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.
IV. THE SOCIAL AND PSYCHOLOGICAL EFFECTS OF OVERCROWDING
Summary
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
Women
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
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.
Neglect
"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
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!' |