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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 Centre (IDRC)

by Dr. Randa Farah
April 2000

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.

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.

Public Spaces
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 District Zone* Area in dunums* Year of Establishment Population upon Establishment Population in 1999
Camp No. 1 Nablus A 45 1950 ? 5,678
Shu'fat Jerusalem C 203 1965 ? 8,864
Kalandia* Jerusalem C 353 1949 3,000 7,964
Jalazone Ramallah B 253 1949 3,500 8,040
Dheisheh Bethlehem A 430 1949 ? 9,624
Jabalia Gaza A 1,435 1954 35,000 97,895

*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 control.

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 Jerusalem'.

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 spaces.

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 pipes.

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 programs.

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.

Private Spaces
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 to eat.

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.

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