________________________________________________________

11. Information on the child's wishes and plans for the future:
With whom does the child wish to be reunited?__________________________
_________________________________________________________________
What is their relationship?___________________________________________
Where and how might they be located?_________________________________

12. Please include other details relevant to tracing the child's family, i.e. names and addresses of significant persons who could provide information:
________________________________________________________________
________________________________________________________________

Signature of Interviewer:_________________ Place:______________________
Organization:_____________________________ Date:____________________

Annex No. 3

Foster Care Placement Agreement/Contract for Interim Care Arrangement

1. The *________________________ after a thorough social assessment agree to place:
_______________________________________________________________
in the care of:
_______________________________________________________________
presently residing in:
_______________________________________________________________

2. The placement took place on:_____________________________________

Mr/Mrs _____________________________________________________will

(a) Care for the child/children in the same way that they would for their own.

(b) Release the child/children without any problems in the event that the parents and/or family members come to reclaim the child/children.

(c) Under no circumstances place the child/children in the care of others including those who might claim right of custody without authorization from UNHCR.

(d) Ensure that the child/children receive the necessary medical follow up and vaccinations.

(e) Obtain prior authorization from UNHCR before moving the child/children to another location, including change of residence in and outside the present location.

3. *________________________________________________ on the other hand will:

(a) Provide supplementary assistance to ensure basic needs of child/children and assist family to meet gap related to needs of child/children.

(b) Undertake monitoring visits on a regular basis, i.e. once a week at the initial stage and once a month thereafter.

(c) Keep the family informed of the progress made to trace the parents and close family of the child/children.

4. NOTE: this is not an adoption agreement, but only a temporary placement agreement to ensure proper family-based care for the child/children while tracing efforts to find the family continue.

5. If family reunification is not accomplished within six months, this agreement will be reviewed by both parties to agree on medium-term care arrangements.

6. If family reunification is not accomplished within six months, this agreement will be reviewed by both parties to agree on medium-term care arrangements.

For	For Foster Parents:
Name:_______________________________________________________________
Signature:____________________________________________________________
Title:________________________________________________________________
Place:________________________________________________________________
Date:________________________________________________________________
This agreement is binding effective:_______________________________________

* Insert name of implementing partner for child welfare activities. In the absence of an implementing partner, UNHCR will sign the agreement with foster parents or other care providers.

Annex No. 4

Programme Actions Required for the Care and Protection of Unaccompanied Children in Emergencies

Annex No. 5

UNHCR Disabled/Medically-at-Risk Form

Resettlement of Disabled/Medically-at-Risk and Victims of Torture

Only for completion for those refugees considered in need of health services available in a resettlement country. To be completed by examining physician.

1. Recommended for priority action:

E = Emergency P = High Priority L = Low Priority

2. Name:__________________________________________________________
Sex:______ Date of Birth:_________________ UNHCR Reg. No:_____________
Camp:____________________________________________________________
Current address:____________________________________________________
Date of examination:________________________________________________

3. Summary Statement:______________________________________________

4. Medical History:_________________________________________________

4.1 Pertinent Results of Investigation/Evaluations:
(i.e. if any blood or urine analysis, ECG, EEG, X-rays, scanner, etc.) _________________________________________________________

5. Health Evaluation:______________________________________________

5.1 Examination Findings:________________________________________
5.2 Diagnosis__________________________________________________

6. Recommended Treatment Management Plan________________________

6.1 With Access to Current Services:________________________________
6.2 With Access to Services in a Country of Resettlement:________________

7. Severity of Condition/Rate of Change/Prognosis:
(i.e. deterioration/improvement, including anticipated rate of change, life expectancy) ____________________________________________________

Expected Changes in Health Status/Prognosis If:

7.1 Remains in present environment:_____________________________
7.2 Resettles in a third country:__________________________________

8. Capability to Carry Out Activities of Daily Living Independently If:

8.1 Remains in present environment:_____________________________
8.2 Resettles in a third country:__________________________________

9. Recommendations (include Urgency of Action):_____________________

10. Other Comments:_____________________________________________

11. Travel - Would the patient need...?

Medical escort: If yes: Nurse: Doctor:
Wheelchair: Stretcher:
Medical apparatus on board: Please specify:_____________________

12. Documenting Personnel:

Name:_____________________ Signature:_________________________
Hospital, Clinic,
Agency, Other: ________________________________Date:___________
Name:_____________________ Signature:_________________________
Hospital, Clinic,
Agency, Other: ________________________________Date:___________

Annex No. 6

Assessment Form for a Person who is Disabled or Chronically Ill

(Complete a separate form for each member of a family who is disabled or chronically ill.)

Case No:________________

Principal Applicant's Name:__________________________________________

1. Name of person who is disabled or chronically ill:_______________________

(underline family name)

Sex: female male Year of Birth:_____________________________________

2. Has lived:		with family		with friends since:
		with relatives		alone	mm	yy

3. If the disabled or chronically ill person lives with someone who is registered separately, provide the full name of the head of that family:
__________________________________________________________________
__________________________________________________________________
(underline family name)

4. Does this person have an illness that has lasted more than three months? yes no
If "yes", give the name of the illness and explain how it affects this person.
__________________________________________________________________

5. This person has difficulty (mark any boxes that apply):

	using his/her legs		speaking
	using his/her hands or arms		learning
	seeing		because of acting sometimes in a strange way
	hearing		with fits
	other (specify)________________________________________________________

6. Describe this disability:
__________________________________________________________________

7. Explain how and when the disability began:_____________________________

8. The list below includes activities required for normal daily living.

Mark the Immediate Assistance box for any activities that the person is not now able to do and with which he/she does not have someone to help.

Mark the Training box beside any activity the person cannot do without assistance. This will show areas where rehabilitation training may be helpful.

Immediate Assistance	Training
		obtaining food, water, fuel (cross out any that do not apply)
		preparing food
		eating food
		washing himself/herself
		dressing
		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
		other (describe)____________________________________

9. Explain how the person previously has been able to accomplish any of the tasks for which immediate assistance is needed:
__________________________________________________________________

10. If a change in the location where the person is living or any special adaptations in or around the house (such as handrails or a ramp) would help in meeting daily needs, please explain:
__________________________________________________________________

11. If the person is an adult, indicate any:

previous occupation_______________________________________________
current occupation________________________________________________

12. Describe any assistance this person needs to establish or improve an occupation:
__________________________________________________________________

13. Has the person ever regularly taken medicine to cure or control illness or disability?

yes	no

If "yes", explain who told the person to take this medicine, where it was obtained, when the person started taking it and whether the person is still taking it:

14. Describe any other rehabilitation training or medical treatment the person has had for the illness or disability. Explain who provided this treatment, where it was provided, when it began and whether it is still being provided:
__________________________________________________________________

15. Add any further details that may be useful to those arranging assistance for this person:
__________________________________________________________________

16.	______________________________________________________________
	Name of the Interviewer	Organization of Interviewer	Date of Interview

17. Plan for Immediate Action

The space below is to be used by medical, rehabilitation and social services staff to indicate what action should be taken in regard to this case.

	Action Required	To be Carried Out by	Recommended by	Date
	Immediate assistance with ____________________________________________
	__________________________________________________________________
	Further assessment of________________________________________________
	__________________________________________________________________
	General medical examination __________________________________________
	__________________________________________________________________
	Specialized medical examination________________________________________ (specify type): ______________________________________________________
	Additional Comments:_________________________________________________

18. Rehabilitation Plan

1. The rehabilitation goal for the refugee is:_________________________
_____________________________________________________________

2. This goal should be achieved by what date?_______________________
_____________________________________________________________

3. If the refugee requires medical treatment, explain what treatment is needed and who will provide it:
_____________________________________________________________

4. Describe any rehabilitation training that is required and who is responsible for it:
_____________________________________________________________

5. Explain what role the refugee and/or the refugee's family will play in this training:
_____________________________________________________________

Annex No. 7

Community Services for Returnees Welfare Needs Assessment

Serial No.________________________

1. Name:_________________________________________________

2. Address: _______________________________________________
________________________________________________________
____________________________ Telephone:___________________

3. Date of Birth: __/__/__ 4. Sex: M/F 5. Marital Status: M/S/D/SP/O

6. Education:

A. Formal Education:_____________________________________
B. Informal Education:____________________________________
C. Other Training:________________________________________
_______________________________________________________

7. Work Experience: (Last job held)_____________________________
__________________________________________________________
(Other jobs)________________________________________________
__________________________________________________________

8. Family Composition:

Name:	Rel:	Age:	Sex:	Remarks:
1.
2.
3.
4.
5.
6.
Special Problems:______________________________________ _____________________________________________________

9. Housing:

A. Current Address:____________________________________________
_____________________________________________________________
B. No. of Persons Living Together:_________ C. No. of Rooms:_________
D. Rel. with Householder:_______________________________________
_____________________________________________________________
E. Problems if Any:_____________________________________________
_____________________________________________________________
_____________________________________________________________
F. Other Information:___________________________________________
_____________________________________________________________
_____________________________________________________________

10. Legal/Security:

A. Applied for Indemnity:	Y/N	If YES, has it been granted:	Y/N
B. Applied for I.D.:	Y/N	If YES, application No._________________________
C. Dependents Born in Exile:	Y/N	If YES, give details.

Name:	Date of Birth	Place of Birth	Remarks, Birth Certificate

F. Births Registered in Country of Origin: Y/N
If YES, give details:
_______________________________________________________________
_______________________________________________________________

11. Health:

A. Special Health Problems:		Y/N
Orthopaedic		Chronic Illness		Blindness
Mental Illness		Addiction		Other
Give Details:______________________________________________________ ________________________________________________________________ ________________________________________________________________

B. Needs for Regular Medical Attention: Y/N If YES, give details:__________
________________________________________________________________
C. Hospitalization: Y/N If YES, give details:____________________________
________________________________________________________________
D. Other Help Needed:_____________________________________________
________________________________________________________________

12. Education:

Name:	Level	Institution	Language	Remarks

13. Other Problems Encountered:

1.____________________________________________________________
2.____________________________________________________________
3.____________________________________________________________

14. Plan of Action:

1.____________________________________________________________
2.____________________________________________________________
3.____________________________________________________________

15. Action Taken

1.____________________________________________________________
2.____________________________________________________________
3.____________________________________________________________

Signature: _____________________________ Date:_____________________

Approved by: __________________________ Date:_____________________

Annex No. 8

Terms of Reference for Community Services Officer ^*
(Focal point)

^* In an emergency there must be at least one person with the time, training and experience to address social aspects on a full-time basis. This could be: a UNHCR Community Services Officer, a consultant, an official of the Ministry of Community Development and/or Social Welfare, an NGO Community Services Expert seconded to UNHCR.

Under the supervision of the UNHCR Representative/Charge Mission, the Social Services Officer in.........................................will undertake the following functions:

1. Co-ordinate all social services activities;

2. Provide technical guidance and support to NGO social workers currently working in camps;

3. Provide training to community volunteers; involve them in structured activities; help define work to be done.

4. Act as a focal point for tracing and family reunification activities until such services are established;

5. Ensure that women, children, vulnerable groups and individuals benefit adequately from the emergency assistance programme provided to the community at large, i.e. food, non-food items and other services;

6. As appropriate, facilitate the establishment of special services to meet the particular needs of women, children and vulnerable groups and individuals, e.g. secure housing for single women, community-based rehabilitation for disabled persons etc;

7. Disseminate and publicize as widely as possible policies on:

(a) Community participation and self-help;
(b) Participation and access to services for women;
(c) Children;
(d) Unaccompanied children;
(e) Community-based rehabilitation for disabled persons.

8. In coordination with the appropriate body, promote information on prevention of disabilities caused by mines, e.g. setting-up a mine awareness campaign particularly aimed at children.

Annex No. 9

Duties and Responsibilities of Community Services Agencies in an Emergency

1. Under the supervision and technical guidance and support of UNHCR, NGOs and/or governmental agencies contracted to deliver social services, will carry out the following activities.

2. At the initial stage of the emergency, the focus of social services will be to respond to the needs, queries and immediate concerns as expressed by the refugees either individually or through their leaders.

The agencies will:

(i) Set-up information and referral services in a central location in each camp. The center will be known as Social/Community Services Centre. The Centre is where:

(a) Persons who have found lost children can report;

(b) Parents who have lost children can come to enquire;

(c) People who require information about various services (i.e. where and how to get food or non-food items, transportation to go back to their village or city of residence, other problems etc.,) can be assisted.

(d) Families can initiate tracing of missing family members.

(ii) Work in close co-operation and collaboration with refugee leaders to mobilize and encourage maximum refugee participation in all activities.

(iii) With the assistance of refugee leaders, as well as through community workers:

(a) Identify all vulnerable groups without support through house-to-house surveys;

(b) Search for unaccompanied children and adolescents including those living with families other than their own or in any other care arrangement;

(c) Identify community resources that can be mobilized to establish community self-help activities.

(iv) Set up an outreach programme to monitor the situation of all identified vulnerable refugees.

(v) Ensure that all children identified as unaccompanied in accordance with UNHCR Guidelines on Refugee Children are registered, documented and that appropriate care arrangements are being made while tracing efforts continue.

(vi) Undertake tracing and family reunification in accordance with guidelines provided.

(vii) In collaboration with medical facilities, follow-up on medical evacuation cases (without support).

(viii) Facilitate the planning and development of appropriate assistance programmes on a regular basis, undertake a socio-economic and demographic survey. The composition and socio-economic profile of the camps' residents should be updated on regular basis.

(ix) With the help of teachers from within the community and other volunteers, organize cultural, recreational and mental development activities for children.

(x) Assist the community in establishing cultural and religious centers.

(xi) Submit brief narrative and statistical reports to the UNHCR office on the type of services provided, achievements, obstacles, etc., on a regular basis.

Annex No. 10

Profile for Community Services Staff in Emergencies

Academic Qualifications

Post-graduate degree in Social Work or practical community oriented training from a recognized university.

Experience

1. At least 5 years experience of direct work with people in distress in a developing country.

2. Has played a supervisory role.

3. Ability to deal with people who are culturally different and can genuinely accept differences and work with and through them.

4. Has worked in a community oriented situation.

5. Has a background in health, counselling, and group dynamics.

6. Knowledge of the UN system, particularly UNHCR's working patterns and methods of operation.

Personality

1. Honest, hardworking, calm, resourceful, flexible, sensitive to the needs of others and a high sense of responsibility as work will entail working in situations with little or no supervision.

2. Is willing to put up with hardships of living conditions, over extended periods of time.

3. Physically capable of coping with the stenuous conditions prevailing in the field.

4. Capacity to put the needs of the beneficiaries before one's own.

5. Creative and innovative in problem solving.

Special Skills Required for Emergency Management

1. Skill in planning and problem solving

2. Ability to involve persons from differing backgrounds in a common cause.

3. Ability to work with and for specially vulnerable groups such as the elderly, the sick, the disabled, unaccompanied children, victims of torture, violence, sexual abuse and rape, as well as others who may be in special need.

4. Capacity to train others and share skills.

5. Ability to collect document information, prepare reports and plan strategies to assist people.

6. Ability to involve refugees in a participatory relationship in problem solving and camp management.

Age

Preferably between 35 and 45 years of age.

Sex

Male and female candidates will be needed. However, in view of the large number of female refugees and the possibility of women staff working with the entire community, female candidates should be given preference, all other things being equal.

Languages

Good working knowledge of spoken and written English. Languages of the region would be an asset. However, candidates should be able to work with and through interpreters.

Availability

72 hours notice and for at least 3 months at a time.

Annex No. 11

Mission Terms of Reference Community Services in Emergencies (Initial Needs Assessment)

The Community Services Officer in the initial stages of the emergency should undertake a mission to accomplish the following:

1. Together with the BO/OCM concerned assess the possibility of a needs assessment to identify the number of vulnerable in the refugee community, i.e. the elderly, children, unaccompanied children, the disabled, the chronically ill, single-headed (female) households, the mentally ill.

2. Review the possibilities to meet these needs within the existing structures and the need to develop innovative means if necessary.

3. Assess the participation of the refugees in the day-to-day management of the refugee situation. In particular, the involvement of women in decision-making and their participation in the handling of resources. The need of women staff and interpreters.

4. Develop a system and procedures for continuing management and handling of assistance in order to establish clear guidelines for the delivery of services as well as reporting patterns from implementing partners.

5. Undertake visits to the various situations urban/camp based where refugees are and establish dialogue with them to assess their perception of the situation.

6. Identify and contact NGOs and Governmental Agencies who could assist in delivering services.

7. Develop job descriptions for staff who may be recruited to organize Community Services and establish clear lines of reporting and accountability.

8. Conduct brief on the job training for staff and volunteers who are involved in assisting refugees.

9. Prepare together with the BO a brief informational handout for the refugees and implementing partners, stating clearly UNHCR's approach, abilities, and limitations.

10. Any other emerging issues relating to refugee management.

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