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.
V. PRIORITIES AND RECOMMENDATIONS
The most urgent priorities in refugee
- Renovation and expansion of
shelters. Improvement of the infrastructure,
especially the asphalting of streets and
the drainage systems and networks.
- Renovations of schools by adding
classrooms to absorb the increasing number
of students. If possible, support the building
of new schools. Improve facilities within schools,
such as introducing computer labs and libraries.
- Increase the number of health
centers and health staff.
- Establish programs for children,
adolescents and youth, women, the elderly
and the disabled taking into consideration
the local culture. Thus separate centers for
females are encouraged.
- Introduce programs for the community
in gender issues to help raise the awareness
of the community. These again have to be implemented
sensitively, as many fear that such programs
aim at 'westernizing' the local community. Programs
such as 'Family Health' could include lectures
on violence, abuse and incest.
Most importantly, it is important
to activate the community-based organizations.
However, initial material, financial and logistical
support is needed, especially at a time when
there are severe cutbacks in UNRWA affecting
the refugee community as a whole. Short-term
investment in the activation and support of the
community to alleviate problems associated with
overcrowding, will in the long run assist them
to become self-supporting and autonomous.
Training in human-resource planning
and managing local organizations is important.
It is therefore recommended that community leadership
be fostered, especially from among the youth,
providing them with training in managing, planning
and implementing programs. Most importantly,
it is necessary to provide training in community
mobilization and encourage volunteer activities.
Most of the refugee camps in the
West Bank and Gaza have universal needs that
will mitigate the effects of overcrowding. However,
there are also specific needs which must be taken
into consideration when implementing projects.
These specific projects may be based on the following
list of recommendation and priorities which are
the sum total of the major and most urgent problems
resulting from overcrowding.
A. Places and Spaces
1. Improved infrastructure diminishes the effects of overcrowding
The social and psychological effects
of overcrowding is exacerbated by the low standards
of the infrastructure in camps. In addition to
the pressures brought about by spatial density
in the camp and overcrowding within shelters,
the environmental factor is depressing and demoralizing.
In most camps the smell of dirty water leaking
from open drainage and sewer pipes permeates
the air and is compounded by the smell of uncollected
garbage bins. In some camps sewer drainage systems
or networks have not been extended. In many alleyways
in refugee camps, it is difficult to walk through,
without having to step into the dirty water or
a hole. This environment is the larger "playground" for
refugees and especially children who spend most
of their childhood in the streets, usually for
lack of proper playgrounds and centers. Consequently,
it is not surprising that refugees point out
that this is an urgent need for improvements
in the overall infrastructure of the camps. Such
improvements, should include the asphalting of
streets, which turn into mud pools in the winter,
as is the case in Jabalia camp.
2. Shabby and Narrow Shelters
need Renovation and Expansion
An urgent priority that cuts across
all camps is shelter renovation, reconstruction
and expansion of housing units. By November last
year, UNRWA's Self-Help approach to shelter rehabilitation
was responsible for the rehabilitation of 60%
of shelters for those enrolled in the Special
Hardship program. If one considers that the SHC
covers approximately 6% of the total refugee
population, it becomes clear that the number
of people who were able to get help is minimal
relative to the needs. In addition, the regulations
surrounding who is eligible for the SHC program
is extremely stringent, leaving out many needy
families who are unable to afford the rehabilitation
of shelters. Nevertheless, the example of UNRWA's
approach is a good one to emulate. The Self-Help
project provides a participatory role to refugees,
involving them in decisions regarding the design,
leaving the responsibility of the actual reconstruction
or renovation to them, and providing three installments,
while following up on the various stages in the
Table 6: Registered Refugees
Recorded as Special Hardship Cases in the WB
The percentage of SHC for the same year are:
Jordan, 19.40%, Gaza, 34.40%, S.A.R. 12.20%,
Lebanon, 19.69%, West Bank, 14.31%
The percentage of SHCs to Registered Refugee
Population as of Nov. 1999 are: Gaza, 8.7%, WB,
5.1%, Lebanon, 10.8%, S.A.R. 6.6%, Jordan, 2.6%.
The average is 5.6%
3. Larger classrooms, more facilities
the UNRWA schools run on a double shift and in
1999, the Agency began to build new schools and
maintaining others, especially in Gaza, where
the average class size fifty pupils per classroom.
Yet, in view of shrinking budgets, these efforts
despite their significance are insufficient and
both the West Bank and Gaza are in need of more
schools to lower the numbers in classes. However,
there are short-term projects which may enhance
the school environment, such as renovations on
existing schools and the building of extra classrooms.
Pupils also suffer in that many of these schools
have small playgrounds which are congested with
students at break time. There are also no spaces
for extra-curricular activities, libraries are
too small and books are few and old, in some
there are no libraries at all.
There is a need to provide counselling services
to students who simply do not have anyone to
turn to for academic support or to counsel them.
There are many students in higher preparatory
grades who do badly in school and special education
programs will be of tremendous help. Also important
are programs upgrading the skills of teachers
in new methods of teaching.
4. An Improved Health Care Program and More
In this area, it is important to
provide financial and logistical support to health
centers. In many camps there is only one center
serving thousands of people, usually the camp
population and surrounding area. Secondly, the
health staff are overworked. Doctors as mentioned
earlier sometimes have to see 150 patients per
day and many patients return home without being
seen. Due to the pressure on the health centers
in camps, many refugees are compelled to seek
private health care adding to their financial
burdens. Therefore, it is important to find ways
to increase the medical staff.
In addition, female doctors are few and many
women avoid male doctors. Hence, there is a need
for female specialists, especially in women's
health issues, such as childbearing, gynecology,
psychologists and psychiatrists.
Clinical psychologists are very few in the camps.
Women and youth are especially in need of counselling.
Some of the women interviewed revealed they were
taking anti-depressants, but usually there are
many social problems left unattended and the
anti-depressents do not solve their problems
at home and in the community. In Shu'fat camp,
a special emphasis was placed on counseling centers
since many youth are addicted to smoking, drugs
such as 'bango' and hashish. Some of the youth
after the Intifada turned to drugs and other
forms of addiction. Finally, specialists in caring
for the disabled are very few and many of the
volunteers have no skills or training in this
B. Programs for Marginalized Segments of Society
1. Children and Adolescents: Playgrounds and
The absence of playgrounds
for children is a real problem in all camps.
In earlier decades and before concrete totally
replaced gardens and filled the available spaces
in refugee camps, children played in front of
their homes. On the one hand, the little gardens
or spaces provided an outlet for families living
in shelters, relieving the stress inside the
shelters and on the other hand, it offered children
a place to play more safely under the scrutiny
of parents and neighbors.
Playgrounds are a priority cited by all those
interviewed and in all camps. The main problem
is that in many camps the space is simply unavailable
or limited. Creative solutions are required to
find the best way to create play centers for
children. In larger camps, more than one play
area/playground/park is needed. Although spaces
are limited, such as in Camp No. 1, alternatives
are possible around camps, if not within them.
Adolescent girls and boys suffer from being
at an age when they are neither 'children' nor 'youth'
in official and international definitions. Adolescent
girls, especially, do not have any places to
go and the concept of 'entertainment' is simply
absent or restricted to visits with relatives
and television. Many of them do not leave the
camp boundaries, except on rare occasions. Ten
or twelve year-old girls cannot play in the streets
like their brothers and neither can they join
in the women's centers providing various programs.
This age group complains that all they do is
stay home and watch over their younger siblings.
It is therefore, imperative that 'girls' clubs
providing indoor sports, social and cultural
activities be established. Similarly boys in
this age group need such centers. When many adolescents
are facing problems in schools, such clubs or
centers could provide assistance and counseling
for slow-learners. This would encourage many
parents to allow their daughters to participate.
2. Youth: Youth Centers, Activities and Programs
for Young Women
The interviews showed that youth,
who constitute a large percentage of the population,
are stereotyped as a 'dangerous' and 'uncontrolled'
segment of society. With low educational standards
at school, limited spaces and centers to enhance
their potential, they feel lost and neglected.
Therefore, it is important that programs and
centers catering to their needs should be established.
These should include extra-curricular activities
ranging from sports to computer training as well
as cultural and social activities, including
art, theater and music. Some of the UNRWA community
based youth centers are beginning to include
young women. However, these are too few and the
social and cultural environment in most camps
does not encourage such mixed centers. Therefore,
centers exclusively for women are needed.
Many young women who may be categorized as 'youth'
are also married. It is not uncommon to meet
women at 18 or 19 with two or three children.
Therefore, programs for young women should integrate
assistance in providing child-care and awareness
raising programs on family planning and health
issues. The lack of these spaces also forces
the younger generation in seeking alternative
ways to express their potential and identity.
Many students who do not do well in school, could
greatly benefit from such centers that provide
group solidarity. On the social level, cultural
and social clubs provide an outlet and an avenue
for personal growth and development.
3. Women: Women's programs, activities and outreach
Programs directed at raising awareness
of women's rights are important, however, some
of these programs have failed in the past because
they did not take into consideration the conservative
environment which exists in many camps. Therefore,
these issues could be introduced within larger
programs such as 'family planning', legal counseling
and general health as the overall framework and
within that provide awareness on gender issues,
physical and psychological abuse, child rearing
and skills training. Middle-aged and older women,
especially those who are not working, comment
that there are no places for them to go. The
women's centers capacity is limited and therefore
it is recommended that the women's centers be
More importantly, it is important to establish
networks that will reach women in their homes,
as there are many who cannot leave their homes
for various reasons. Some of these women suffer
from depression, abuse or health problems and
they remain without support, because they cannot
reach the center. Thus an approach which aims
at reaching out towards the community will be
more successful than expecting the community
to reach to the center, at least until the centers
are well established.
There is a need to provide community awareness
programs, directed at the family as a whole.
Many women for example, point out that it is
the men who need education on the problems they
face as women in the family and society. Men
point out that women do not understand the pressure
placed upon them to be the primary providers
for extended families. Therefore, it is important
to include programs directed at the family as
a whole and in relation to the local community,
its needs and problems.
4. Taboos: Breaking Through
Issues such as incest,
rape, addiction and sexual disease are generally
taboo and remain hidden in private domains. Often
individuals suffer alone with nowhere to go for
assistance or counseling. Health centers are
one avenue that could provide such counseling.
These issues are very important to tackle and
occur more frequently than is publicly acknowledged.
Methods such as a public survey do not reveal
these carefully hidden problems.
Therefore, problems such as incest should be
dealt with sensitively and in consultation with
local community leaders, especially women's organizations
and health care staff. Special channels and means
of reaching these individuals must be developed,
for example, hotlines, counselors, clinical psychologists
and so on.
C. Poverty Alleviation Programs
Poverty and overcrowding
are in most cases interlinked. In addition to
providing support in shelter rehabilitation,
it is important to implement projects that target
poorer families to help them become economically
independent. These may include both family-run
businesses and enterprises that create employment.
The poverty alleviation schemes should be based
on a thorough needs assessment and economic viability
of projects, whether they are income-generating
projects or micro-enterprises and/or loans/grants
Also, job-placement programs that help youth
and skilled refugees could be developed. A suggestion
from the field was that income generating projects
are needed, because they might 'entice the youth'
to stay within the community and therefore continue
their education. It is important to provide awareness
programs on the significance of education for
both boys and girls.
D. Activating Local Community Organizations
primary problem with existing services and organizations
is that these are insufficient and in many cases
ineffective. A small percentage of the community
benefits from many of the available services.
Moreover, many of the programs are targeted at
one segment of the community and the family as
a unit, for example, is neglected. This latter
issue is significant, in that in Palestinian
society the family is the basic unit of society
and the individual is closely entangled in family
relations. There is also overlap in services
due to lack of coordination by the local and
international organizations providing services
in camps. In some cases, the programs are not
based on local priorities and identified needs,
but respond more to international and donor prerogatives