Forum '85 Panel Tackles Health Problems of Women Refugees

Times Staff Writer

"Our purpose here is to discuss how to improve the situation of women and children who are 80% of the 10 million refugees in the world," Catherine O'Neill said at the beginning of the International Rescue Committee's workshop on the maternal and child health care problems of refugees.

"Our purpose is not to find out how to stop the creation of refugees," she went on, "or solve the political problems. We're here to discuss what problems they face and what recommendations we might make to the United Nations High Commission for Refugees and to our countries."

The problems that women face as refugees were not given as much emphasis at the Mexico City official governmental and unofficial non-governmental world conferences that marked the beginning of the United Nations Decade for Women in 1975 or at the mid-decade conferences in Copenhagen in 1980.

Here in Nairobi, where the end of the Decade for Women is being marked with Forum '85, the meeting for non-governmental organizations that ran from July 10 through Friday, and the U.N. conference that is in progress through Friday, refugee women are a major theme. Their situation, for example, is one of four priorities listed by the United States delegation, led by Maureen Reagan.

Keeping It Focused

O'Neill, a former resident of Los Angeles who was active in Democratic politics, is on the board of the International Rescue Committee and lives in Paris. Knowing she had a potentially volatile workshop to moderate at the Forum, she said later, she made the plea early to keep things focused and leave politics out of it. As such workshops tended to go, this one did remain focused.

Medical workers from the 50-year-old nonpartisan IRC told of the health problems--physical, mental and social--that women and children suffer. It was a sickening account of human destruction.

There was a universal profile that was applicable to most refugee situations women found themselves in, Jane Kronenberger said.

Family separation, individuals in flight and loss of family members to disease or war, left many women as family heads for the first time, responsible for children, food, shelter. Heads of family, but not heads of household, she said, since they were in flight, separated from the traditional support network of extended family and the small village they had left behind, prey to physical abuse from soldiers, border guards, pirates.

(Later, a relief worker from Djibouti would expand the profile to include prevalence of rape in the camps on the part of eligibility workers, citing one example of the nightly visits of a police chief and his friends. If the women ever were to receive their registration cards, she said, they had to acquiesce to the demands for sex.)

If they made it to their destination, Kronenberger said, they arrived weakened and traumatized, ignorant of the local language, often uneducated and unskilled, and restricted in their movements by the host country and any male family members. Prostitution and selling bootleg alcohol, Kronenberger said, were the means of support most available to them. Obtaining what limited food there is often depends on the political channels that inevitably spring up in the camps.

Using the Ethiopian famine as a case history, Martha Ryan and Roseanne Murphy told what they had witnessed last December, Ryan speaking of the social situation and Murphy of the health problems.

Refugees coming into the Sudan from Tigre in Ethiopia, Ryan said, arrived from small villages of about 100 people in the cold highlands, having walked for 14 to 30 days with minimal food and water. Some 4,000 of them entered daily, experiencing temperatures that reached high above 100.

No food or shelter had been prepared for them, and they sat starving, thirsty and frightened in the sun, waiting to be counted.

"There was an eerie feeling of silence that hung over them," Ryan said.

'Beginning of the Breakdown'

They had migrated en masse from their villages, she said. Old people who couldn't make it were left behind on the way, she said, and "that was the beginning of the breakdown" of the social structure.

People died of dehydration, exhaustion and illness on the journey, she said. Mothers lost children. By the time they arrived, the support system was gone.

It was in this condition that Roseanne Murphy, a pediatric nurse practitioner, first saw them. She was medical coordinator at the time, before the relief agencies arrived.

She quietly detailed the conditions there--severe malnutrition, measles (which alone took 2,000 children in six weeks, she said), overcrowding, lack of water, no sanitation, diarrheal diseases. In everything, she said, the breakdown of the social structure was a great health hazard, increasing vulnerability and risk of disease.

People put rags over trees and gathered straw for shelter. They were living three square meters per person, she said, citing the World Health Organization's recommendation of 20 square meters for safe shelter.

There were no provisions for pregnant women, she said. They were lying on the ground under rags, giving birth alone, the social structure having deteriorated to the point where "there was total apathy. Women were not helping each other. Traditionally there is a birth attendant. I saw none of this."

The chronically malnourished women delivered babies of low birth weight whom they could not breast-feed. The children did not survive, she said.

'Last to Receive Care'

Because the women are responsible for collecting fuel and water, and taking the children for health care and feeding programs, Murphy said, "They are the last to receive health care. When the outpatient department was finally set up, men made up 67% of the patients. The women couldn't take the time."

Into the chaos of the early days of the camps in Sudan, an attempt was made to involve the women in the planning as some order and the routines of daily lives began to emerge, according to another panelist, Peggy Kronenberger (sister to Jane and also an IRC worker).

They approached the village spokespersons, an elder usually, and asked them to select women with some health care experience. They trained these "home visitors" in preventive medicine, and, since they were illiterate, combined literacy training with health care.

If there is a concept that has taken hold during the Decade for Women, it is that women must share in decision-making, especially in matters of development. Recognition of this necessity has worked its way into the literature and documents that the United Nations has published. It has become a requirement for funding proposals--jargon, almost--a commonplace on everyone's lips. It is not questioned. But neither, it was frequently noted last week, is it very much practiced.

Before opening the workshop for comment and recommendations, the IRC staff made its own recommendations. Besides the basic provision of food, water and shelter, and collection of data, Murphy urged the participation of women, perhaps through their placement on village councils, in all aspects of camp life; the establishment of women's health centers staffed by more women personnel; education and literacy training; and training in preventive health care and sanitation. (Later, a workshop participant seconded this, saying men were often hired as health care workers because they knew English and were literate, whereas the major health problems in the camps were women's problems.)

Core of Recommendations

Participation in decision-making was at the core of most of the recommendations to come out of the workshop, and O'Neill later concluded by saying they would make it a stronger part of their recommendations, noting it was obvious the one overriding need was to "put the pressure" on the United Nations High Commission for Refugees to make it a requirement.

The workshop also saw other participants sharing problems, successful approaches and recommendations.

A UNICEF worker from Bangladesh and Thailand urged that camps provide income-generating activities for women. It was especially essential, she said, since money was often necessary to get camp food. The reality was, that far from women sharing in the distribution, host governments often controlled it absolutely, not allowing any participation of the recipients.

A Nicaraguan woman talked of resettling internal refugees from the northern border area "where the contras are fighting," saying the attempts to involve women were often thwarted by the men who "keep taking over." She urged that workers be respectful of culture, especially regarding pregnancy, noting that many refugee women have never been to a doctor. Acknowledging the breakdown of the social structure others had described, she said they had appealed to religious values, and worked gradually on the idea of sharing.

In Zimbabwe, a woman from that country said, refugees from Mozambique are not placed in camps, but in "Mozambiquen communities," where Mozambiquen women direct the supplemental feeding program for children and where education programs and materials are in their own language.

A woman from the outlawed African National Congress of South Africa, said the same health conditions pertained to South African black women and children living inside their own country as did to refugees. Migration laws, she said, confined black women and children to rural areas while the men worked in urban areas. She asked the workshop to support her by urging the removal of discriminatory laws in South Africa.

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