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State of World Population 2010

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Chapter Six

Living without an anchor: refugees and the internally displaced

In Amman, Mazin Mohammed Riadh, who fled to Jordan from Iraq in 2007 in the midst of sectarian violence, remembers how he could not break the nervous habit of looking in the rearview mirror of his car to see if someone was following him. In the Jordanian city of Zarqa, 18-year-old Shahad cries every night because her father has been refused resettlement in the United States and she thinks she has no future as a refugee.

An Iraqi refugee student runs with Jordanian students at the Shemeisani Elementary School in Amman, Jordan.
©Getty Images/Salah Malkawi

Across town, Kadeja Jaber tells how she uses her ingenuity to keep her small home in exile happy since her family was forced to leave the Iraqi city of Najaf after her brother was killed.

More than 40 million people around the world—a number roughly equal to the population of Kenya or Spain or Poland—are uprooted from their homes and internally displaced within their own countries or living as refugees in another country. Each one of them, many of whom will never go home, are often “disoriented, traumatized, confused, fearful, disempowered, dependent, helpless,” said John Holmes, Under-Secretary-General for Humanitarian Affairs, when the United Nations launched a new report in May 2010 showing that internally displaced people outnumber refugees.

Over the last decade or two, the Office of United Nations High Commissioner for Refugees (UNHCR) has out of necessity blurred a once-clear line between the internally displaced and refugees who flee from country to country. Both populations have similar needs and similar fears when conflict forces them into flight. Iraq is a case in point. According to the UNHCR and government estimates, in mid-2010, there were 4.8 million Iraqis “of concern,” a description that means they felt that they could no longer live safely at home. Of these, more than 2.6 million were displaced within Iraq and 1.9 million had crossed borders into another country. Conversations with Iraqi families who have sought refuge in Jordan reveal that many of them have experienced both: first moving from place to place in Iraq in search of safety and then finally, and in desperation, fleeing the country entirely, sometimes with death threats hanging over them. After national elections in Iraq in 2010, a new fear has complicated the lives of Iraqi refugees who say they are concerned that with the Iraqi political climate declared to be “normal” and sectarian violence reduced (though not ended) they will be sent back by host countries in Europe and some parts of the Middle East.

Iraq, with about 29 million people, is a youthful country. The median age of its people is just over 20, with more than a third of the population falling into the 0-14 age group, and about a fifth in the 15-24 age group. So among the frightened people are solemn, wide-eyed children who barely grasp what has become of their lives. Their parents, fathers and mothers suffer anguish.

Mazin Mohammed Riadh, who says it took him six months to overcome the fear of being followed, is a 37-year-old engineer from Baghdad. He recalls how his wife and children lived in terror when the family arrived in Jordan from Iraq in the summer of 2007. Several relatives of his wife, Hirraa Abass Fadhil, who is 26, had been killed by members of a Shiite militia because of their Sunni names; one uncle targeted for death was an imam. “My son was frightened when he saw a policeman because of his experience back home, because of the sectarian nature of the police,” Riadh said. He takes the little boy into the street to shake hands and talk with Jordanian police officers to learn that they will not harm him. Riadh said that he and his wife had problems of their own to overcome before they were able to focus on their children. “We needed to settle down mentally. We needed to feel secure first. When we came to terms with things around here, then I started to teach my children to live normally.”

The couple’s two young sons, Abdullah, born in 2003, and Abdurrahman, born two years later, are now adjusting reasonably well, their parents said. The problem is Adam, the 15-year-old brother of Hirraa, one of her three siblings living with them in Jordan. Their mother died in 2000 giving birth to the youngest of the three, a sister named Nawal. Their father died a year later of heart disease. Another sister, Havaa, is 19, unsettled and unsure about her future because university education in Jordan, much of it private, is beyond the family’s financial means. Riadh said that he had promised his wife that he would always look after her sisters and brother and keep them all together as a family. That pledge has led to an unexpected setback in their lives as refugees, said Riadh, a softspoken man obviously shaken and distressed by dissension in the family over their next move.

Riadh, who has engineering skills, had been offered resettlement in the United States. Adam refused to go, and his family won’t leave without him. The situation they face—their future in the hands of a disturbed 15 year old—illustrates well, but sadly, the complications of refugee life that go on even after a return to some sense of security. Adam has never recovered from the killing of his brother, Omar, gunned down at the age of 18 in Baghdad when he entered a Shia neighborhood where someone recognized him as a resident of a Sunni section of the city known to harbor Al Qaeda terrorists. In Iraq by 2007, Hirraa said, “Corpses filled the street, both Shia and Sunni.” In Amman, the Jordanian capital, the UNHCR office had prepared for a flood of Iraqi refugees in 2003, after the American-led invasion of Iraq. But they did not come then. It was not until 2006 and after, when sectarian killings began to explode, that many Iraqis were finally forced to flee. That was the setting from which Riadh escaped.

“For Adam, things are terrible,” Riadh said, through an interpreter. “Omar was his idol, his friend, his brother. After he died, Adam used to dream about him every night. He would go out in the streets hoping to find him alive to bring him back. Omar’s death has affected the whole family, but it has affected Adam most. He was in a horrible mental state when we arrived in Jordan. He didn’t want to see anybody. He did not want to go to school. We took him for counselling. He went once or twice and then he said, ‘Am I crazy that you are taking me there?’ He did not want anybody to see him there. We are forcing him to go to school. The first year he came here he got into a fight; it was a fight between two schoolboys because he was an Iraqi.”

When the chance to move to the United States was offered, Adam was adamant that he would not go. He had heard a rumor that he would be drafted into the American army, but that was only one excuse, and the fact that there is no conscription in the United States made no difference. “He is threatening that if we try to force him to go he will leave here and go back to Baghdad, even if that means getting killed,” said Riadh. That is why, in mid-2010, the family’s future was put on hold. Riadh was determined to keep trying.

The Riadh family’s experience in Amman has been eased by the generosity of Jordanian and international non-governmental organizations and moves to open government social services, including basic education and some subsidized health care, to them. Reproductive health services, often free, are widely available for Iraqis in Jordan. In the Riadh family, Hirraa, who has been looking after her own two children and her sisters and brother during stressful times, gets regular attention from the Jordan Health Aid Society, a five-year-old non-profit, non-governmental organization that has begun to expand regionally with mobile clinics. In Amman, the medical teams make house calls, so that women do not have to go out alone in a still-strange city. The care Hirraa gets includes regular diagnostic tests and screenings.

Dr. Manal Tahtamouni, Director of the Institute for Family Health of the Noor Al Hussein Foundation in Amman, examines a patient.
©Institute for Family Health

Until he refused further treatment Adam was counselled by the Institute for Family Health of the Noor Al Hussein Foundation in Amman, which was originally established as a mother-child health centre in 1986 under the patronage of Queen Noor, the widow of King Hussein, who died in 1999. In 2002, with European Union financing and advice from UNFPA, the institute expanded into a comprehensive psychosocial counselling centre. Now 30 per cent of the institute’s clients are men, including many seeking counselling, said Manal Tahtamouni, an obstetrician-gynecologist who is the institute’s director. The institute also offers rehabilitation services and assistance for victims of torture or gender-based violence. The Iraqi clientele grew after refugees began arriving.

“At the moment we have a steering committee of Iraqi men,” Tahtamouni said. “They have taken overall management of one of our projects.” She said that Iraqis, many of whom are professionals or generally middle class, come with high expectations for themselves but little sense of community. “Individuals or families, they are mainly isolated not only from the host community but from other Iraqi families as well. We try to involve Iraqis and Jordanians in the same activities, so that they can socialize and help with integration.”

[27] Women account for half of world’s refugee population

Women and girls represented, on average, 49 per cent of “persons of concern” to the United Nations High Commissioner for Refugees (UNHCR) in 2009. They constituted 47 per cent of refugees and asylum-seekers, and half of all internally displaced persons and returnees (former refugees). Forty-one per cent of refugees and asylum-seekers were children below 18 years of age.

The lowest proportion of refugee women is to be found in Europe (44 per cent), and the highest is in the Central Africa and Great Lakes region (53 per cent). These averages, however, hide significant variations across population groups and locations. For instance, on average women represent 51 per cent of refugee returnees but only 40 per cent of asylum-seekers in locations where data is available. In Chad, for instance, refugee women represent one-third (33 per cent) of refugees in urban areas but up to 70 per cent of refugees in the Daha 1 camp.

Some 45 per cent of persons of concern to UNHCR were children under the age of 18, 11 per cent of whom were under the age of five. Half of the population was between the ages of 18 and 59 years, whereas 5 per cent were 60 years or older. Among refugees and people in refugee-like situations, children constituted 41 per cent of the population. Their proportion was significantly higher among those refugees who returned home in 2009 (54 per cent). This poses considerable challenges for reintegration programmes, in particular with respect to education in those locations where schools have been damaged or destroyed.

Source: 2009 Global Trends: Refugees, Asylum-seekers, Returnees, Internally Displaced and Stateless Persons, United Nations High Commissioner for Refugees

Zeina Jadaan, Assistant Protection Officer for the UNHCR in Jordan, says that bullying of Iraqi children in school has raised awareness among Jordanians as well as Iraqi refugees about the broad interpretation of gender-based violence and attacks based on nationality. Both physical and psychological abuse are too often silently accepted by society and victims themselves. “They do not always know that what they are doing is abuse,” she said. “Women often think that being beaten is normal.” Jadaan said that child abuse is frequently related to sexual and gender-based violence among refugees living out of their home environments and under multiple challenges. Her analysis is echoed widely—in such places as different as Bosnia and Herzegovina and Liberia, where directors of counselling centres say that domestic violence and child abuse are often linked to conflict or other societal disruptions.

Cases of both gender-based violence and child abuse brought to the attention of UNHCR are first analysed and investigated through interviews conducted in a sympathetic manner: How can we help? As in virtually any part of the world, abusers among the refugees are often family members or other people known by the victim. Some cases are eventually referred by UNHCR to the Jordanian Government’s Family Protection Department, which Jadaan described as “very efficient and helpful.” The Department is “a one-stop shop,” she said. Its services include psychosocial counselling, legal counselling, reconciliation counselling for individuals or families and health and forensic work. “And what is even more important,” Jadaan said, “is that they have the power, being a government agency, to tell the husband or whoever the perpetrator is that they have to abide by the laws, whether international conventions or national laws. They can refer cases to the courts if necessary.”

Despite the help Iraqis can find in Jordan to get them through a traumatic period,  the reality remains that for a family like Riadh’s, resettlement in a third country is often the best hope of building a better life as long as conditions remain dangerous in Iraq.  Jordan has not signed the 1951 refugee convention, and Iraqis are treated as temporary “guests,” not able to work legally in the country, though some have found jobs in the informal sector or under sponsorship programmes. “Without legal status or access to livelihoods, and facing a precarious economic situation,” UNHCR says, “an increasing number of Iraqis are finding themselves in dire circumstances.”

By some estimates, there may be as many as half a million Iraqi refugees in Jordan. But only about 30,000 have registered with UNHCR. About 12,000 of them are given financial support, according to family size and needs, ranging from just under $100 [70 Jordanian dinars] a month to as much as $400 [290 dinars] for larger families with special vulnerabilities. Most use the cash assistance for rent, food and medicine.

Iraqi sisters at their home in Amman, Jordan.
©UNHCR/P. Sands

Arafat Jamal, deputy representative in Jordan of the UNHCR, said that the Iraqi refugee population in Jordan is not in sprawling camps as outsiders might picture; Jordan was opposed to such settlements. There are no fields of tents flying the UNHCR flag. Rather the Iraqis, many of them middle class and from urban areas, moved directly into cities or large towns in Jordan and had to find places to rent. The financial assistance they receive is dispensed through ATM machines (a system now also in use among Iraqi refugees in Damascus). Meanwhile, more and more well-educated and wealthier Iraqis are moving on to third countries, leaving behind a residual population that has fewer resources and is more dependent on support from international donors and aid agencies.

Christians are among the poorest Iraqi refugees. One of the international groups working with Iraqi Christians in Jordan is Messengers of Peace, a non-governmental organization based in Spain but with operations in 40 counties. Many Christians were targeted by extremists in some parts of Iraq. Father Khlail Jaar, who represents the organization in Amman, says many of these Christians who came to Amman say they do not receive the level of support services they had expected, he wrote in a 2008 report. His assistance programme, though it aids people of all faiths, has 75 per cent Iraqi Christian clients.

Some of the poorest Iraqis in Jordan have found homes in cities and towns away from Amman because costs of living in the capital are high. In a crumbling alleyway in the city of Zarqa, about 30 kilometres north of Amman on the road towards Damascus, Hassan Alibayadh lives on the edge of subsistence with his wife, Azhar Ghani, and two teenage children, a daughter, Shahad, 18, and a son, Ahmad, 17. Their front room is barely large enough for a small sofa, a few chairs and an old refrigerator; their clothing is on hangers in a stairwell. Alibayadh is a visibly troubled man who had just learned that his application for asylum in the United States had been rejected, even though he had been told earlier that he met the criteria for resettlement. He wonders: Was it because he is a Shia and thought to be safe in Iraq with its Shia-led government, even under a death threat? Was it because he had once served in the Iraqi army, though long years ago? Was it because he was brain-damaged by an explosion while in military service, or because he suffers from epilepsy? He doesn’t know, and he refuses to go back to UNHCR and ask for a review.

“I was so depressed by the refusal I couldn’t even watch television,” he said. “My world blacked out.” Now confined to his shabby home, the third they have lived in and fallen behind in paying rent on, he is accused by his son of ruining their life. His daughter, he says, cries every night. His wife is holding the family together. “My wife is very resourceful,” he said. “One month she pays the rent, the next she pays the shopkeeper. She keeps the ball rolling.” His current landlord was not threatening to evict them as others had done for late payment of rent, set at about $84 a month for a few small rooms.

In a more cheerful house in Zarqa, in a neighborhood where low-income Iraqis have formed a sense of community, 22-year-old Kadeja Jaber is also keeping her family afloat. A mother of a two-month-old baby and a boy of four, she has covered the dull gray walls of their small house with gift-wrapping paper to brighten the atmosphere. She received a grant from the Jordanian Red Crescent to buy mattresses and cloth to cover them to make a comfortable sofa. She took courses in embroidery, doll-making and sewing various items for sale such as tote bags and hanging cloths with pockets for storing household items. She enrolled in a four-day home-production course run by a non-governmental organization under Jordanian royal patronage and was given 100 Jordanian dinars (about $140) when the course ended as a challenge to “invest” it in something she could sell for profit. She bought ingredients and made sweet biscuits and other food for sale, and came out with money to spare.

The family, Shiites from the city of Najaf, where her brother was killed, has secured regular stipends from various sources that, along with income from occasional work her husband, an automobile refinisher, can find, give them a total income of about $400 a month. Jaber, who is illiterate, says that she is taking birth-control pills because they cannot afford to have more children.

[28] Maternal health elusive to many migrant women

Migrant-hosting communities the world over need to provide accessible, acceptable and affordable maternal and child health services for all migrants, irrespective of their legal status, in order to lessen the vulnerability of women to migration, says the International Organization for Migration (IOM).

“Women and girls, especially when forced to migrate or when in an irregular situation, are disproportionately affected by the risks of migration because of their vulnerability to exploitation and violence,” says IOM Deputy Director General Ndioro Ndiaye. “This vulnerability is being exacerbated to unacceptable levels by the lack of access to appropriate maternal and child health services in particular, which can have a long-term public and social cost.”

A lack of access to maternal and child health services, often thought of as preventative care, can and does lead to life-threatening situations with tragic results because problems have not been spotted in good time or because the right skills and treatment are unavailable.

Babies and children of women who have not had antenatal care can be more susceptible to problems such as premature births and growth and development issues. A lack of access to maternal and child health services can also perpetuate poor health among migrant communities, which in the long run puts a greater strain on health systems in host societies.

Not following an immunization programme can not only impact outbreaks of communicable diseases, but can also affect a child’s access to school. Those at most risk across the globe are irregular migrant women and those forced to migrate, such as the internally displaced or asylum-seekers.

Recent studies in some European countries have shown that a lack of legal status, while increasing irregular migrant women's risk to violence and sexual assault, also reduces their access to prenatal care. This is particularly worrying given that irregular migrant women are more likely to experience unwanted pregnancies than other women due to a lack of access to family planning services and education as well as the result of sexual violence.

“The fear of deportation is a major barrier for many irregular migrants seeking care since the priority is to stay hidden in society. The best they can hope for in destination countries is emergency care, and maternal and child health doesn’t fall into this bracket until it is too late,” Ndiaye adds.

In East Africa, IOM health staff cite the lack of such migrant-friendly services promoting reproductive and maternal and child health, including pre and post-natal care, assisted delivery and child survival programmes, as the most pressing issue facing migrant women. Such problems are evident in destination regions such as Europe too. For displaced women, distance to health facilities is the main stumbling block to reproductive and maternal health services, especially in rural areas.

Among the solutions is establishing and developing existing midwifery and community health skills among migrant communities. This would help spot problems and potential problems in advance and build knowledge about when a patient needs to be referred. In Iraq and Afghanistan, for example, some of IOM’s responses have included the training of displaced women as traditional birth attendants who can provide these vital midwifery skills. These kinds of programmes can also be taken into migrant communities in destination countries. A major advantage of doing so would be that these migrant community health workers would understand the social and cultural factors that hinder accessibility to and acceptability of existing health services.

Source: Gender and Migration News, May 2009, International Organization for Migration

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