Young
People in Refugee Situations
Young
people often have an easier time adapting to a new situation than their
parents do. They learn how to "work the system" quickly. In trying to
understand their special circumstances and meet their needs, it is helpful
to remember the following:
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Adolescence is a time for learning about close relationships.
In normal situations, much of this information is gained from peers
and from role models in the young person's family and community.
These people may not be available in refugee settings. As respected
adults in the lives of young people, male and female service providers
may become important role models and should be aware of their potential
influence.
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Young people often lack a well-developed future orientation.
This can be reinforced by refugee or displaced status.
Projects that provide these young people with a reason to look to
the future may also help them consider the consequences of unsafe
sexual activity and the need to take responsibility for their actions.
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The behaviour of young people in refugee or displaced situations
may not be subjected to the same kind of scrutiny as it would be
under normal circumstances.
The separation from one's homeland, one's elders and one's traditional
culture may create a situation in which risky behaviour is less
socially controlled. Thus there is a greater risk of early teen
pregnancy, sexually transmitted diseases (STDs), drug abuse, violence,
etc.
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Young people are not a homogeneous group.
Young women and young men face very different problems and opportunities.
Young women are much more vulnerable to common RH problems and they
invariably bear most of the consequences. Also, young people aged
10 to 14 years have different needs than those aged 16 to18 or 20
to 24. And different cultures have different expectations for youth
in these different age groups. For example, in some cultures, marriage
is acceptable/ expected for a 14- year-old girl; in many other cultures,
it is not.
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In many countries with high STD/ HIV prevalence, the most vulnerable
group is young women.
The AIDS epidemic is exacerbating the health risks that young women
face. Their lack of power over their sexual and reproductive lives
compounds the risks of unwanted pregnancy, unsafe abortion and STD/
HIV infection, all of which are likely to occur more frequently
in refugee situations.
The
background characteristics of young people, including their religion,
cultural upbringing, place of origin (rural or urban), and level of
education will, to some extent, define their needs. However, basic RH
needs include:
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information on sexuality and reproductive health
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access to family planning services
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prenatal and post-abortion care
-
safe delivery
-
treatment of unsafe abortions
-
diagnosis and treatment of sexually transmitted diseases
-
protection from sexual abuse
-
culturally appropriate psychosocial counselling and/ or mental health
services
-
negotiating skills
Principles
in Working with Young People
The primary principle in working effectively with young people is
to promote their participation. Although this principle applies to
the provision of RH services in adult populations, it is particularly
important for young people. As a group, young people often have a
"culture" of their own, with particular norms and values. They may
not respond to services designed for adults. They are at a stage in
life where they need to develop a sense of control over their bodies
and their health. At the same time, since they are young and relatively
inexperienced, they need guidance that is both sensitive and reassuring.
The best way to encourage young people to participate is to develop
a partnership between them and the providers with proper regard for
parental guidance and responsibilities. Services will be more accepted
if they are tailored to the needs as identified by young people, themselves.
Other principles to remember:
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Service providers must understand the cultural sensitivities surrounding
the provision of information and services to young people.
To the extent possible, community leaders and parents should be
involved in developing programmes targeted at young people. Service
providers with deep cultural knowledge (especially if the provider
is part of that culture) are more likely to provide services acceptable
to the community than those considered "outsiders".
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Programmes should identify and encourage peer leadership and communication.
Peers are usually perceived as safe and trustworthy sources of information.
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It is essential to have links between health and community services.
Links between health and community services are necessary to ensure
that young people get the appropriate treatment for problems which
might be revealed through one service but require additional assistance
from another service (e. g., sexual violence or unsafe abortion).
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Young people need privacy.
The problems that bring them to a service provider often make them
feel ashamed, embarrassed or confused. Though space may be at a
premium in a refugee camp, it is important for providers to try
to create the most private space possible in which to talk to young
people.
-
Confidentiality must be guaranteed.
Service providers need to maintain confidentiality in their dealings
with young people and be honest with them about their health problems.
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In most cultures, the gender of the service provider is important.
A young person should be referred to a provider of the same sex.
In
the absence of information specific to the young people, providers must
assume that many of the common problems cited above may be worse in
the refugee situation. The disruption of health and education services
and general state of disorder imply a lack of protection and supervision,
increased sexual violence, and a greater need to exchange sex for food,
shelter, safe passage and protection. It is important to obtain information
about a young person's history of STDs and pregnancy status, unsafe
abortion, rape and other forms of sexual abuse. Health care providers
should also be aware of a young person's knowledge about and access
to any form of contraception, and his/ her beliefs, attitudes, perceptions
and values.
More specifically, it is important to gather information about:
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cultural norms related to sexual relationships and rites of passage
into adulthood (including harmful traditional practices, such as
female genital mutilation)
-
current norms/ practices/ perceptions/ attitudes related to sex
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typical patterns of adult authority over adolescent behaviour within
the camp
-
services available to young people (and applicable restrictions)
and the degree to which the refugee community understands this availability
-
perceptions of camp staff/ service providers related to providing
RH services to young people
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n young people's perceptions of their RH needs
This information can be gathered through camp records, interviews and
focus group discussions and possibly through simple survey techniques.
(Some further guidance is found in Appendix One
on IEC.)
Responding
to the RH Needs of Young People
Young
people need basic information about sexuality and reproduction. They
also need to learn how to protect their reproductive health. In many
refugee settlements, formal education ends after primary school. Therefore,
information about reproductive health must be communicated in creative
ways. Any organised activity for youth -- sports, video showings, handicraft
"clubs" -- may provide an opportunity for disseminating important health
information to participants.
It has been proven that sex education leads to safe behaviour and does
not encourage earlier or increased sexual activity. (See UNAIDS document
in Further Reading.) Therefore, young people should be informed about
STD/ HIV/ AIDS and early pregnancy, and appropriate advice and supplies
should be made available to them. Young people need to develop certain
skills to be able to make informed, responsible decisions about their
sexual behaviour. They need to be able to resist pressure, be assertive,
negotiate, and resolve conflicts. They also need to know about contraceptives,
such as condoms, and feel confident enough to use them. Peer counselling
and peer education can be very effective in strengthening these skills
and attitudes.
Young girls who do not attend school and who are destined to marry immediately
after the start of menstruation may be particularly difficult to reach.
However, their society may allow a community worker to visit the girls
at home and discuss health matters relating to preparations for parenthood.
Rape may be the reason an adolescent first approaches health services.
Many victims of rape and sexual abuse are girls, but boys are also vulnerable
to sexual violence. Young people who have been sexually abused need
immediate health services and access to a safe environment.
In refugee situations, adolescent girls and boys may be forced into
selling sex simply to survive. Refugee-community members should be involved
in identifying ways to protect girls and women from sexual violence
and coercion. One possible protective measure is to ensure that women
administer the distribution of food and shelter. (See Chapter
Four -- Sexual Violence.)
If an adolescent is pregnant, it is vital to provide her with good antenatal
care, since young women, especially those under 15 years of age, are
prone to complications of pregnancy and delivery. Many young pregnant
women will resort to unsafe abortion. They will need special care if
complications from an unsafe abortion develop. Information about family
planning must be readily displayed and available to help keep unwanted
pregnancies to a minimum. (See Chapter Six -Family Planning).
Adolescent boys engaging in homosexual intercourse should be taught
how to prevent STD/ HIV. However, IEC messages related to STDs should
not label this behaviour in a way that may stigmatise the boys (e. g.,
as homosexual), but should refer to the behaviour as "men having sex
with men" or "same-gender sex".
Psychological trauma resulting from refugee experiences may make young
people reluctant to seek services related to their sexual health. But
they do need to know that these services are available to them, that
they will receive care and support if they want it, and that they will
not be judged or punished in any way. Information about the services
could be displayed in places where young people gather or provided through
other activities or social services.
Psychosocial support and counselling should be provided by trained counsellors
whenever needed, but particularly in cases of sexual abuse and unwanted
pregnancy.
Community-Based
Programmes
Ideally,
a person with experience in RH services for young people should participate
in the needs assessment and planning of the programmes. Young people
from all age groups should be identified, as quickly as possible, to
help design the programmes and eventually to take a leadership role.
When an assessment of current needs and available resources has been
made, the group of service providers and young people who are assembled
to develop the programme can consider the project objectives and develop
the corresponding activities. Planners should define simple mechanisms
for collecting information that can later be used to measure the project's
impact. That information will also guide any modifications made to the
programme. Young people should be involved in evaluating and modifying
the programme.
RH
services for young people are more effective and acceptable when they
are linked to other activities or settings, for example recreation or
work. Youth centres, developed in some refugee settlements, offer a
place for young people to learn, play and receive health services. In
other refugee settings, young people have access to health services
during special hours, usually after school or after work. Young people
need their own physical spaces for social interaction. These may be
the best venues for providing health services.
Monitoring and Supervision
RH
programmes should be monitored to ensure young people have access to
health services and health care providers are caring for young people
without stigmatising them.
To be sure young people are attending health services and being targetted
with health information, many RH indicators should be measured by age
and sex break down. See Chapter Nine for select
indicators for young people.
Further Readings
"A
Picture of Health: A Review and Annotated Bibliography of the Health
of Young People in Developing Countries", WHO, Geneva, 1995.
"Action
for Adolescent Health: Towards a Common Agenda", recommendations from
WHO, UNFPA, and UNICEF, 1997.
"Coming
of Age: From Facts to Action for Adolescent Sexual and Reproductive
Health", WHO/ FRH/ ADH/ 97.18, Geneva, 1997.
"Counselling
Skills Training in Adolescent Sexuality and Reproductive Health: A Facilitator's
Guide", WHO, Geneva, 1993.
"Refugee
Children: Guidelines for Protection and Care", UNHCR, Geneva, 1994.
"Technical
Report of the WHO/ UNFPA/ UNICEF Study Group on Programming for Adolescent
Health", WHO, Geneva, 1997.
"The
Impact of HIV and Sexual Health Education on the Sexual Behaviour of
Young People: A Review Update", UNAIDS, Geneva, 1998.
"Working
with Young People in Sexual Health and HIV/ AIDS: A Resource Pack",
AHRTAG, London, 1996.
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