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A city in the making? Refugee governance presents ethical dilemmas

Posted by African Press International on November 4, 2013

A city in the making?

HIGHLIGHTS

  • Camp to be divided into 12 districts
  • Traditional leaders to take the helm
  • Opposition to UNHCR governance plans
  • Refugee governance presents ethical dilemmas

ZA’ATARI,  – “It has become very quiet”, says Kilian Kleinschmidt about recent months in Jordan’s Za’atari camp for Syrian refugees.

As the UN Refugee Agency (UNHCR) manager for the camp, which has now become the fourth largest population centre in Jordan, he has been tasked with bringing order to life here.

More than a year after the camp’s founding in July 2012, Kleinschmidt describes it as a settlement slowly transforming into something much more permanent.

But this transformation has consequences. One of the demands of an increasingly long-term operation is a greater focus by UNHCR on the camp’s governance – a sensitive area at the crossroads of politics and humanitarian relief.

Kleinschmidt has extensive plans for a governance structure: 12 districts with a variety of committees, assigned administration and humanitarian personnel per district, and a central administration headed by a Jordanian deputy governor.

“Traditional leaders” who have emerged from within the camp and are trusted by UNHCR and the Jordanian authorities may be integrated into some sort of representative camp committee.

But these plans have been met with fierce opposition by various self-appointed street leaders in Za’atari, who have long profited from the disorder and built their own power bases.

The clash highlights the challenge of trying to introduce governance structures to a refugee camp from above when there has already been something – unhealthy as it may be – forming at the grassroots.

Putting down roots

Size and time can present major challenges to UNHCR in managing camps, French anthropologist Michel Agier suggests in his critical book Managing the Undesirables: Refugee Camps and Humanitarian Government. As soon as the camps last beyond the emergency phase, they transform into spaces with which people begin to identify.

“In effect, while developing in material terms, and to a degree also economically, the refugee camps form themselves into social and political milieus,” Agier writes. He describes the “permanent paradox”, a life of refugees in camps “between an indefinite temporality and a space that is transformed because its occupants necessarily appropriate it in order to live in it.”

This is certainly the case in Za’atari.

“Some time ago, we had no idea who is who in the camp. There were protests and fights all the time,” Kleinschmidt explains, leaning back in his chair in the shadow of an awning between the containers of the so-called base camp, where humanitarian agencies have set up their offices. Now his focus is more on long-term administration and his plans to establish an all-encompassing electric grid in the camp, as well as a network of public transportation.

“In the end, what we see here is a temporary city in the making,” he says.

In the Sham-Élysées – the shopping street in the camp, named after the Champs-Élysées in Paris and a pun on the popular name for Syria: `al-Sham’ – businesses run into the wee hours of the night.

A young Syrian named Qassem proudly presents the construction site of his “shopping center”, comprising five white pre-fabricated containers, or “pre-fabs”. Soon it should be selling imported goods from Syria, he explains.

Some refugees have built themselves “mansions” by grouping together several pre-fabs, while one has even opened an improvised swimming pool to which he asks entry fees.

As Za’atari transforms from a hasty emergency response into a more permanent settlement, with no clear end on the horizon, many new challenges are surfacing for the camp’s management, among them politics and crime-control. The need for sustainable governance has become all the more clear.

Good and bad leaders

According to Liisa Malkki, an expert on refugee camps and an associate professor of anthropology at Stanford University, while old power structures often remain relevant, refugee settings also create opportunities for new people to become influential.

Some so-called street leaders have used the smuggling of humanitarian goods, and even amphetamines, to build their power base.

Some achieved authority as rebel leaders in the conflict in Syria, others established themselves by being among the first to arrive in Za’atari. “They came with their men and controlled local business and other things in the camp, often making a profit,” said Kleinschmidt.

Bulldozers are currently digging a deep ditch around the whole camp to clamp down on smuggling, which Kleinschmidt hopes will reduce the influence of some of the street leaders.

“The new leaders will be traditional Syrian authorities, sheikhs, who bring wisdom with them. They don’t need to scream in order to earn the people’s respect.”

Each of Za’tari’s planned 12 districts will accommodate around 10,000 residents. Leaders from each district should be represented in a yet-to-be finalized political structure. In addition, a new initiative funded by the US government will create a neighbourhood watch: out of 1,000 voluntary candidates, about 600 will be chosen in consultation with the “traditional” refugee leadership to patrol the streets, after background checks by the Jordanian police. They will work hand in hand with community police units, supported by Jordanian law, customary rules and camp rules.

These new security forces should “neutralize” and “isolate” the groups that have become instruments of corrupt and criminal structures dominating parts of the camp, whom Kleinschmidt accuses of extortion, theft and smuggling.

“The new leaders will be traditional Syrian authorities, sheikhs, who bring wisdom with them. They don’t need to scream in order to earn the people’s respect.”

One of them is an elderly man named Abu Wael, dressed in an ankle-long white garment, a `thawb’. “I don’t have time today; a delegation from the Jordanian prince is coming,” he said, passing by the base camp, rushing to the important meeting.

According to Kleinschmidt, just the day before, Abu Wael and some other elders sat together in one of the “mansions” in the camp and engaged in traditional conflict resolution, after an unmarried couple was caught sleeping together. They negotiated the matter between the families.

These new leaders should support UNHCR to build up a reliable structure of governance in the camp, while also helping to cut down on crime and delegitimizing the self-made leaders.

But the “old leaders” promise resistance. One of the more powerful leaders among them is Abu Hussein, 49, from the southern Syrian city of Dera’a and a former commander in the rebel Free Syrian Army (FSA). For most in the camp he is known simply as `Aqed’, the “Colonel”.

The Colonel

From a side street just off Sham-Élysées, a metal door leads to an improvised garden with patches of artificial lawn spread over the sandy ground. It is surrounded by several inter-connected pre-fabs that form the space where Abu Hussein lives with his wife and children.

“I am against everything going wrong here in the camp,” he says, as his wife serves a plate of self-cooked mlehi (meat with yogurt sauce and bread). “Nothing inside this dish is from UNHCR, that’s for sure,” he says. “We don’t want to put anything from them in our pocket.”

The Colonel

Abu Hussein is respected by many in the district he rules. He is often seen walking into the main street at night, where groups of young men are waiting for him. He sends them to patrol side streets in pairs, organizes female guards in community kitchens and keeps everyone “safe”, he boasts. One of his self-assigned duties is to organize workers in the camp. For the few positions available with humanitarian organizations for camp residents, he determines how shifts rotate and who is allowed to fill the positions.

However, Kleinschmidt says many of these “bosses” in the camp are already on their way down.

“They have a chance if they cooperate. Otherwise the Jordanian authorities will deal with them accordingly,” he said.

The new system of governance should decrease the influence of people like Abu Hussein by giving other people in the camp a stronger voice.

Street politics

Abu Hussein oversees an entire district. One notch below him are “street-leaders” who deal with the everyday problems in the camp.

One of them is Abu Asim from the Syrian village of al-Sanamen, in Dera’a Governorate, from where he fled with his family after what he says was a massacre last May. His own house was destroyed by a bomb, he recalls.

Sitting on cushions between two containers, Abu Asim pours sticky tea into his cup and lights a cigarette.

“To be respected in this camp,” he said, “you need to be wise and politically strong.” Via phone calls and personal visits, he solves “all kinds of problems”, like quarrels, water disputes, distribution issues, or broken toilets.

He too has heard about the newly planned committees in the camp. “I think UNHCR has to keep its hands away from politics,” he cautioned.

Humanitarian governance

The power struggles in Za’atari reflect the ethical dilemmas involved in the transformation from humanitarian emergency response to long-term refugee crisis. In his book, Agier writes that refugee camps – and humanitarianism more broadly – have become part of a global system to “manage” what are often seen as “undesirable” refugee populations and separate them from the general public.

“Humanitarian intervention borders on policing,” he writes. “There is no care without control.” This “humanitarian government”, as he calls it, deprives refugees of the practice of citizenship.

Although refugee self-governance always occurs when people live in settlements long enough, the official position of the humanitarian community has long been that such politics do not take place, Malkki, the Stanford researcher, told IRIN.

But Kleinschmidt is different. He has long advocated treating Za’atari like any other city in Jordan. “The humanitarian practice has long been to manage a camp for 20-30 years in more or less the same [short-term] way, instead of building up sustainable service delivery and governance.”

The Ministry of Interior’s Syrian Refugee Camp Directorate did not respond to IRIN’s request for an interview.

However, according to Oraib Rantwai, head of the Al-Quds Center for Political Studies in the capital Amman, the Jordanian government has been cautious in accepting any permanent structures being built in Za’atari for fear of angering its local population, which is suffering from strained services as a result of the refugee presence.

“People in Jordan ask themselves: how long will these refugees stay?”

ah/ha/cb/oa  source http://www.irinnews.org

 

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Norway to take in 1 000 Syrian refugees

Posted by African Press International on September 23, 2013

 

“The Government decided today to accept 1 000 Syrian refugees for resettlement to Norway. The war in Syria has led to an acute refugee situation. Syria’s neighbouring countries have taken in close to two million refugees. The capacity of these countries is at breaking point and the UNHCR has appealed to other countries to help,” said Minister of Foreign Affairs Espen Barth Eide.

There is no immediate solution to the conflict in Syria in sight. So far the conflict has led to massive flows of refugees to Syria’s neighbouring countries. In mid-September some 730 000 Syrian refugees were registered in Lebanon, 520 000 were registered in Jordan, 464 000 in Turkey, 117 000 in Iraq and 117 000 in Egypt. The UN High Commissioner for Refugees (UNHCR) and Syria’s neighbouring countries have appealed to countries outside the region to resettle some of the refugees currently living in Syria’s neighbouring countries as a matter of urgency.

“Syria’s neighbouring countries have displayed an enormous sense of responsibility for the refugees from Syria. One in every four people in Lebanon is now a Syrian refugee. Syria’s neighbouring countries, in particular Lebanon and Jordan, are reaching the limit of what they can cope with. If nothing is done, they may choose to close their borders. It is therefore crucial that Norway and other like-minded countries show solidarity and take in Syrian refugees,” Mr Eide said.

Following calls from UNHCR, Norway has provided substantial aid to help Syrian refugees in Syria’s neighbouring countries. Since the start of the conflict in Syria in 2011, Norway has provided a total of NOK 850 million in humanitarian aid.

The further quota of 1 000 refugees from Syria will come in addition to Norway’s annual UNHCR resettlement quota of approximately 1 200 refugees.

“Norway has a tradition of doing what it can in response to major international refugee crises and of providing a safe haven for refugees. This time is no exception. We know that Norwegian municipalities will make every effort to take in and integrate these refugees. As a country we can be proud of this and we will do everything we can to support the municipalities in this process,” said Minister of Children, Equality and Social Inclusion Inga Marte Thorkildsen.

The additional resettlement quota that the Government has decided to establish is reserved for refugees from Syria who are recognised by UNHCR, preferably those living in Lebanon and Jordan. The total cost of the quota is estimated to be approximately NOK 770 million.

 

 

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Za’atari camp for Syrian refugees costs $500,000 a day to run

Posted by African Press International on July 29, 2013

Za’atari camp for Syrian refugees, seen here in the foreground of Jordanian villages and towns, costs $500,000 a day to run

ZA’ATARI,  – Just on the other side of Jordan’s Za’atari camp for Syrian refugees, now one of the world’s most notorious camps, lies another Za’atari: a poor village inhabited by some 12,000 Jordanians.

“If I were given a tent like this, I would cherish it and protect it,” said villager Hamda Masaeed, while pointing at the ever-growing mass of tents with the logo of the UN Refugee Agency (UNHCR) stretching from the Syrian camp into the heart of the village of Za’atari, from which the camp got its name.

The seventy-year-old lives with two sons and seven grandchildren, also in a tent – but she built hers herself using pipes, blankets and the remains of wheat bags. It is old and tattered; one side was recently burned; and she does not own the land it sits on.

What she does own are three worn-out mattresses, a one-ring stove, and an old fridge that works only when there is electricity. Masaeed siphons electricity from her neighbour for six Jordanian dinars (US$8.50) a month, but if often cuts out.

She and other residents of the village have watched as the Syrian camp has grown over the past year to become home to some 120,000 refugees.

“It is a massive city in the heart of our little village now,” she told IRIN.

According to the social council of the municipality, the village itself has so far taken in 3,000 Syrian refugees.

Refugees do not by any means live lives of luxury: camp life is harsh and unlike the locals, they have had to endure the long journey of displacement and the psychological trauma of losing loved ones.

But only one main road divides the two Za’ataris; and while trucks carry food, blankets, clothes and medicine to Syrian refugees in the camp, the other Za’atari remains “forgotten”.

“Don’t they realize that we need help too?” Masaeed asked.

It is not only donations that pass by Masaeed’s tent, but also international journalists, aid workers, diplomats, and the world’s top officials.

One taxi driver told IRIN he deliberately drives visiting journalists through Za’atari village before dropping them at the camp, to show them that poverty also exists on the other side of the camp.

“People come from all parts of the world to write about the conditions of Syrian refugees, but these people [villagers] are also living in miserable conditions,” said Iyad Salhi, a driver from the capital Amman.

In the village, there is one mosque, two schools, and a small charity – the Za’atari Charitable Society – that “operates occasionally in Ramadan”. Its office doors were shut when IRIN passed by and no one answered the phone.

While complaints about a perceived shortage of water by residents of the Syrian camp have made it to local and international media, residents of the other Za’atari have to beg truck drivers to stop to sell them water. As in many other parts of Jordan, government-supplied water is not regular.

“They drive past us every day. Although we are paying for water, they do not sell it to us. They prefer to [sign contracts with] the camp,” said Mohammad Masaeed, Hamda’s son.

“Some promise us to come back, but they never do,” he added.

Protest in Za’atari village

This month, local media reported that gendarmerie forces quelled a protest by residents of Za’atari village when they went to demand jobs inside the camp.

Hamda Masaeed sits in her makeshift tent in Za’atari village

UNHCR says the local community has benefited, if insufficiently, from the camp economy: some people have been hired as contractors and workers in the camp.

But Nadia Salameh says she was recently laid off from a cleaner’s job at the camp to be replaced by refugees.

“They recruited us on a temporary basis, but then they gave the jobs to Syrians,” she said.

“It is so unfair when they [Syrians] receive everything for free, but we have to pay for food, gas, clothes, and rent,” she told IRIN.

Aid agencies working with poor Jordanians say they struggle to help them now.

“Donors’ attention has been focused on Syrians. They ignored the locals, who have always lived in poverty,” said Abdullah Zubi, programme coordinator at the Hashemite Fund for Human Development. “Keep in mind numbers of needy Jordanian families are increasing.”

He said his organization, a semi-governmental development organization, has been gradually reducing the number of needy families they are helping during Ramadan, when Muslims usually increase their charitable giving.

“We were able to help some 1,800 Jordanian families with packages of food every Ramadan, but as donors have been reducing their donations, we can only help 500 families this year,” he told IRIN.

International aid agencies are increasingly looking to provide assistance to local communities to avoid tensions with Syrian refugees.

UNHCR, through International Relief and Development (IRD), has provided services in the community, including improved public transport facilities and sanitation equipment. UNHCR has also supported the Ministry of Health in providing health services there.

The NGO Mercy Corps has set up community dialogues to try to address social cohesion and peaceful coexistence. It is also implementing a $20 million project – funded by the US Agency for International Development – to improve water delivery in northern Jordan, including Za’atari village.

But the needs are large – the most cited are a waste water network, a new school and better health facilities. Humanitarian agencies responding to the Syrian crisis are already having to prioritize due to rising refugee needs and insufficient funding and aid workers says donor funding for host communities is always hardest to come by.

Sad twist

In a sad twist, some Syrian refugees are now donating to poor Jordanians, or selling them extra food they receive from aid agencies at a discounted price. In Mafraq, the governorate in which the two Za’ataris are located, food blankets, tents, and other items with UNHCR logos are publicly for sale.

That is how Um Saleem, a Jordanian resident of Mafraq, has coped over the last two years, as previous donations from generous Jordanians have slowed.

Um Saleem’s kitchen

IRIN visited her as she was cooking a chicken given her by a Syrian woman living in her neighbourhood. It was the first time she had eaten meat in a month.

When Hajjar Ahmad, a Syrian refugee who lives in Za’atari camp, visited her sister in a village in Mafraq, she was “astonished” how much poverty she saw. She gave her sister extra food and blankets to distribute to Jordanians.

“We are living better than them,” Ahmad said.

aa/ha/cb  source http://www.irinnews.org

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Syria’s forgotten sanitation crisis

Posted by African Press International on July 7, 2013

A baby plays in a tub of water at Za’atari camp for Syrian refugees in Jordan

DUBAI,  – Bombs, clashes and airstrikes have killed at least 92,000 in Syria, according to the UN High Commissioner for Human Rights. But millions of people – and more still across the region – are at risk due to something much less discussed: sanitation.

Summer heat, shortages of clean water, a crumbling health system, breakdowns in waste management services, and overcrowded conditions in common shelters have led to a rise in potentially life-threatening diseases.

As summer temperatures rise, poor hygiene and sanitation are an increasing concern. The World Health Organization wrote last month: “outbreaks are inevitable.”

Up to 8,000 Syrians leave every day, often for overcrowded camps in neighbouring countries. The scale of population movement means that the threat is not just confined to Syria. Already, diseases have appeared in Turkey and Jordan that had not been seen for years, if not decades, before the Syrian crisis.

“The international community must now seriously view the ever worsening humanitarian and health situation as a threat to regional security and their own national interests,” public health doctors Adam Coutts and Fouad M. Fouad wrote in The Lancet medical journal on 29 June.

ha/cb source http://www.irinnews.org

 

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Overnight in Za’atari camp in Jordan

Posted by African Press International on June 24, 2013

ZA’ATARI CAMP,  – It is 9pm. The front entrance to Za’atari is lit mostly by the red and blue lights of the Jordanian gendarmerie vehicles parked at the entrance – little assurance of security to the 120,000 residents here, who say police rarely enter the camp. 

The place has the feel of a lively city – music plays from personal speakers; children scream giddily as they play football; friends and relatives gather in each other’s tents, chit-chatting into the night.

I stand on the other side of a fence that separates the sprawling city from what aid workers call “base camp”, home to the offices of UN agencies and NGOs, watching the camp like a screenplay.

A few young refugees call out to me, interrupting my daze. We speak through the barbed wire until they insist emphatically that I join them in their tent for a proper chat.

The tent is sparse, but clean and spacious; lit – with fluctuating power – by a network of crisscrossing wires, illegally hooked up to the electricity grid.

As we sit cross-legged on the floor – they have already offered me `labneh’ (yoghurt cheese) and olives, which they brought with them from Syria – they complain about inequitable shelter in the camp. Refugees use different and sometime fake IDs to get more aid, the father tells me; and those with money buy caravans while those who come empty-handed are left in tents, exposed to heat, dust, respiratory illnesses, fires and thefts.

“I heard a whole family died of a fire in the camp,” the mother says. Her neighbour, a widow, stops by to borrow a broom. Hers was stolen during a recent robbery in her tent, along with 5,000 Syrian pounds (US$50), four blankets and the few supplies she owned. Fellow refugees then stoned her tent while she was sleeping.

Desperation

“The dealings between us Syrians are dire,” the mother says, blaming it on desperation. “It’s every man for himself here,” her husband adds. “I feel I have no value any more, as if I’m not a human being.”

At 10pm, night staff of the UN Refugee Agency (UNHCR) arrive from Amman in a minivan, joining another 45 staff from the International Organization for Migration, the Norwegian Refugee Council and Save the Children, who have, by now, a well-tuned system for welcoming new arrivals to the camp.

Tonight, there are 244 of them.

Many have spent days en route, trying to escape Syria. They include pregnant women and sick children. At the border, they are met by Jordanian soldiers, who board them onto buses to the camp. I watch as they unload their suitcases, some of them clearly exhausted.

One mother of five carries her crying toddler in one hand and a suitcase in the other as she tries to cajole her sleepy children to follow her towards the registration desk. She appears to be barely keeping herself together, but seeks assistance from no one.

Though I cannot quite put my finger on them, there are other emotions at play.

There is relief, almost elation.

“We’ve spent two years amid the fighting and the fear,” says one refugee. “This is the first day we can breathe easy.”

But there is also sorrow. Or rather, a sense of guilt.

One 19-year-old cradles her newborn, wrapped in a blanket. She travelled with her baby, literally just days old, from Aleppo, 500km north of Jordan, sleeping in a different village every night. Her husband, who fled to Jordan before her, has not yet seen his daughter.

The young woman is quiet and unexpressive while we speak. When I ask how she is feeling after her long journey, she smiles and says she is relieved to be in Jordan. But just as quickly, the smile falls from her face, as she remembers those still back in Syria.

Others appear nonchalant about their journey, which for some, involves dodging shelling and crossing a river-bed on foot. Desensitized, I wonder? In denial? In shock?

I sit outside the UNHCR registration office, speaking to each of the refugees as they wait their turn to enter. One old man warns me not to open the Pandora’s Box and walks away, but many others are keen to share their experiences. One after the other, they tell harrowing stories as I take notes. 

“Among us, there are stories to fill many more notebooks,” one man says.

What I saw… I’ll never forget

But the old man’s warning soon proves true.

One man in a white traditional gown breaks down in tears as he remembers the charred bodies of two of his cousins. The corpses lay in a pool of water on a street in rural Aleppo for seven days until relatives risked death crossing a checkpoint to retrieve them.

He dug their graves himself.

“What I saw, what I experienced, I’ll never forget,” he says, his sun-bleached face twisted in emotion. “There is a limit to what a person can take.”

Around 1.30am, the last cases are registered, and I head back outside, where four large “pre-fabs” have been set up to accommodate those who need a place to sleep until they receive a personal tent in the morning. They lie like lost souls on the cold, grey, concrete, the brisk air streaming through the windows – a rude, but accurate, awakening to life in refuge.

One man mistakes me for an aid worker and asks for more blankets for his grandchildren. They are a family of five and only have three blankets, he says. I have no blankets, but offer him my jacket. Ashamed, he politely refuses, and promises they will make do just fine.

By the end of the night, I feel lost in the refugees’ stories, emotionally confused and overcome.

I cannot imagine how they withstand the pressures of the long, tiring journey and the overwhelming procedures upon arrival: government registration, pink slip, vaccinations for your children, welcome package, food ration card, voucher for tent, blanket, sleeping map, questions, so many questions.

A rowdy crowd is gathered around the thin opening in the barbed wire fence separating the registration area from the camp. The new arrivals push their way through the mass of people, lugging their possessions and entering a new phase of difficulty, another unknown world.

“It hurts to think: How did this happen to us?” one elderly woman tells me. When I comment on the strength I have witnessed among the refugees, she responds:

“It’s eat or be eaten. You’re the wolf or the sheep.”

 

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Huge need for aid to Syrian refugees

Posted by African Press International on June 22, 2013

“The situation in Syria and its neighbouring countries is more acute than the worst forecasts predicted at the turn of the year. We are facing the most serious refugee crisis since the Second World War,” said Minister of Foreign Affairs Espen Barth Eide during a visit to the border area between Jordan and Syria today.

“The pressure caused by the refugees and ethnic divides seen in the war in Syria are fuelling concerns that the conflict could spread to neighbouring countries,” Mr Eide said.

The humanitarian situation inside Syria is deteriorating steadily. After two years of civil war, public services have ceased to function in large parts of the country and much of the country’s infrastructure has been destroyed. According to the UN, more than 1.6 million people have fled Syria. If the current trend continues, the number of refugees could have risen to 3.5 million by the end of 2013. In addition there are now an estimated 4.25 million internally displaced persons inside Syria itself.

“International efforts to bring an end to the war in Syria must continue. Unfortunately there are few encouraging signs in the work being done to find a political solution to the conflict. This was emphasised in my talks with UN Special Representative for Syria Lakhdar Brahimi. Nevertheless, our humanitarian efforts must continue unabated. The need for assistance is great both in and outside Syria,” Mr Eide said.

Foreign Minister Eide visited Jordan on Thursday together with UN High Commissioner for Refugees António Guterres, in connection with the celebration of World Refugee Day. During the visit, Mr Eide had talks with Prime Minister of Jordan Abdullah Ensour, among others. Mr Eide also visited refugees from Syria in the border area between Jordan and Syria.

“In my talks in Jordan today, I have praised the Jordanian authorities for the help they have provided to Syrian refugees. At the same time it is crucial that help reaches all refugees and not only those living in refugee camps. It is also vital that the Jordanian authorities, together with the UN and other aid organisations, ensure the necessary level of security,” Mr Eide said.

Due to the situation in and around Syria, the UN has launched its largest ever emergency appeal. The Government has decided to contribute NOK 150 million to the appeal. This total will be made up of the extraordinary allocation of NOK 100 million made in May and the entire reserve of NOK 50 million of the Foreign Ministry’s humanitarian budget.

“In our talks, the UN High Commissioner for Refugees emphasised just how extensive the refugee crisis is, and the huge need for aid that is still unmet. It is vital that the international community now assists Jordan and other neighbouring countries in dealing with the flow of refugees from Syria. The UN plays an important coordinating role here,” Mr Eide said.

Including this most recent contribution, Norway has allocated a total of NOK 360 million to the crisis in Syria in 2013, and a total of NOK 575 million since the conflict started in spring 2011. The Government allocated NOK 210 million to UN humanitarian appeals for Syria in the first half of 2013.

 

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Unwanted pregnancies in Syria – Rise in incomplete abortions and STIs

Posted by African Press International on May 30, 2013

A baby in Turkey’s Islahiye camp for Syrian refugees

HIGHLIGHTS

  • 250,000 Syrian pregnancies this year
  • Deteriorating neonatal care in Syria
  • Rise in incomplete abortions and STIs
  • “Compensating lives” in refugee camp

ZA’ATARI CAMP, JORDAN, 29 May 2013 (IRIN) – When aid workers with the UN Population Fund (UNFPA) speak to women inside Syria – many of them displaced from their homes and living in cramped collective shelters – they say they would rather do anything than get pregnant.

“No one wants to be pregnant in the shelters… That’s universal wherever we go,” said Laila Baker, UNFPA representative in Syria. “There is no place to take care of the baby and it’s another mouth to feed.”

In addition, they fear the delivery process will face complications, as access to antenatal care and safe delivery services, including emergency obstetrics, is now extremely limited in the country.

Yet, UNFPA estimates that some 250,000 women in Syria and in refugee settings will become pregnant by the end of 2013.

After more than two years of conflict, Syria’s healthcare system has broken down, hospitals have been destroyed, medical personnel have fled the country, supply routes have been disrupted, and in many places, family planning tools are not readily available.

Fadia Salameh found out she was pregnant after arriving in Za’atari camp for Syrian refugees in northern Jordan. The medical centre in her home town in the suburbs of Hama, “which witnessed heavy shelling”, had no more contraceptives in stock, so she stopped taking birth control pills.

“Our village ran out of everything – food, bread, and medicine,” she told IRIN from the camp, where she sought help from a UNFPA clinic.

In 2012, UNFPA in Syria distributed nearly 1.5 million family planning pills, 40,000 injectables, 45,000 intrauterine devices (IUDs), and 21,000 condoms in governorates affected by the conflict. But the shipments are irregular and do not meet the high level of need.

Mobile UNFPA teams also visit shelters, providing women’s health care and distributing vouchers that women can use to get free maternal health and emergency obstetric services at a clinic of their choice.

The Syrian Ministry of Health has remained active throughout the crisis, and some maternity wards and teaching hospitals are still offering obstetric or maternal health care.

“Conjugal room”

Internally displaced persons (IDPs) face additional challenges related to family planning and unsafe sex as a result of the crowded living conditions, especially in common shelters. UNFPA estimates there will be 1.65 million women of reproductive age living as IDPs by the end of 2013.

While they may not want to have children, displaced married couples do still want to have sex, even requesting that aid agencies set up what they called a “conjugal room” in one shelter in Rural Damascus, for privacy.

UNFPA has not yet been able to conduct a survey to establish the scale of the problem, but at least in the capital Damascus, a growing number of sexually transmitted infections (STIs) have been detected in routine visits to clinics, Baker said.

“We are really concerned that unwanted pregnancies and STIs may become an issue where they were not in Syria,” she told IRIN. “And when you do have an unwanted pregnancy or an STI, you do not [necessarily] have access [in Syria] to the care you need.”

Maternal and infant mortality

Before the conflict, 96 percent of deliveries in Syria (whether at home or at the hospital) were assisted by a skilled birth attendant, but previously strong registration systems have since broken down.

As such, figures are not available, but Baker suspects maternal and neonatal deaths are also on the rise.

Partners told Baker of two women in the central city of Homs who died in recent months after giving birth without anaesthesia. The drugs had run out and could not be replaced because it proved too hard to get them across frontlines. Doctors operated on one woman post-mortem to save her baby girl. She is now four months old and being raised by her grandmother. The fate of the second baby is unknown.

Births by Caesarean section are 3-5 times higher than in normal conditions, Baker said: women schedule them in advance to try to avoid having to rush to hospital in unpredictable and often dangerous circumstances.

In one hospital in Homs, 75 percent of all babies are delivered using the surgical procedure. Women often have to walk or take the bus home within hours of the operation, because of general insecurity and fear of not being able to get home. Their husbands usually do not accompany them for fear of arrest while in hospital.

But even with the advance planning, they can run into problems. On 5 May, mortar shells reportedly hit the main referral hospital for maternal health in Syria, located in Damascus, seriously damaging it, just as one woman was lying on an operating table, prepared for a C-section.

As recounted to IRIN by Elizabeth Hoff, representative of the World Health Organization (WHO) in Syria who visited the hospital shortly after the shelling, the woman panicked, pulled out her catheter tube and I.V. fluid therapy, and ran. Two other women aborted in shock.

Women are admitted to hospital for no more than eight hours, because of the increasing number of patients and insufficient beds, Hoff said.

Late last year, WHO said doctors had been reporting a rise in “incomplete abortions”. Abortion is illegal in Syria, so instead women take pills that do not always work.

“They don’t see how they are going to face a pregnancy because of all the difficulties, and another child to cater for when they can hardly cater for those they have,” Hoff told IRIN at the time.

“Compensating lives”

But just across the border, in the dusty, burgeoning Za’atari camp for Syrian refugees in Jordan, birth trends are quite different.

Many women say the camp conditions are “not suitable” to have children; an online campaign by the Syrian women’s group Refugees not Captives calls on refugee women to postpone pregnancies until they return to Syria.

But others want to “compensate lives” lost in the conflict.

“We are not going to stop having children because of [the conflict],” said Um Ahmad, a mother of seven, while waiting in a queue to be seen by a doctor. Two of her brothers were killed, she said, “and that is why I want to stop using the IUD to give birth again…

At a makeshift clinic for displaced people in northern Syria, this baby shows symptoms of intestinal distress

“If Syrians stop having children while [so many are being killed], the nation will vanish,” she told IRIN.

Every day, a crowd of Syrian women and girls forms outside a UNFPA-supported reproductive health clinic, seeking advice on family planning and fertility, as well as pregnancy tests and health check-ups.

“We are recording high rates of pregnancies daily,” said midwife Munira Shaban. “[We do have] clients come to seek help as they want to become pregnant. The numbers increase as the camp grows bigger.”

The clinic sees about 90 women a day, and one third of them come with pregnancy-related inquiries, whether they be tests or treatment, according to gynaecologist Reema Dyab.

All forms of family planning are available in the clinic, Dyab said, but “the demand for this service is low… Most of our patients have asked for help in treating problems preventing pregnancies, and the majority indicated they wanted to stop using contraceptives,” she told IRIN.

Some women said they were pressured by their in-laws to have more children.

“They expect me to have more babies now, because my husband lost two of his brothers in the war,” said Um Khaled*. “I am expected to give them back all males that were lost.”

Newly-born babies often carry names of relatives who died in the conflict, refugees said.

Many pregnancies at Za’atari camp also involve child mothers, Dyab warned.

The clinic, run by the Jordan Health Aid Society, registered 58 pregnancies involving mothers below the age of 18 during the last week of February alone.

(Before the uprising in Syria, 11.6 percent of girls aged 15-19 were married).

Raising awareness

STIs have not broken out in the camp, but the chances that people are having unsafe sex are “high”, Dyab said.

“Women tell us that their husbands refuse to use condoms, which is very common in this cultural context. Even if some people take condoms, it does not mean they are used correctly.”

Heather Lorenzen, a reproductive health officer at UNFPA in Jordan, said although it is challenging to tackle issues of sexual and reproductive health in the camp due to cultural sensitivities, aid agencies are trying to raise awareness. For example, UNFPA holds seminars about early marriage and family planning methods in the camp.

“This is an opportunity for women to learn about services available and decide what is suitable for them,” she told IRIN.

She said it is important to compare the current situation with reproductive health norms in Syria before the conflict erupted.

“If we look back, birth rates have been high over the past years in Syria. Early marriages have been high in Syria, so it is difficult to see if pregnancy rates increased as a result of the war or if early marriages have become a coping mechanism.”

*not a real name

aa/ha/cb source http://www.irinnews.org.

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