Refugee women speak: a beneficiary assessment in Somalia for health and self-reliance.

Between September 1987 and March 1988 health and social service professionals conducted a rapid assessment of women and children at 13 refugee camps (Hiran and Gedo regions and in a southern region) in Somalia to determine the psychosocial needs of these refugees. About 80% of the mothers claimed to have considerable emotional stress. The causes of this stress were traumatic past experiences including rape by hostile local men or husbands; family break-ups; intense workload little recreating; loss of self-esteem; isolation; anxiety and fear; and depression. The study team determined that almost 10% of the women exhibited psychological dysfunction. This dysfunction manifested itself in various ways: suicidal thoughts explosive or very suppressed anger reliving of past traumatic experiences a sense of helplessness and paralysis of initiative guilt and self-blame (particularly toward children) isolation and withdrawal distrust of others hopelessness and despair. Even though planned refugee services were of high quality the women tended to rank them low especially food rations. Mothers ranked health services as lower than average yet they were more likely to seek help from a trained health worker than from a traditional Islamic healer (66% vs. 22%). Children especially feared illness but mothers tended to underestimate this fear. 60% of children liked primary schools more than any other service in the camps followed by Koranic school. Boys were much more likely to attend both types of schools than were girls. These results led the study team to make several recommendations for future planning of refugee services. For example it is important to include refugees especially women early on in the process of planning and managing camp services. This participation should be ongoing. Health workers need to be trained to identify symptoms of psychological stress. Adequate numbers of recreational facilities for children are essential. Other recommendations ranged from womens groups for psychological counseling to skills/business training and credit for women.