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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.


Overcrowding in the camps, lack of playgrounds and facilities for youth, adolescents and children means that streets are the primary places for play and interaction with peer groups. However, streets are primarily dominated by boys and male youth. Therefore, one major effect of overcrowding is that female children, adolescents and youth are confined in shelters, while boys and male youth dominate the camp alleyways and streets. Both situations foster carelessness and general low morale.

Schools suffer from overcrowding in classes, small playgrounds and absence of facilities for extra-curricular activities. Physical and verbal abuse of pupils is common and is the predominant form of discipline resulting from the inability of teachers to control large numbers of students, lack of teaching skills and general frustration.

Similarly, health centers are congested, doctors see an average of a hundred patients per day and very often more than that. Many sick people remain without proper care. Women, especially burdened with domestic responsibilities towards the extended family, including the elderly and disabled, suffer from fatigue, depression and anxiety, with no specialists or counseling services to help them. Women, including those who work are socially restricted in their movements, while men enjoy more freedom of movement in public spaces.

In the private domain, shelters are overcrowded due to the large family size. Overcrowding in the shelters and the close proximity of neighbors, nullifies the possibility of any privacy or 'quiet time'. This has a ripple effect on all the members of the household, including: stress, incest, inability to study, beating of wives and children, quarreling and yelling. Quarreling with neighbors is also common, due to overcrowding.

The lack and/or ineffective community centers catering to the needs of the various segments of society, such as the elderly, the disabled, women and youth, has compounded the problem of overcrowding by limiting the spaces available, mainly to the streets or shelters.

Another effect of overcrowding and poverty is that they encourage early marriage to lighten the burden at home, which means pulling young girls out of school. In many cases, early marriages lead to early divorces. Similarly, many boys drop out of school, so that they can work to help their families financially, or because there is general neglect at home and school of their individual needs.

Dominated Spaces

Boys in the Streets and Men in the Coffee Shops
Boys: While you can see both boys and girls playing in the streets, in reality the streets are a male-dominated space. Girls may play in the street only until they are around nine years of age. For boys, streets have become the main play area for such games as soccer. Many times, such areas are where the garbage bins are collected and where children play barefoot, and this leads to health problems. Since 'space' becomes a contested area, boys often fight with one another over who has the right to play in a particular place. Parents complain that street playing pushes their children into delinquent behaviour, such as smoking and in some camps drug abuse (for example, in Shu'fat camp). After-school street gatherings means that there are no other activities in which growing boys can participate, whether they are sports, cultural or social activities, thus limiting their potential. Community responsibility is usually fostered in centers for adolescents and youth, at school and in volunteer work, but these are absent or too few to have a real effect on the majority of youth.

Girls : Girls up to eight or nine years of age may be seen playing near their shelters, but beyond that age they are confined to their homes and usually carry out domestic responsibilities around the house, especially house cleaning and caring for their younger sisters and brothers. Many girls do not leave the camp except to visit relatives who happen to live outside. One of the major complaints made by girls is that the boys are 'always in the streets' and that their parents do not 'allow them to play outside, because there are boys' and that anyway, 'boys bother them if they happen to walk in the streets'. Consequently, girls also question, "Where do we go? Where can we play?"

The Coffee House? Men's spaces
Although men have more social and economic mobility, they also suffer from overcrowding in the camps. Men's responses to overcrowding reveal that they suffer from the tension caused by the demands of family members and unemployment. Many of them noted they 'run away to the coffee shops' in the camp, though there are very few. Refugees also use the overcrowding in coffee shops as an index of unemployment. For example, the more men there are in the coffee shops, the higher the unemployment of men. The pressures and frustration men face due to poverty and in the larger society is often unleashed on women who complain that men are often aggressive, anxious and unable to cope with the demands and responsibilities of making a living. The coffee shops in refugee camps are almost entirely occupied by men, places where men exchange news and socialize with their male friends.

Where do we go? What Can We Do? Women's Voices
Women spend most of their time in the private space of the house. With the exception of those who work outside of the house for a living, generally, women leave the house only to visit neighbours and relatives. A small percentage of women are active in the public domain and these include women who work in local community organizations. According to a doctor working in a health clinic in one of the camps, it became apparent that some women make appointments to visit clinics so that they have the opportunity to leave the house, socialize and meet up with other women. Generally, women are not allowed much movement. In many cases, the permission of the husband is required. Similarly, girls are restricted from moving about freely. Older and married women have more freedom in this regard than their daughters, especially once they reach adolescence. In conditions of overcrowding, movement is never anonymous, girls and women are targets of gossip and families are protective of their daughters' reputation. Therefore, adolescent girls do not attend many programs, since parents fear such social taboos. One important effect of overcrowding is that it excludes women further from public spaces, which are primarily dominated by males.

The programs set up for women are only partially successful. In recent years women's organizations and centers began to spread in refugee camps. Of special significance are women's community-based centers. Once again, shortfalls and shrinking budgets meant that many of these centers need support and are not able to meet the needs of large populations. Many of the women activists note that they cannot reach many women who are confined at home and are restricted from leaving the homes, even to join women's centers or to take up training courses. Some women would emphasize that this is the 'way it is' and society will not allow them to break away from traditional roles. During the Intifada, the space for their political and social participation in the public arena, opened up. However, after the Intifada, women's roles were diminished and they were compelled to retreat to the private domain.

Moreover, the economic conditions in the West Bank and Gaza have forced many men to seek work in Israel and they are sometimes away from family for days. Upon their return, they encounter problems, which are related to the conflicting worlds to which they are exposed at the political, social and cultural levels while working in Israel. Women's narratives reveal that they suffer from changes in how their husbands treat them upon their return, in some cases these different experiences destabilize their relationships at home. There is no study to evaluate the number and effect of husbands leaving their families, either to work in Israel or migrate to other countries.

Women whose husbands have left the home for long periods suffer from high stress levels, due to the massive responsibilities they are left to cope with alone. Such responsibilities include taking care of many children, finding a source of livelihood, because husbands do not always send money back, and taking care of parents and sometimes in-laws. Some women interviewed for this report, noted that their husbands had remarried, had forgotten about them and it had been years since they heard news. This area needs further research, but it is evident that the combined effect of poverty, overcrowding and social restrictions on women causes depression and frustration among women.

Lack of Privacy and Noise

"Noise, Everywhere! Too close to neighbours and No Privacy!"
Due to overcrowded conditions and the closeness of shelters to one another, the noise levels are usually very high. Men, women and children complain that there is never a 'moment's peace'. If the family manages to keep the noise level down, the noise from the neighborhood is heard. This creates stress, especially for the sick, the disabled and students trying to study. Moreover, there is simply no place to be alone or to conduct a 'personal' matter without the scrutiny of many others. The lack of privacy leads to social control, enhanced by overcrowding. This affects all members of society.

The shelters are so cramped and literally stuck together, it is almost impossible not to overhear the neighbors. This creates many problems among families in the same neighborhood. Children who play in the streets get into fights and adults are dragged into the conflict. Adults explained that they had to restrict and in a few cases sever relations with the neighbours to 'protect' their daughters from the young men living next door. Conflicts sometimes erupt, because the boys next door try to harass the neighbor's daughters. Overcrowding also means that neighbors fight over simple things like trying to clean one's home. Dirty water sometimes flows into the neighbor's house and this also often leads to 'not so neighborly fights'.

Violence Against Children and Women

Beating and shouting: A prevalent practice
Beating and yelling is a common and observed form of discipline at home and in schools. It is common for parents to beat their children and husbands sometimes beat their wives. Physical abuse against women that is rarely publicized occurs. For example, a woman showed me the marks of physical abuse, but I was told not to publicize it, otherwise her husband will beat her again. In turn, women and men beat their children, a form of venting out their general frustration. For men, it is often their inability to provide their families with basic needs and their demands for certain foods, clothes, etc. For women, it is the burden of responsibilities at home and the lack of space and support.

In schools beating is quite common. Teachers using rulers to beat children is an accepted if illegal practice. There are different justifications including: " Parents want us to discipline their children this way !" " If we do not use the ruler, they do not respect us !" " We were beaten as children and look at us now, we are okay !" " Theory is one thing and practice another!" "How can we discipline children when there are over fifty students in the classrooms?" These were common remarks heard from teachers, social workers and parents in all the camps. This is certainly related if not exclusively attributed to overcrowding in the classrooms, teachers simply do not have the time or the space to apply modern methods of education. In most cases, they themselves are under tremendous stress and are underpaid.

Some children reported being injured by the beating and often they do not tell their parents, fearing that they will be beaten even more. Beating children as a result of the inability to discipline large numbers of pupils in class also leads to humiliation and fosters defeat and the lack of motivation to do better in school, contrary to what teachers claim. Many of the students who are beaten, simply do not want to go to school, some end up dropping out, despite the beatings or because of it. As observed during a field visit in refugee camps, parents actually request that their children be disciplined through beating, because 'they are not studying' at home.

The degree to which husbands beat their wives is difficult to assess as is the case with some of these socially sensitive issues. Many women refuse to talk about this, fearing the repercussions and more violence against them from husbands, fathers and brothers. However, many of women's narratives, collected for this report and in other studies, revealed that they had been victims of physical abuse and violence, ranging from a 'light' beating to physical abuse leaving scars and injuries. Field observation shows that overcrowding is certainly related to violence against women, in the sense that it creates frustration, but it is not the only factor.

In turn, both men and women beat children. Women, confined to small spaces at home, restricted from leaving their shelters also beat their children. Screaming babies, children demanding to be fed, other children fighting with one another, poverty and social pressure, often express themselves in anger vented on the less powerful in society and children are victims of such abuse.

Depression, Anxiety and Emotional Stress

Many women suffer from depression and high anxiety levels, especially women who have many children, are not working and whose husbands are absent for long periods. There are many women who have problems at home with their husbands, but do not have the social support networks to deal with these problems. Such problems include psychological and physical abuse by husbands and other members of the extended family.

As explained in an earlier section, overcrowding reflects itself in the health centers and the ratio of health staff to patients. In the area of health women are especially vulnerable, because many of the stresses they face in their daily lives turn into depression, often with physical symptoms, but there is never the time for doctors, specialists and counsellors to deal with these cases. Interviews with women and community workers indicated that many women suffer from severe depression and many are given medication to which they get addicted. Some women are not very aware of the side-effects of the pills they are prescribed.

One important reason for women's depression is the large responsibility placed upon their shoulders. It is the mothers who take care of the physical and social needs of several members of the family, which may include many children, in-laws, the elderly and if there is a disabled member, it is also the mother who feeds, cleans and conducts the daily chores. I met a few women who were divorced, or whose husbands were absent from the home for extended periods of time. These women had to ensure that there was always food on the table, that the children were clothed, etc. but they also had to take the parents or in-laws to doctors, cook and carry food to their relatives and in many cases with very little money. Thus, the constant pressure and unrelenting responsibilities with little support, except from unmarried daughters, leads to high levels of depression and anxiety.

Youth is another segment of society suffering from depression. Their role during the Intifada, during which they were rendered 'heroes' empowered them and provided them with authority in their families and communities. The imprisonment of youth was viewed as a certification of their power and the necessary sacrifice for the 'nation.' However, the individual suffering and fear of the experience of imprisonment, repression and often torture in prisons, resulted in the loss of years of education and self-development that is suppressed and neglected.

Youth are seeking their new position in the changing political and social environment. Indeed, many parents and adults express that the 'Intifada' was responsible for the 'lost youth.' Today, youth are seen to overcrowd street corners, and 'disrupt' society; they are viewed as being irresponsible and careless. The youth feel this transformation in society of their position from 'heroes' to 'hooligans' as they put it. They had lost their role and feel there is a void in their lives, with no real prospects for the future. Many were unable to pick up were they left off prior to the Intifada and turned to work in Israel, some joined the security forces in the PNA, others are unemployed and have turned to drugs and drinking. In some families, the repression in prison made the sons turn their anger and aggression against their families and community. This aggression manifests itself in beating up sisters or younger brothers, fighting in the streets and getting into trouble with others. Youth also occupy and move in overcrowded spaces, which are limited in scope and opportunities to develop.

The whole refugee community suffers from general depression in the sense that their expectations of the peace process were much higher than what has actually changed since the PNA relocated to Gaza and the West Bank. High unemployment rates, poverty and the belief that the 'outsiders from Tunis' took over political power and authority, to which they were entitled adds to a sense of disappointment and uncertainty regarding their future.

Quarrels: In Families, among Peers and Neighbors
The stress created in the family and household due to the physical presence of six, ten or twelve members (sometimes more) in a small shelter, creates conflict between parents and children, children among one another, in-laws and relatives, which manifests itself in screaming, beating and ostracizing. It is not uncommon for daughters-in-law to fight with parents-in-law and end up returning to their parent's homes for periods at a time. In the streets and schools, peers fight among one another for the same reasons. Space is very limited and many camp inhabitants attempt to create private corners to do 'one's own business' in private, whether it is playing, studying or just interacting with others.

Neighbors, as indicated earlier also have to co-exist in increasingly narrow spaces, where the walls that separate them are the only boundaries distinguishing one family from the next. In addition, the generational gap between grandparents, parents and children and the changing world views enhances such. Grandparents and parents alike are critical of children, telling them how things were and should be. This is compounded by the lack of space for the youth and children to grow and develop their own ideas. This increases the tension at home and leads to family quarrels.

Many of the quarrels among neighours are due to the need to expand the shelters. In many cases, expanding the shelter or building another room encroaches on, and is done at the expense of, the neighbor's privacy and sometimes in violation of building regulations. Consequently, conflicts emerge as to who has a just case. Is it the neighbor whose family has grown so much and needs an extra room, or, the neighbor who is affected by the new expansion in a way that obstructs the sun, proper ventilation and privacy?

Early Marriage and Divorce
According to refugees and social workers, early marriage is not decreasing. Many girls are married at fourteen and fifteen years of age. In another field study, this emerged as a source of anxiety to many girls, who sometimes do not have a choice and in poorer families are forced to leave school in order to marry. There are social and economic reasons for this practice. Socially, early marriage is an acceptable practice, inherited from the older generations, where mothers and grandmothers were also married off very young. Although the younger generation looks negatively at early marriage, economic prerogatives come into play and this practice is repeated in the younger generation. The cultural discourse encouraging early marriage is poverty. Marrying young girls early means one 'less mouth to feed' and more space at home. Adults noted that the conservative environment in camps encourages parents to marry off their children, especially daughters as soon as they can to ensure that 'she or he does not get into trouble,' or in the case of girls, that she is 'not too old' as some put it. In the case of boys in poorer families, especially those who receive assistance from UNRWA under the Special Hardship Cases program, many are encouraged to marry before they turn 18, so that the family does not lose rations and/or assistance from the Agency.

School Drop Outs
Families with six or more children of varying ages cramped in one or two rooms find it almost impossible to provide attention to all the children and follow up on each child's work at school. Some parents are themselves illiterate and hence cannot provide support at that level. For some parents, education is not an urgent priority in their world view, especially for girls, who are expected to get married. Education in their perspective may be an obstacle, rather than an asset. This problem is mirrored in schools. With overcrowded classrooms, teachers are stressed and can hardly manage to go through the required curriculum, much less to pay attention to the individual needs of their students.

Therefore, students who need special encouragement or assistance from the school system do not find such support and opt to drop out. Others simply are enticed by work opportunities while in grade eight or nine and prefer to work in Israel, the PA or other local institutions to obtain pocket money, which parents are unable to provide. Many parents complain that their sons are creating problems at home, because they want to drop out of school. Other students want to drop out without getting a skill or seeking alternative educational courses. Finally, there is simply no place to concentrate and study. The shelters are filled with noise and there is no space where students can sit and work. In cases where parents are able to maintain a 'quiet' household for children to study, the noise in the streets drowns the silence within.

In the classroom, the duration for each subject is 45 minutes and teachers are eager to cover the required material. Consequently, teachers find it hard to allow for class participation, as the time allocated is not sufficient to allow so many students' active participation or expression of ideas. Teachers have little time outside the classroom to provide counseling or individual interaction. Thus, students, especially teenagers, find that no one has the time for them either at school or at home. Therefore, overcrowding in school and home discourages students from doing well and some end up dropping out. Officially, drop out rates

Dropping out of school at grade nine is not uncommon among girls. UNRWA schools do not provide secondary education and once they graduate many girls are not encouraged to continue with secondary schools. The reason is usually that parents do not have the means to spend money on transportation and other school expenses for all children. Generally, parents would rather spend the money for school on boys than on girls. In addition, many of the parents interviewed expressed their unwillingness to allow their daughters to take public buses and go outside the camp, even for the purpose of studying fearing 'gossip' and 'slander' from the larger community. Consequently, the incidence of girls being pulled out before completing secondary levels is high and many get married even before they turn eighteen.


"No One Cares!"

The Disabled
One important effect of overcrowding is neglect, especially for the most vulnerable in society. Centers for the disabled are limited and many of the volunteers in refugee camps, mainly community members, are not trained professionally to deal with the disabled, as is the case in Shu'fat camp. The disabled, especially children, suffer from neglect because there are not enough centers and poverty hinders families from sending them to private rehabilitation centers. There are often too many children at home to leave time for adequate attention to the disabled member of the family. In addition, lack of sufficient awareness about disability in the community, reflects itself in neglect and sometimes the marginalization of the disabled. In fact, in some cases, parents do not like to publicize they have disabled children. Some of these children are taken out from the school system and stay at home with no proper care or therapy. In most cases this exacerbates their condition.

Children and adolescents
As mentioned earlier, overcrowding, poverty and large families lead to neglect. Parents do not have time to pay attention to the individual needs of children. Pressures to procure their daily bread marginalize children and often push male sons to work too early or, while still in school. Both at home and school, the problems of children and adolescents are left unattended. This is most apparent among adolescent girls who complain there is no one 'who listens or cares for them, instead everyone 'yells.'

Thus, for young girls, the space in school playgrounds are places where they socialize with their peer groups and an avenue to talk about their problems to their friends. Even then, if they stay too long after school in the playground, they are literally 'kicked out' and ordered to go home. This generates a sense of frustration, fear and anxiety, especially among girls with a difficult home life. For example, some are forced to marry early or are beaten by older brothers or parents.

The Elderly
In general, the elderly live with one of the sons, usually the eldest. In overcrowded conditions, the elderly live together with the members of the son's family, sometimes with other unmarried brothers. The responsibility for tending to the needs of the elderly falls on the shoulder of the daughter-in-law when the son is married, or with the daughters if there are no unmarried sons. However, daughters-in-law have their own family to care for and hence cannot always attend to the needs of the elderly. The situation is stressful for both generations, as daughters-in-law feel they are squeezed between the younger dependent children and the elderly people living in the house. Moreover, simple tasks such as food preparation, bathing and clothing the elderly who are sick also fall on the shoulder of the younger women. Conflicts are common between the two generations, especially in cases when the elderly feel they are being neglected or have differences in opinion regarding how children should be raised.

In other cases, the elderly live alone, either because most of their children have moved outside the camp and/or because the shelter of their son is too small, his family is too large or he does not have the financial means to accommodate his parents. In this case the parents are able to maintain their own place, but again, the main problem is neglect. Field visits indicated that the shelters of the elderly are in bad need of renovation and reconstruction and cases have been sited when the roofs simply fell in on the heads of the elderly. In the past, UNRWA was able to extend its shelter rehabilitation program beyond those enrolled in the Special Hardship Case program. The elderly are not identified as a priority segment by UNRWA as are the disabled, women and youth. Therefore, programs geared to the elderly are diminishing. In some camps, the local mosque provides two hot meals per week to the elderly who have no one to look after them.

Incest is a problem that occurs more often than is publicly acknowledged. The crowded houses where growing brothers and sisters sleep next to one another and in most cases, parents with children in the room, leads to incest. Both women and men during one-on-one interviews confirmed that the problem of incest is not uncommon, but did not wish to discuss the issue in public or in larger groups. In a few cases, these problems became public knowledge.

Incest that occurs between family members is silenced and it is almost impossible to evaluate its effect on girls especially, since they would never dare discuss it with any adults, men or women. Even community leaders suggested in some interviews that incest is an issue that should not be publicized, because it often backfires on the victims of incest, usually young girls and sometimes boys. In some cases, the victim becomes the 'sinner.'

It is apparent there is a direct relationship between incest and overcrowding. Even adults would describe how when they were younger they slept all in a row like 'sardines' sometimes ten of them. In addition, it is quite common for children to sleep in the parent's room and for babies to sleep next to the parents. Older men and women would disclose that the used to 'hear' or 'see' what 'went on between their parents.' There is a marked contradiction between public taboos on sexuality and the personal and private experiences of people in terms of what they have learned and experienced as children about sexual practices and sexuality. One young man noted 'I learned everything there is to know about it in the camp, from my parents, my brothers and sisters, when we played as boys together in the cemetery near the camp and behind trees!'

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