Following the end of WWII, in December 1950, the Office of the United Nations High Commissioner for Refugees (UNHCR) was established. In July of 1951, the Convention Relating to the Status of Refugees came into effect. This convention was set up as an international instrument to protect the rights of refugees. At the core of this regime was the "fundamental right of any individual to seek and enjoy asylum from persecution in other countries" (Human Rights Watch: World Report 2001). Embodied in article 14(1) of the Universal Declaration of Human Rights is the recognition that when all other forms of human rights protection have failed, individuals must be able leave their country freely and seek refuge elsewhere. Unfortunately, the right to seek refuge elsewhere is slowly being taken away. Industrialized states have become fixated with erecting barriers to keep people out.
Until recently, refugee movements were a result of Cold War politics. For the first time in history, nearly every war going on in the world today is being fought within borders, not across them. Gone are the days when refugees held high geopolitical and military value. Now, refugees are being blamed for everything from threatening the local environment, causing a rise in crime, to being threats to national and regional security. Since 1985 the number of refugees has risen dramatically, from less that 10 million to almost 20 million (Peters and Wolper, 336). More and more people are becoming displaced while fewer countries are willing to help. Those most strongly affected by all of this are the millions of women and girls who find themselves in either a position of displacement, or as refugees.
Though all refugees face problems concerning healthcare and protection, refugee women are susceptible to problems specific to their sex. When the decision to flee one's home country is made, women open themselves as well as their female children up to situations of rape, sexual assault, and violence. Often times the women are fleeing without their husbands. This is because their husbands have either been killed, are in jail, are fighting, or have already fled or gone into hiding. Once refugees reach their country of refuge, they are not necessarily safe. Rape and sexual assault occur throughout the refugee's journey, and very frequently continues throughout their time in the camps. As Sima Wali states, "The perpetrators of sexual violence against refugee women fleeing across borders are frequently those assigned to protect them-- border and military guards and camp administrators-- as well as refugee men" (Peters and Wolper, 338).
In this new age of internal conflict rape has become a frequently used weapon of war. It is used to "humiliate and demoralize [one's] opponent" (Cole, 67). "It has become clear over the past decade that refugee and displaced women and girls are no longer by-products of war but, rather, specific objects of warfare" (Peters and Wolper, 338). Women become especially vulnerable when seeking asylum across the border. They are frequently attacked and raped by police, military personnel, border guards, and traveling bandits. Because "most of the programs and services offered to refugees [within the camps] are developed, implemented, and administered by men," women once again find themselves at the hands of their male counterparts (Cole, 66). Sexual favors are demanded in exchange for food, relief assistance, and documentation. Domestic violence rises while women are forced into childbearing to replenish the male population lost to war (Peters and Wolper, 337).
The issue of rape, in many cultures, is one of shame and dishonor. After a woman has been raped, she is often ostracized by her community and is seen as unfit to marry. In extreme cases, women who have been raped are then rejected by their families for having disgraced and dishonored them. A consequence of this rejection is that women do not report the rapes to refugee workers. A study done in Winnipeg found that "over 1/2 of rape victims and 94% of other sexual assault victims didn't tell any professional outsider about the assault" (Cole, 69). Oftentimes, women will approach camp doctors and relief workers with symptoms that are psychosomatic of their experiences (Cole, 69). Unfortunately, many who work in the camps are not properly trained to recognize that the women's symptoms are the result of sexual trauma. Another common problem concerning the reporting of rape and sexual assault is that it is frequently men who are asking the questions. Most women, when asked if they have been sexually assaulted or raped, are not willing to disclose such information to men.
Along with sexual assault, the issue of health care is a major area of concern for refugees. Most refugee camps have their refugees living in unsanitary conditions where they lack clean water, sufficient amounts of food, and where disease and death are common. With most of refugee households being run by women, many of them are unable to leave their camp homes to retrieve food, water, and wood for cooking. Male refugees often run the job of food disbursement within the camps. These men frequently overlook the food needs of women and their children, the elderly, and the handicapped. Malnourishment stems from women not being given as much food as men, and the fact that they often live in homes where there isn't a male head of household. As a result, they are not viewed as valuable or deserving of their rations.
In many camps, the need for medical attention is often overlooked. Clinics are either too far away, or there are few, if any female physicians. When clinics are placed two far from camps, women often have to compromise between making the journey (sometimes lasting several days) and leaving their children at home. Or, not making the trip and hoping that their child's illness is not life threatening. More often that not they choose the latter.
It is a common practice in many cultures for women to seek medical attention only from female doctors. As it stands, most doctors in refugee camps are male. This causes women to avoid seeking medical attention, even in the most dire of cases. Women often arrive to their camps in states of severe dehydration and malnutrition. The conditions within the camps themselves only work to exacerbate these health problems.
Chief among women's health care concerns is the need for family planning. Though for many, the lack of these services is a continuation of the conditions that existed before they were driven from their homes, it is nonetheless a significant issue in women's health care. In situations where pre- and post-natal health care is nonexistent, mortality rates for women and children are extremely high. Without birth spacing services, refugee and displaced women are unable to avoid frequent, high-risk pregnancies in situations already adverse because of dislocation, physical danger, and minimal food, shelter, and sanitation. Reproductive health care is urgently needed and wanted in camps around the world.
Over the past several years, Mother and Child Health Care programs have been organized in an attempt to reduce infant and maternal mortality rates. These programs have focused on the health aspects of pregnant and lactating mothers and children, and have achieved some success. It is now generally recognized that their scope has to be expanded. Says Serge Male, UNHCR's senior epidemiologist, "The trouble with MCH programs is that they restrict women to the role of mother. This is very reductive. What about young girls...[or] women who are past child-bearing age...?" Something that organizations need to keep in mind is that it is also very important to include older women in health care programs because in many traditional societies they wield the influence and power to change old ways of thinking and guide the younger women. Most importantly, in order for refugee health programs to be successful, it is absolutely essential that they include female physicians. This cannot be stated enough.
Along with the lack of primary health care, refugee camps are severely lacking in psychological care for their inhabitants. By the time refugees have made it to the camps, most have suffered through intensely traumatic experiences. Most deeply affected by these traumas are women. They have no doubt already lost one or more children in the fighting they have just fled. Women find themselves left to carry the burden of taking care of the children and household duties, as well as taking care of responsibilities that would otherwise have been their husband's. When the choice to flee has been made, people leave more than just their homes and belongings behind. Families are often split up; causing women to lose the support they once gained from their extended relatives. Once they arrive in their country of refuge, they are left to deal with languages and cultures they may not be familiar with. Also, many families are often grouped into one large dwelling. People find themselves being forced to share a living space with total strangers. In some cases, tribes and societies that have historically been enemies, are expected to live within the same camps, side by side, sharing the same latrines and wash areas.
Experiences of rape, loss of loved ones, hunger, illness, and the witnessing of violent events, leave many refugees with severe psychological trauma. Many refugees suffer from Post-Traumatic Stress Disorder. This is a condition whereby the inflicted finds themselves reliving the traumatic event over and over again in their heads. Another, very common condition among refugees is "escape trauma". [This term] "has been used to refer to the scars left from the experience of fleeing one's country to escape persecution" (Cole, 70). When people flee their homes, they are faced with the distress of leaving their homeland with no knowledge of when, or if, they will be able to return home.
There are several reasons as to why the psychological needs of refugees frequently go unmet. In many refugee situations, there simply are not enough funds. Another very common problem is that although certain therapies may work for people of one culture, it does not necessarily mean that they will work for those of another. The ways, in which Post-Traumatic Stress Disorder is dealt with here in the States, are not so effective in other areas of the world. For many women suffering psychological trauma, they refuse to seek help based on a cultural stigma toward mental illness. Others fear that by seeking help, they will damage their chances at immigration. In other cases, the staff within the camps simply are not trained to notice signs of severe trauma. Sadly, many organizations do not feel that the psychological health of the refugees in their camps is their responsibility.
Though women constitute more than three-fourths of the world's refugee and displaced populations, organizations throughout the world still fail to see that more has to be done to meet their needs. Many fail to acknowledge that because of their sex, refugee women have special needs that need to be met. These organizations are not alone in feeling this way. The UNHCR still has a great deal of work to do where it comes to refugee women's issues. The unfortunate side of all of this is that even when NGOs are aware that changes need to be made, they often do not have the money to make the changes. The UNHCR is currently working to revamp their policies concerning women, and working to inform their staff as well as organizations the world over that more needs to be done. Though strides have been made just within the past decade, there is no doubt that more needs to be done. With the help of selfless volunteers and the United Nations, it is possible that some day the importance of refugee women's issues will be realized, and women will no longer have to feel fear while living in what is supposed to be their safe havens.