A Report on the Psychological Effects of Overcrowding in Refugee Camps in the West Bank and Gaza Strip
Source: Prepared for the Expert and Advisory
Services Fund - International Development Research
by Dr. Randa Farah
This work was carried out with
the aid of a grant from the Expert and Advisory
Services Fund which is administered by the International
Development Research Centre, Ottawa, Canada and
financially supported by the Canadian International
Development Agency in cooperation with the Department
of Foreign Affairs and International Trade.
III. THE CAUSES OF OVERCROWDING
While "overcrowding" is both a cause and effect, it is possible to
delineate the main direct causes of overcrowding in the West Bank
and Gaza refugee camps. The causes are very important to take into
consideration for policy-makers, donor countries and organizations
working with refugees. As budgets allocated for refugees shrink, there
is an increased need to examine these causes, in order to implement
solutions and projects with long-term impact on the refugee community.
In addition, causes and effects are linked and it is difficult sometimes
to separate one factor from another, because they are so entangled.
One of the effects of overcrowding, for example, is yelling and screaming
at children, which has a ripple effect on the ability of children
to study. However, these factors have been separated as much as possible
to highlight the main issues related to this subject.
It is important to note at the beginning of this section
that the causes and effects of overcrowding in the West Bank and Gaza
are exacerbated by restrictions on movement imposed by the Israeli
authorities. UNRWA vehicles and/or personnel, whether transporting
doctors, teachers or sanitation and disposal workers are often denied
access to refugee camps. In such cases, garbage collection is weeks
overdue, doctors cannot reach patients and students cannot attend
vocational schools (especially Gazan students who attend vocational
training classes in the West Bank).
In this report, public spaces refer to areas such as streets, schools
and other public centres such as health and community centres. In
fact, due to overcrowding, almost all spaces become 'public'. The
shelter or the 'home' is so close to the neighbors in most cases,
that 'privacy' or the 'private domain' becomes a theoretical construct.
In addition, culturally, the dichotomy between the private and public
domains are ambiguous. Issues and spaces considered 'private' in western
societies may be very public in other cultures and vice versa.
Table 5: Camp Area, Zone and Population
|Name of Camp
||Area in dunums*
||Year of Establishment
|Camp No. 1
*One dunum is equivalent to 1000 sq. meters
*Zone A refers to areas within Palestinian Authority territory, Zone
B is under joint Israeli/Palestinian control and zone C is under Israeli
Shu'fat Camp: It is estimated that over 4000 people have moved into
the camp over the past few years so that they could maintain their
residency rights in Jerusalem.
*Although close to Ramallah, Israel considers
it as part of 'Greater
Almost 600,000 refugees live in 20,678 dunums, which is the total
area for refugee camps in the West Bank and Gaza. As the population
began to encroach on every vacant area, sometimes in violation of
building regulations, 'empty' spaces, once used as playgrounds, or
gardens began to disappear, so that today there are hardly any unused
In addition to the lack of space to build upon horizontally, the
infrastructure in many camps, mainly streets and sewerage systems,
are below international standards of hygiene and environmental health.
In al-Jalazon camp, for example, sewerage networks are non-existent
and people use individual septic tanks. This has a ripple effect on
the soil, due to the chemical breakdown and experts pointed out this
may effect the shelters themselves in the future. Furthermore, the
population density places pressure on the existing water supply, electricity
and other public utilities. In most of the camps alleyways are often
flooded with dirty water, usually from broken and disintegrating sewerage
Although many of the camp alleyways and streets are paved, there
are many that still need paving and/or repair. In Jabalia camp, for
example, it is a real problem, because the main streets are not asphalted
and in the winter they turn into mud pools. More importantly, many
of the shelters are on the same level as the streets, it is therefore
not surprising that some shelters are flooded with dirty water in
the winter. This situation forces the inhabitants of the shelters
to sleep and live in a smaller corner of the house, until the water
has been drained out.
As for public services, they are not sufficient, especially garbage
disposal and it is not uncommon to see children playing around overflowing
disposal garbage bins. Although UNRWA provides regular sanitation
and disposal services, the deficit and cutbacks in its budget hinders
it from hiring more staff and employees to provide these services
to a steadily growing population. Many of these disposal bins are
placed in wider streets, at the entrances of camps or in areas making
it accessible for collection. These areas are similarly attractive
to boys who seek wider areas and spaces to play. Many of the boys
(to a lesser extent girls) are seen barefoot playing football and
other games, due to lack of other spaces.
With the increase in population, people began to build vertically,
second and third levels, usually accommodating sons and their families.
As horizontal expansion is no longer possible in the majority of camps,
the buildings are rising higher and higher. This situation means that
the sun-light never enters into many of these shelters and there is
no air ventilation, therefore shelters are very damp in the winter
and humid in the summer. In addition to the health dimension, social
problems are compounded as shelters push closer to one another and
the neighborhood becomes overcrowded with large families, almost nullifying
the concept of privacy and creating conflicts over space, children
and intrusion. Some streets have become so narrow from over-building
that it is sometimes difficult for more than one person to walk through.
Schools, Health Clinics and Community Centres
The main problem in schools is the occupancy rate per classroom.
In fact, Gaza has the highest average rate of occupancy in UNRWA's
five fields of operation. UNRWA's Commissioner General's report to
the General Assembly 30 July 1998 - 1 June 1999, notes that in Gaza
it is 50 pupils per classroom, while in PA schools it is lower although
still too high, reaching 43 on average. During the same period Gaza
Strip UNRWA schools accommodated 159,892 students in 168 schools in
the six-year elementary and three-year preparatory cycles. Many of
these are on a double-shift basis. In one year the increase was 6%
or 9,023 pupils. In 1998/1999 in the West Bank, UNRWA operated 98
schools, 36 for boys and 46 for girls at the elementary and preparatory
levels totalling 51,944 pupils. UNRWA schools in the West Bank in
camps are overcrowded compared to schools built outside the camps.
Although UNRWA has been building new schools, these have not been
sufficient to meet the requirements of new enrolment. Most of the
classrooms are cramped and students sit 'too close for comfort', usually
on very old furniture and in small classrooms.
Moreover, most of the schools have very small playgrounds, so during
the short breaks and between shifts one encounters sometimes two thousand
students, one shift leaving school and the other coming in. Also lacking
are rooms for meetings, reading, libraries and computer facilities.
This situation is de-moralizing for both teachers and students. Teachers
similarly complain about not having proper rooms to rest, prepare
or meet with other teachers and frustration levels are high.
Daycare centers and nurseries, (nurseries much less than daycare
centers) which exist in most camps, are similarly overcrowded and
the environment needs improvement in terms of ventilation, the general
physical layout, the toys and learning materials, the tools and the
level of skills of teachers. Teachers are not always trained, or insufficiently
trained in Early Childhood Education. In most refugee camps, these
centers hardly meet the needs of the population.
Health clinics and centers
Ill health, a common and pervasive effect of overcrowding, reflects
itself in the number of daily visits to UNRWA's health centers. On
average, there are 100 patients per doctor each day and in Gaza it
is 118. On some days, doctors report they have seen 150 patients.
Doctors also report that due to the large number of patients, they
almost never have the time to actually physically check the patient.
The procedure is to quickly ask the patient about the symptoms and
prescribe medicine, such as an antibiotic. The ratio of one health
clinic per 10,000 people remains far below national standards, which
are 1 per 5,000. A dentist visits camps twice or at the most three
times per week, which is never sufficient for the densely populated
camps. Refugees point out, that they have to remain in pain until
the day the dentist arrives, otherwise they have to seek private doctors
and many cannot afford to pay for private health care.
Similarly, for the disabled, the centers are insufficient. Although
there is no comprehensive national census on the incidences of disability,
smaller surveys conducted in some refugee camps indicate that people
with disabilities constitute approximately 3.5% of the population.
These incidences rose in the last two decades, particularly in Lebanon,
the West Bank and Gaza, due to armed conflict which caused a significant
increase in the number of people with disabilities. The Rehabilitation
Center for the Visually Impaired (RCVI) in Gaza has approximately
160 clients including 100 children. However, this is below what is
needed. A house- to- house survey identified no less than 1100 disabled
refugees in Jabalia camp alone. Overcrowding compounded with insufficient
rehabilitation centers, has negative effects on many people with disabilities.
Many of the children with disabilities are currently confined to their
homes, because either there are no places at rehabilitation centers
to absorb them and/or they are not integrated into the regular school
Social and Cultural Centers: Programs and Activities
Adolescents and Youth
There is usually one Youth Activity
Center in each refugee camp. However, they are not all very effective
or active and certainly they are not sufficient to accommodate the
large populations in the camps. With the exception of a few, these
centers respond to the needs of a small percentage of the youth population
and are primarily male dominated. Their activities are mostly sports,
especially football or 'soccer', which excludes young women. Although a few Youth Activity
Centers have begun to include women, these remain extremely few. Streets
are also places where youth 'hang out' a great deal and there is generally
a negative stereotype regarding the 'idle youth'. Youth are blamed
for many of the social problems, such as 'fighting, getting into trouble,
delinquency and immoral behavior'.
The reality is that a large number of youth are unemployed and out
of school and there are not many avenues to grow and develop. Even
vocational schools are sometimes difficult to access, either because
children do not meet the requirements, are too poor, or are unable
to attend these places due to Israeli-imposed travel restrictions.
In many cases, they take the buses and leave to spend time walking
around the closest urban centers, such as Ramallah or Nablus. There
are insufficient programs and centers for youth to provide sports
and social activities, but also learning facilities in computers,
arts, theatre and other opportunities.
When camps were first established, children played
in the space still available in front of their houses. Often these
spaces were gardens with trees and constituted safe places to play.
Today, gardens and spaces have disappeared, which means children do
not have playgrounds, a vital space where they develop and grow through
interacting with other children and playing safely and freely. Most
children do not enjoy the simple activity of going down a slide or
being pushed in a swing. This is particularly important since over
half the population is fourteen years and younger and the fertility
rate is one of the highest in the world as Marshy and other studies
show over five percent per year. Although organizations such as CIDA
have begun to assist in establishing such places, there is still a
high demand. These children would all ask visitors to "look around in the camp" and then ask, "where
do we play?"
Men and Women
Lack of land area to create new centers and overcrowding means that
existing social and cultural clubs are overcrowded and do not meet
the requirements of the population. Social restrictions on women and
girls have hindered their participation in the few existing clubs
and centers. Public libraries, cinemas, theatre and art centers, computer
training centers, and affordable family outing places are lacking.
Indoor sports are too few to mention or totally absent.
Women complain that men can still go to the coffee shops at any time
of the day or night. Indeed many of them go to the urban centers such
as Ramallah and might even enjoy sitting with friends in a restaurant
there, at least those with the financial means to do so. However,
women point out they have no place to go at all. UNRWA's Women's Program
Center is more active in some camps than in others, such as in Shu'fat
camp, however, the majority of women are not participants in the programs
offered. A large segment is also socially restricted from joining
many community activities, they are home-bound. In any case, women
point out that one Women's Center in refugee camps is again not sufficient
to cover the needs of the population and a variety of programs are
needed to respond to the needs and culture of the local communities.
The basic social unit of Palestinian society is the
family, hence private space here refers mainly to the shelters in
which the extended or nuclear family resides.
Shelters and the Extended Family
Overcrowding is also related
to the size of shelters housing large families. The size of an average
housing unit is 3 by 3 meters. In the West Bank and Gaza, official
figures point out that approximately 40% of households have a density
of three persons or more per room. In most shelters, there is one
room utilized more than others, at one time there might be four to
six people in the same room. While the population continues to increase,
the small shelters are no longer 'habitable',
yet poverty hinders most families from improving,
renovating, relocating or expanding their habitats. People with some
means simply push the camp boundaries by building along and near refugee
camps illegally. These were individual initiatives and meant that
the family had some means to invest in the materials needed to build
houses, if not to buy the land.
There is a large number of shelters which are in bad need of renovation.
UNRWA's Peace Implementation Program budget permitted renovation of
a few shelters belonging to refugees enrolled in the Special Hardship
Case program. However, the pre-requisites to entitle a family to the
SHC program are so restrictive that it leaves out a large number of
impoverished refugee families. UNRWA Commissioner General's report
on shelters is indicative of the situation: " It was estimated
that some 12,881 SHC families, representing 25 percent of the Agency-wide
total and comprising 50,020 persons, still lived in housing that did
not meet minimally acceptable standards for structural soundness,
hygiene, ventilation and space relative to family size ."
A visitor to refugee houses will observe that there is always a room
which needs painting, furniture, floor tiles or concrete ceilings.
Sometimes, houses have huge holes as families await better financial
conditions to install a window or door. In addition, overcrowded and
cramped neighborhoods, means that the sun cannot reach many of these
homes and the inhabitants suffer from chest problems and humidity
related illnesses, such as rheumatism and arthritis. In one case in
Gaza, a girl developed a skin disease related to the asbestos in the
roof of the shelter. Most of the inhabitants of shelters sleep on
mattresses on floors and this is particularly bad for children, when
the floors are not cemented or tiled properly. In the winter, things
get worse with water leaking into the shelters.
The cultural dimension impacts the way the daily life is practised
in the private space. In some of the shelters, there is a room where
only male visitors are allowed, which means that women and children
are confined into smaller areas. Visits to families where there was
more than one wife, showed that small shelters are further divided
into sections, so that one wife and her children sleep in one section
and the other wife and her family occupies the other. However, this
living arrangement is not prevalent and wives of the same man usually
do not stay in the same house. The living room is the main room, which
is used for several purposes; it is a living area, a place where visitors
sit, a sleeping area at night and a place where the family gathers
Although official figures suggest that the average family size is
around 4.5, field observation and the inhabitants of the camp suggest
a higher figure. Many of the families visited had ten or more members.
The difference in figures is due to the fact that registration figures
are based on the nuclear family. However, many of the newlyweds move
in with their in-laws and hence there might be more than one nuclear
family living in the same house. There are a few smaller families,
but these are single parent households, divorcees who in any case
end up living with other kin members. The family is an extended one,
where there are often three generations living in the same shelter.
In addition, newlyweds often begin their marital life by living with
the husband's family, which means that conflicts are not unusual between
the wife and the in-laws, sometimes extending to the whole family.
At the very least, each nuclear family houses other members for periods
of time and it is cyclical. When married children
acquire the means to move out, they usually do so leaving elders behind
with younger unmarried brothers and sisters. A return to the parents
home occurs in the case of divorce or economic hardship. In other
words, the unit which belonged to the parents when they first registered
remains as a form of security and final resort for members of the
family who do not have the means to become independent. In the case
of the refugee community this is a necessity.