CHAPTER 4
Chapter 1 By Force, Not by Choice:
Refugee Women and Asylum-Seekers

Expanded Protections and Recognition

Violence Against Women and Girls

Reproductive Health, Including HIV Prevention

Repatriation, Integration and Resettlement

With a faint voice and half-closed eyes, Hajja tells her story: Five months ago, when she was four months pregnant, she fled her village to seek refuge from a conflict that is still tearing apart the lives of countless people living in Darfur, Sudan. She, her husband and their seven children made the 55 kilometre trek under the scorching desert sun before reaching Kalma camp—a safe haven that huddles along the train tracks near the Chad/Sudan border. They left behind their home, their friends and a life to which they may never be able to return.

Home to over 100,000 internally displaced persons (IDPs), Kalma is the largest camp operating in Darfur. Many of its residents will eventually seek safety in other countries on other continents. But on 10 May, 2005, Hajji gave birth to a beautiful and healthy baby at an UNFPA-supported women's clinic run by the Médecins du Monde. Her name is "Hope" and it is a moniker that serves as both an invocation for the future and testimony to all that her family has lost. Hope is also what enables millions of women, men and children to flee conflict, persecution and human rights abuses—despite hardship, uncertainty, fear and violence. But it is force, not choice, that compels so many to abandon their families, homes, communities and the very countries in which they were born.

Although forced displacement entails risks for everyone who attempts it, women and girls face particular challenges—during flight, through temporary refuge and in final settlement. In 2005, there were approximately 12.7 million refugees in the world, roughly half of them women, and 773,500 individuals seeking asylum globally.(1) As well as risks and hazards, however, flight offers refugees an opportunity to escape exploitation, discrimination and persecution. The breakdown of society can also afford an opportunity to rebuild anew on a foundation of equality and respect for human rights. Following the end of hostilities, women refugees play a critical role in building a lasting peace and restoring social and economic order.(2) For many refugee women, reconstruction can offer an escape from discrimination and the opportunity to exercise new-found autonomy. For many, however, it does not.

Women and girls face many dangers and obstacles throughout the entire refugee experience. When schools and medical facilities close, jobs are lost and armed groups seize control, it is largely women and girls who assume care for children, the infirm and the elderly. Many must contend with unwanted and forced pregnancies and have special needs relating to sexual and reproductive health issues. They also often bear a disproportionate share of responsibilities and burdens. Certain groups of women—such as those who head households, ex-combatants, the elderly, the disabled, widows, young mothers and unaccompanied adolescent girls—are more vulnerable and require special protection and support. Although women make up a higher proportion of elderly refugees, their particular needs are often neglected.(3) Many are also widowed and care for orphaned or separated children.




14

GROUNDS FOR ASYLUM: RECOGNIZING GENDER-BASED PERSECUTION

Today, too many women still face considerable obstacles in their attempts to present claims of persecution—a major reason why, unlike refugees, they are usually underrepresented among asylum-seekers. For historical reasons, and because exclusively male delegations did not consider that persecution could be based on gender, the 1951 Refugee Convention and its 1967 Protocol did not specifically recognize it as a valid reason to claim refugee status.(1)

In 2002, UNHCR released a set of international guidelines affirming that the international definition of refugees "covers gender-related claims". (2) These include forms of persecution that are particular to women, or that primarily affect women, or occur because they are women—such as severe forms of gender discrimination (i.e., Afghan women under the Taliban).(3) Gender-related asylum claims can include sexual violence, domestic violence, trafficking, coerced family planning, forced abortion, female genital mutilation/cutting (FGM/C) honour killings, forced marriage, punishment for going against social mores and discrimination against same-sex partners.(4) In all cases, individuals seeking gender-related asylum need to satisfy the eligibility criteria for refugee status as defined by the Convention.

Despite these and other developments, officials tend to favour a narrow definition of what constitutes a refugee. This means they are sometimes reluctant to recognize gender-related persecution as grounds for asylum—especially that perpetrated by private citizens and where the state is unable to provide protection.(5) Some argue that violence against women is of too personal a nature to amount to persecution; others fear that all applicants seeking asylum on the basis of discrimination or assault would have to be approved if women were considered a "particular social group". Experience in Canada and the US, however, has proven that this is not the case.(6)

In 1993, Canada was the first country in the world to adopt guidelines that define women as a "particular social group" as put forth by the 1951 Convention. This laid the foundation for gender guidelines in other countries, including Australia, South Africa, the UK and the US.(7) In 1995, the United States Government granted asylum to a woman fleeing FGM/C. It was an important precedent, and the Government subsequently granted asylum on the basis of honour killings and forced marriage.

In 2004, the European Council adopted a directive that, among other issues, recognized child- and gender-specific forms of persecution, including sexual violence. This statute, applicable to nearly all EU Member States, calls for countries to comply by passing and enforcing domestic legislation by October 2006.(8) Although the EU's goal is to establish a common asylum system for all members by 2010, each country currently maintains its own policies. For example, 17 of 41 European countries surveyed during a 2004 UNHCR study recognize sexual violence explicitly as a form of persecution, but the rest had not. Just over half acknowledge that discrimination can constitute a form of persecution while three quarters do not recognize sexual exploitation or forced prostitution in their asylum procedures. Two thirds, however, recognize non-state agents of persecution.(9)

The UK stands out as one of the most progressive European countries when it comes to policies that protect female asylum-seekers. In addition to the 2004 release of Gender Issues in the Asylum Claim, case law recognizes the role of non-state armed groups in fomenting sexual violence.(10) However, even in countries with more progressive policies, application can be inconsistent.(11) The consolidation of EU asylum policies offers an opportunity to strengthen and standardize guidelines for female asylum-seekers.

Nonetheless, men are more likely to apply and be granted asylum than women. In 2000, women accounted for only 33 per cent of asylum applications in Canada, (12) and in 2002, roughly one third in Europe. (13) This is because women are usually not the primary applicants (male relatives are); gendered reasons may make case presentation more difficult (i.e., shame regarding painful experiences of rape or torture, and embarrassment over relaying personal information to male interviewers). Other issues include the fact that women are more likely to be interviewed alongside spouses or other intimate partners when they are not the primary applicant—even when they have borne the brunt of persecution. This is sometimes compounded by interviewer ignorance of how cultural differences regarding female demeanor can influence the interview outcome (for example, reluctance to establish eye contact). (14)

In addition, some national asylum guidelines are more likely to recognize those persecuted by the state (more often men) than victims of non-state persecution (more often women, who are more likely to be threatened by members of their family or community—such as in cases of "honour killings", FGM/C or violent spouses).(15) Even when women are politically active, their involvement is usually "low-level" and not as high profile as men's. Much of it is undertaken from the home, which means evidence for the claim can be harder to gather. Thus, female asylum-seekers may challenge conventional notions of politically based persecution, and are therefore more likely to face barriers when filing a claim.(16)

Failure to recognize gender-related claims—beyond perpetuating uncertainty and fear of being deported back to a threatening situation—has also been linked to irregular migration and higher risks of exploitation. Some women with legitimate claims may opt out of the process altogether and become undocumented migrants instead. And since many countries bar asylum-seekers from legally working, this means many women are forced to take whatever jobs are available—even though this might increase the risk of being exploited and/or trafficked. (17)

Though policies and practices remain inconsistent and vary from country to country, some good practices have emerged for others to draw from. These include gender-sensitive and cross-cultural training that targets officials and includes informing female asylum-seekers of their rights—such as the right to be interviewed separately and confidentially and to register claims independently. UNHCR recommends that a same-sex interviewer be assigned to speak to women apart from other family members in order to allow greater privacy and freedom of expression.(18)


Expanded Protections and Recognition

After many years of ignoring the differing needs, roles and experiences of women and men, the international community is making important strides towards protecting refugee women and girls and advancing their rights.

The 1951 UN Convention Relating to the Status of Refugees and its 1967 Protocol defines refugees as those who are outside their country of nationality "owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion".(4) Under international humanitarian law, governments are bound to protect refugees from violence and to safeguard their rights, including rights to education, work, freedom of movement and of religion.(5) They are also bound by the principle of non-refoulement—whereby refugees cannot be forced to return to their country of origin if they have a reasonable fear that doing so will endanger their lives.

Today, various international agreements focus on empowering and protecting women. In 1991, the United Nations High Commissioner for Refugees (UNHCR) issued Guidelines on the Protection of Refugee Women. These were established to better address the needs of refugee women and enhance their involvement in decision-making. Guidelines on sexual and gender-based violence issued in 2003 provide additional measures to ensure protection and support survivors. (6) Humanitarian relief agencies have made considerable progress by making reproductive health services more widely available, address¬ing gender-based violence, increasing the enrolment of girls in schools and involving women refugees in camp management. (7)

In recent years, the international community has also undertaken important initiatives designed to protect women from rape during and after conflict, and bring perpetrators to justice.(8) Among the most significant, is the Rome Statute of the International Criminal Court (ICC), which defines sexual violence as a war crime—a precedent established by international criminal tribunals in Rwanda and the former Yugoslavia. (9) UN Security Council resolutions passed between 1999 and 2003 to protect children during armed conflict also note the needs and vulnerabilities of girls and condemn sexual violence during peacekeeping operations.(10)

Throughout the UN conferences of the 1990s, governments agreed to provide special protection and meet the needs of refugee women. These agreements include the 1994 International Programme of Action on Population and Development and the 1995 Beijing Declaration and Platform for Action. In 2000, the UN Security Council passed Resolution 1325, a landmark decision mandating the participation of women in the peace process and calling for protection and support for women living amid armed conflict.(11) The 2005 World Summit Outcome Document, adopted by heads of state and governments, reiterated the importance of implementing UN Security Council Resolution 1325.(12)

LIFE IN THE CAMPS

Refugees often wind up living in a variety of temporary arrangements. In some cases, they stay with host families or settle in urban areas. For most, however, life continues on in camps. While some provide refuge for a few thousand, others hold far more. (In 2003, Afghans living in Pakistani camps numbered over one million.(13)) And while some refugees remain for only a few months, protracted instability in the country of origin means that this is the exception. As of 2003, the average duration of years spent in a refugee camp was 17 years.(14) A number of Palestinian camps were established as early as 1948 and 1967.(15)

Many refugees arrive at their destinations exhausted, ill and traumatized. Before their arrival, they have often witnessed, if not experienced directly, extreme violence. Even while in the camp, refugees may get caught in fighting between factions, clans or nationalities, and be vulnerable to cross-border attacks. Ethnic or religious differences with the host community can fuel resentment.

Especially at the outset of an emergency, shelter, water, food, medicine and health services may be insufficient for the number of people seeking refuge. Education for children is a major concern: Only 3 per cent of the estimated 1.5 million refugee adolescents in developing countries between the ages of 12 and 17 were attending secondary school based on year 2000 estimates.(16) Girls face particular barriers. This is because women and girls usually spend more time doing domestic work, such as gathering food, fuel and water, instead of going to school or earning an income.(17) In response, more and more educational programmes are specifically targeting girls to ensure they complete their education. For young mothers this can be particularly tough. In 2003 and 2004, UNHCR and the US Embassy paid the tuition fees of young Angolan refugee mothers in the Meheba camp in Zambia. The girls were also offered childcare and the support of older women mentors.(18)

Among some refugee groups, traditional cultural norms can become more entrenched as a result of displacement. This can lead to even more limitations on female autonomy. Afghan refugees in Pakistan, for example, adopted a more extreme form of purdah (the separation of men and women) during displacement that the Taliban then strictly enforced when they returned to Afghanistan.(19) Nevertheless, the active participation of communities and women themselves can help overcome discriminatory attitudes. Particularly vital is to ensure that women, especially heads of households, have access to educational and livelihood opportunities. In Pakistan, Save the Children offers a health and literacy programme for Afghan refugee women living in remote provinces. The German Development Organization (GTZ) has offered literacy courses for the past 18 years in many of the 250 refugee camps it has supported.(20) In Liberia, in 2002, UNHCR provided literacy training for a group of women who would then go on to teach other women. The organization also supported livelihood programmes: In one project, 80 per cent of the 339 refugees receiving skills and income-generating training were women and adolescent girls.(21)

In Ghana's Buduburam camp, Unite for Sight established a unique programme that provides economic alternatives for female Liberian refugees so destitute that they were often forced to trade sex for food.(22) There, female heads of household produce hand-made eyeglass cases for sale on the world market. All proceeds go to fund an eye care clinic for the camp's refugees.(23) Another UNHCR programme provides a small monthly stipend and medical care to registered Congolese refugees living in Kampala, Uganda. These programmes also help send displaced children to school. Most urban refugees in Kampala are widows with three or more children.(24)



Violence Against Women and Girls

Violence is a reality of camp life. Women and girls are at particular risk when they go outside the camp perimeters to collect firewood, water and other scarce resources. Between 1996 and 1997, in the Dadaab camps in northeast Kenya, approximately 90 per cent of reported rapes occurred while Somali women were out gathering firewood or tending livestock.(25) In the late 1990s, Ethiopian women reported being fearful of collecting firewood owing to local hostility fuelled by competition for scarce resources.(26) In 2001, women living in Zambian camps revealed that it was not uncommon to trade sex for fish—a sought-after staple food.(27) Poorly designed settlements can add to the risk. In some cases, latrines and showers are built along the edge of the camps. Women and girls will often avoid them altogether for fear of rape.

High unemployment, stress and frustration among male refugees can also lead to increased domestic violence. In 2001, in six camps in Guinea, five times the number of domestic violence cases were reported as compared to rape cases.(28) Furthermore, some men may feel resentful over being excluded from projects that focus primarily on women and young people. (29)

Adolescent girls and young women are at particular risk. Armed groups often prowl the camps in search of children to abduct and recruit as combatants and, if girls, as sexual slaves, cooks and cleaners. Near northern Uganda, aid workers report that girls are ingratiating themselves with camp middlemen in order to avoid being passed on to armed groups.(30) In eastern Chad, Sudanese girls charge that locals attack and rape them whenever they try to gather firewood.(31) Community members, families and peers can also pose a threat. Relatives sometimes force girls into early marriage in exchange for money or as a means of securing their own physical safety.(32)

Even protectors have been exposed as abusers. In 2002, the international community learned that young women were being exploited in West Africa's refugee camps. What was really shocking was that it was at the hands of UN and NGO relief staff, as well as international peacekeepers—the very individuals tasked to protect them. Investigators found that staff were bartering humanitarian supplies and services—such as wheat, plastic sheeting, medicine, ration cards and education courses—in exchange for sex, most often with girls between the ages of 13 and 18.(33) Victims included separated children, child heads of household and children in foster care or those living with relatives. Nearly all were young women and girls, and while experts believe young boys were also victimized, tremendous stigma prevented any discussion of the matter. (34) This prompted the UN General Assembly in 2003 to adopt a resolution calling for an investigation.(35) The UN Secretary-General followed up with a bulletin issued that same year urging the international community to step up measures aimed at preventing sexual exploitation and abuse and requiring UN staff and non-UN collaborating entities to comply with international humanitarian law.(36) It also called on UN staff to report any concern or suspicion of sexual exploitation or abuse. The Secretary-General's policy of zero tolerance has reinvigorated efforts and led to the establishment of peacekeeping conduct and discipline units. Investigations of personnel have also resulted in a number of dismissals. By early 2006, between 70 and 90 per cent of civilian police and military personnel also received training on the topic.(37)

Survivors of gender-based violence may face long-term injury, unwanted pregnancies, sexual dysfunction, post-traumatic stress disorders and STIs, including HIV/AIDS. In Sierra Leone, it is estimated that 70 to 90 per cent of survivors raped during the 1991 to 2002 war contracted STIs, including HIV/AIDS.(38) In March 2006, UNHCR reported that fully two thirds of the Sudanese women refugees who were being treated in the Abeche Regional Hospital in Chad had been raped. The youngest victim was only ten years old.(39) UNFPA and UNHCR are supporting the hospital to treat women suffering from fistula, which is caused by obstructed labour or extreme sexual violence. Because women are too ashamed to report rape and seek assistance, UNHCR has been working to establish a referral system that coordinates medical and legal assistance. (40) Personnel with the International Medical Corps are also consulting with older women and traditional leaders to discuss post-rape trauma followed by culturally sensitive counselling sessions targeting the entire family.(41) Building on a pilot project for rape survivors in the United Republic of Tanzania, UNFPA and UNHCR trained camp health-care providers in Kenya and Uganda in 2005 on clinical management and post-exposure prophylaxis (to diminish the risks of HIV infection).(42)

With support from the Reproductive Health in Conflict Response Consortium, refugee women living in Thailand have developed a guide to assist survivors of gender-based violence. The guide sets standards of care, including those related to health care, counselling, advocacy and case management. (43) In Sierra Leone’s Kono district, where refugees have begun to return home, UNHCR and the International Rescue Committee (IRC) have helped establish women-led community centres that, among other things, offer tips on how to avoid and respond to gender-based violence. Women, men and youth have come together to establish action groups designed to raise awareness and provide an opportunity to discuss related issues. The initiative is part of a larger community empowerment initiative led by the Government, UNHCR and other implementing partners.(44)

In Burundi, UNHCR provides firewood and has installed mills within the camps. Camp security forces now include women.(45) In addition, over 70 older refugee women were appointed to serve as mères volontaires (volunteer mothers) to identify, assist and care for young rape victims. They have, in turn, recruited older men to act as pères volontaires, because men can play a key role when it comes to preventing sexual violence. (46) Elders are also active in Kenya, where they were organized into anti-rape committees in order to discourage attacks on Somali women and girls. Elders embarked on several practical measures—including planting special thorn bushes around the camps in a bid to discourage would-be human predators.(47)




15

RE-VICTIMIZING WOMEN AND CHILDREN: TRAFFICKING IN REFUGEES

Refugee and displaced women and children are especially vulnerable to trafficking. During the 1990s Tajikistan conflict and its aftermath, displaced women and children were trafficked for sexual exploitation in countries of Eastern and Western Europe and the Persian Gulf.(1)

In Southern Africa, refugees are both the traffickers and the trafficked. The IOM reports that male refugees often recruit their own relatives from their country of origin. In many cases, women and children are forced into sex work with all profits going to family members. Some traffickers assist their victims to apply for refugee status in order to prevent deportation and, thus, protect their "investment".(2)

Strict or inadequate asylum policies can make refugees even more vulnerable. In Thailand, displaced Burmese asylum seekers denied refugee status are often forced "underground", where they are more likely to be trafficked and enslaved. (3)


Women are also playing an important security role elsewhere. For example, UNHCR has trained 90 Ugandan police officers, including 25 women, to work with Congolese refugees. Police officers took turns playing survivors reporting rape. The aim was to improve interview skills, learn how to collect forensic evidence, acquire information on referral services and learn about Uganda's laws involving gender-based violence.(48)



Reproductive Health, Including HIV Prevention

Recent reports by researchers and humanitarian relief organizations indicate that women living in camps may actually benefit from better access to reproductive health services, including family planning, than women in the host country or in their country of origin.(49) Refugee populations often have a lower incidence of pregnancy-related problems than women living in the host community and origin countries. This is largely owing to improved access to health care in camp settings.(50) A 2004 global evaluation of 8.5 million displaced people found that almost all camps offered at least one family planning method, including oral contraceptives (96 per cent) and condoms (95 per cent). In addition, HIV prevention education was offered in 89 per cent of the sites, and diagnosis and treatment of STIs was available in 84 per cent of the sites.(51) Similarly, efforts to raise awareness of HIV/AIDS and other STIs are making an impact in some areas. In Kenya, refugees actually knew significantly more about preventing HIV than counterparts in their host community or their compatriots in southern Sudan: 72 per cent of the camp refugees knew about the three main methods of HIV prevention, compared to only 32 per cent of the local population.(52)



Displacement can undermine reproductive health and rights—a serious issue given the fact that an estimated 25 per cent of refugee women of reproductive age will be pregnant at any one time.



However, despite progress, displacement can, and still does, undermine reproductive health and rights—fundamental needs already in jeopardy in many situations. This is a serious issue owing to the fact that an estimated 25 per cent of refugee women of reproductive age will be pregnant at any one time.(53) Without access to reproductive health services, pregnancy and delivery-related complications can lead to maternal and infant mortality, low birth weight and other negative outcomes. Unprotected sex and teenage pregnancies are also common in refugee camps. Adolescents face particularly high risks of death during childbirth: In war-torn Southern Sudan, girls were found to be more likely to die in pregnancy and childbirth than finish primary school.(54)

Flight and displacement can lead to higher STI rates and HIV prevalence. Sex work, sexual exploitation and trafficking can increase transmission rates. This is perhaps best exemplified by the ongoing war in the Democratic Republic of the Congo (DRC). Before hostilities erupted in 1997, 5 per cent of the population was HIV positive. In 2002, that number had climbed to 20 per cent in the eastern parts of the country where conflict was most intense.(55) In other cases, prolonged crises may serve to temporarily slow the spread of HIV by isolating populations and disrupting transportation routes and rural-to-urban migration. This was the case of conflicts lasting many years in Angola, Sierra Leona and Southern Sudan, where HIV prevalence rates were found to be lower than those in neighbouring countries.(56) Once stability is restored, however, and people are again able to move freely, countries risk a post-conflict surge in HIV prevalence if prevention programmes are not forthcoming.

The international community is continuing to step up efforts. Today, many refugees are increasingly benefiting from reproductive health programmes. In 2005, UNFPA provided support in Benin and Ghana for refugees fleeing unrest in Togo—including supplementary food and immunization services to pregnant women and children, maternity health kits, male and female condoms, treatment for sexually transmitted infections, insect-treated mosquito nets and soap. (57) In the Sherkole camp for Sudanese refugees in Ethiopia, UNFPA supports the IRC in mobilizing elders, women's groups and other community leaders to raise awareness of family planning, maternal and child health and formulate strategies to change harmful practices. (58) In the Islamic Republic of Iran, UNICEF and WHO have supported the Assisting Marsh Arabs and Refugees (AMAR) International Charitable Foundation to train more than 100 female health volunteers to reach out to Iraqis living in refugee camps, as well as Afghan refugees in urban areas. The aim is to provide information on maternal health care, immunization and family planning.(59)

In Yemen, Marie Stopes International (MSI) has run reproductive health centres for Somali refugees and the local population since 1998. UNFPA and UNHCR-supported health education sessions have reached thousands of refugees.(60) Similarly, in the Yarenja camp for Sudanese refugees in Ethiopia, IRC and UNFPA-supported Anti-HIV/AIDS and Reproductive Health Clubs report at least 55 per cent of refugees aged 14 to 45 now know how to prevent STIs, including HIV. Girls clubs were particularly effective.(61)



Repatriation, Integration and Resettlement

Refugees usually have three "durable solutions" available to them: voluntary repatriation to their country of origin; local integration in the country of asylum; or resettling in a third country. (62) As mentioned before, however, many refugees end up living in camps for many years, with limited prospects of securing any of the aforementioned solutions.

International organizations, notably UNHCR and IOM, coordinate repatriation and offer medical services. They also accompany the most vulnerable refugees. Host governments often favour repatriation and overlook the possibility of local integration owing to restrictions on the numbers of refugees—even though it offers a practical short- and long-term solution. This is especially the case where prolonged instability in countries of origin make it impossible to return.(63) Papua New Guinea—along with Belize, Mexico and Uganda—are among the few exceptions.(64) In 2005, Papua New Guinea granted 184 refugees from Indonesia residency permits only one year after their arrival. Furthermore, the Government made permits available to both men and women in an explicit recognition of equal rights and its commitment to gender equality.(65)

While for many years only a few countries offered refugees the option of resettling to a third country, more are now providing this alternative.(66) Today, UNHCR is attempting to prioritize female-headed households and victims of gender-based violence. (67) In 2004, the Guinea office of UNHCR made a special attempt to include more women when it submitted 2,500 names to the US Refugee Program.(68) Brazil has also started welcoming more female-headed families. Upon arrival, they are offered language courses, job training, employment assistance, microcredit, and childcare.(69)

Facilitating the social, cultural and economic integration of refugee women, however, can be challenging. Many female refugees are weighted down with domestic duties and childcare. Male family members may object when women work outside the home. Isolation and lack of familiarity with the host society can lead to depression. To address this need, the Canadian Council for Refugees holds weekly group meetings for women refugees and provides childcare during the sessions. Organizers encourage women to lean on each other for mutual support and become more independent.(70)

Immigrant-to-immigrant programmes can be especially helpful for new arrivals. In Australia, women immigrants from the Cook Islands are reaching out to newly arrived refugees from the Horn of Africa.(71) Elsewhere, various efforts are now under way to expand access to health care and to overcome the sociocultural and linguistic barriers that can keep many from seeking services. In Canada, where efforts are ongoing to integrate refugees into the existing health-care system, more experienced former refugee women are assisting newcomers to access health, social and education assistance.(72) In Austria, the Omega Health Care Center provides psychological and social counselling, as well as medical care, to refugees and other victims of torture, with attention to gender issues.(73) In the US, the non-profit organization RAINBO works with refugee communities to raise awareness of sexual and reproductive health concerns, with an emphasis on female genital mutilation/cutting (FGM/C). It also works with health providers to improve quality of care for women who have undergone the practice.(74)

Despite progress, challenges remain, much as they do for migrant women generally. This reflects the situation in many host countries—mixed progress, and significant gaps between policy and implementation.