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.

V. PRIORITIES AND RECOMMENDATIONS
The most urgent priorities in refugee camps are:

1. Renovation and expansion of shelters. Improvement of the infrastructure, especially the asphalting of streets and the drainage systems and networks.
2. 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.
3. Increase the number of health centers and health staff.
4. 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.
5. 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 reconstruction.

Table 6: Registered Refugees Recorded as Special Hardship Cases in the WB and Gaza

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
Many of 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 Health Centers
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 area.

B. Programs for Marginalized Segments of Society

1. Children and Adolescents: Playgrounds and Children's Programs
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 activities
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 expanded.

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 schemes.

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
The 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 and priorities.