Reproductive health services for refugees by refugees: an example from Guinea

The need to involve refugees in their own reproductive health (RH) services has long been recognised, but there is a lack of published examples describing how this can be achieved collaboratively between refugee initiatives, UNHCR, bilateral development organisations and international relief agencies. This paper outlines the work, outputs and lessons learnt of the Reproductive Health Group (RHG), an organisation of Liberian and Sierra Leonean refugee midwives and laywomen providing RH services to fellow refugees in Guinea's Forest Region between 1996 and 2000. Working as part of the Guinean health system, RHG midwives and community facilitators helped make the RH services in their region the most effective in Guinea at the time. Looking at RHG's achievements, the challenges it faced and partly overcame, it is argued that refugee organisations can plan and implement RH services for refugees where UNHCR and its international partners ensure that they receive funding and technical assistance.     

Nutritional risk factors for older refugees

This study describes risk factors for poor nutrition among older Rwandan refugees. The most important areas of nutritional risk for older refugees are: physical ability and mobility; income and access to land; access to appropriate food rations; meeting basic needs such as water, fuel, shelter; equal access to essential services (food distribution, health services, mills, feeding programmes); and psycho-social trauma. Women and older elderly (> 70 years) are significantly more often in disadvantaged positions, such as having poor socio-economic status, poor health, poor mobility, lower food intake, diminished social status, respect and social network. Older refugees are at higher risk than younger refugees and at higher risk than older people in stable situations. They should remain in good nutritional and general health for their own well-being and that of their dependants. In addition to an adequate diet, a support network seems to be an important preventive aspect.     

Planning STI/HIV prevention among refugees and mobile populations: situation assessment of Sudanese refugees

This article reflects an investigation of knowledge, attitudes and behaviours and HIV/STI prevalence of Sudanese refugees and Ethiopian sex workers in 1992. It represents one of the earliest such investigations within an African refugee population. The investigation took place in the Dimma refugee settlement in south-western Ethiopia and study participants included Sudanese refugee men and women and Ethiopian female sex workers. Methods used for this investigation included focus group discussions, behavioural surveys and serologic testing. The main outcome measures of the investigation were HIV/STI knowledge, attitudes and behaviours and biological markers for HIV, syphilis and herpes simplex 2. The study findings indicate that in the early 1990s, knowledge about AIDS and condom use was low among Sudanese refugee women and not one reported having ever used a condom. Furthermore, sexual contact between refugee men and sex workers was frequent during the time of this study and the prevalence of HIV and other STIs was high. The results confirm a widely held assumption that highly mobile and transient populations in Africa are susceptible to STIs and HIV, in large part due to their knowledge, attitudes and behaviours.     

Desertification, refugees and regional conflict in west Africa

This article documents the potential for inter-state conflict in the migration of hundreds of thousands of famine refugees across international borders in West Africa. Nigeria and Ghana, for example, have to deal not only with the effects of land degradation in their northern territories but also with the influx of famine victims from Mali, Niger, Chad and Burkino Faso. These migrations put an enormous extra burden on the fragile and already overstretched social and economic infrastructures of the host countries. The construction of dams for irrigation and electricity generation in international river basins, is another cause of inter-state conflict related to land degradation. The capacity of West African states to find peaceful solutions to these problems is being undermined by the increasing impoverishment and marginalisation of their populations. A self-serving neo-colonialist governing elite is caught in the economic stranglehold of the advanced capitalist nations. While there is thus no short term solution to the problem of land degradation, immediate steps should at least be taken to give legal protection to those who are forced to cross international borders because of drought and famine.     

Rural refugees in Africa: Past experience, future pointers

Rapid change In rural Africa raises new policy problems In dealing with mass influxes of rural refugees. Self-settlement in agriculture has become less feasible and is less acceptable now that Its disadvantages are better understood. Organized smallholder settlement can be a better solution where it is economically viable, refugees have freedom of movement, and staff are suitable. But growing land shortage means that Increasing proportions of refugees are being placed in camps. To offset this trend, more attention is suggested to programmes for groups of refugees, categorized by time of arrival, by ability to self-settle or to farm, and by skills and experience. Practically-oriented social science research can contribute to these and other approaches which will require imagination and ingenuity. Solutions to future rural refugee problems should be linked with programmes of social and economic development which will make easier the achievement of humanitarian objectives.     

Chaos, order and world view: tibetan refugees in Switzerland

This article is about culturally specific responses to extreme events. The concept of social chaos and some criteria for distinguishing this concept are discussed. Social chaos refers to an extreme situation in which neither the rules of normal behaviour nor those for coping with unexpected problems apply. It is suggested that the concept of world view may be an asset in the study of social chaos. The case of Tibetan refugees in Switzerland is presented to show how the ability of a society to survive a disaster is related to the specific outlook on the world shared by members of that society. Finally, it is asked whether it would be possible to account for a society's response to disasters, on the basis of socio-cultural factors.