Challenges for refugee women and mothers around the world

Last week I had the opportunity to attend the world-first premiere of a new theatrical production called the “Baulkham Hills African Ladies Troupe” which has just started its run in Sydney.

The production is the brainchild of writer and director Ros Horin, a member of Australia for UNHCR's Women's Committee that helps raise funds for UNHCR's women's health initiatives. It tells the real-life story of four powerful African women, three of whom are refugees. Not only have they helped write the play but they also appear as first time actors in it.

The Baulkham Hills African Ladies Troupe (Photo by H. Lohr)

I hear many stories of refugees but this is one of the most raw, moving and inspiring testaments to the resilience of refugee women I have experienced outside refugee camps. I took my two teenage children who were both confronted by the stories they heard but also swept up in the joy and laughter that characterised the play. I urge everyone who has the opportunity to go and see this production which goes to the heart of the experience of refugee women. The details are below:

A Sliver Of Hope Amid The Gloom

Australia for UNHCR National Director Naomi Steer has just left famine-stricken Somalia – a situation described as “the worst humanitarian disaster in the world”.

I was in Somalia last week when the United Nations declared parts of the country to be in famine. With some estimates putting acute malnutrition rates as high as 50% in southern parts of the country, the scenario is very grim. Refugee camps in Kenya and Ethiopia are overflowing with new arrivals desperately seeking relief assistance. With an estimated 3.7 million people affected by the drought – that’s one in every two Somalis – the situation is very bad.

I was in Galkayo district as part of a UNHCR mission looking at the situation of displaced people within Somalia and how Australians might provide support. Flying into Galkayo, the landscape below was tough, red, rocky earth.

Galkayo is in the middle of Somalia, midway between the capital Mogadishu and the coastal town of Bossaso, a jumping-off point for refugees trying to make it across the Gulf of Aden into Yemen. In my pre-mission security briefing I had been advised to keep a low profile, be appropriately covered at all times and to avoid conflict. I was given a card with advice about what to do if taken hostage. It was all pretty confronting stuff but necessary given Galkayo is rated as a Level 5 Security Phase, one short of the most extreme rating of 6. All movement round Galkayo is with an armed security escort. A strict curfew is enforced between 8am and 5pm.

During my stay, I visited several camps for internally displaced people (IDPs). The path to one settlement was strewn with discarded blue plastic bags – the “Galkayo flower” as someone cynically described it to me. People were squatting in the dirt making shelters out of twigs and rags and cardboard. They were barely able to keep out the never-ending wind and sandy grit that clung to everything. In one camp, a newly arrived family worked against the clock to get their shelter up before night. Their meagre belongings, carted many hundreds of miles from their village in the south, lay strewn on the ground around their camp site. They had gathered together a collection of used vegetable oil tins which they were going to use as a bed base. Next door a woman had gathered rocks together as her base and she cried as she told me she had never thought her life would lead to this situation.

Outside, a chirpy little boy showed me his torn-off thumbnail. One of the many young children who work as child labourers here, Mohammed told me that he was a shoe shine boy but was worried that with his infected finger he would not be able to do his job. This was important to him as he said his parents fought all the time, his mother blaming his father for not providing food for the family.

A little girl nearby clung to her mother, her swollen belly and feet indicating acute malnutrition. The mother told me her daughter had been in hospital for two weeks but, now released, wouldn’t eat her ration of Plumpynut – the high-protein, peanut-based therapeutic food provided to acute malnutrition cases. But there was nothing else for her to eat.

The displaced population in Galkayo are either refugees from war, famine or both. People tell stories of failed crops, of whole flocks of sheep and goats dying from thirst and lack of feed. Many had fled Mogadishu after seeing family members killed in missile attacks or caught in cross fire. One woman arrived only days before, still in shock after learning that both her brother and father had been killed in the family home after staying behind to protect their window fittings and roof sheeting from looters during missile raids.  Another young woman showed me remnants of shrapnel in her hands and legs. Everyone here has run out of coping strategies. It is the end of the line.

In the midst of all this gloom stands the oasis of the Galkayo Medical Centre. Established by Dr Gaima in 2004, the hospital provides a huge range of health services including being the main referral hospital for fistula repair in Somalia.

Dr Gaima, until recently, was the only trained gynaecologist in Puntland. In contrast to so much of what I have seen, the hospital is spotless, the staff efficient and friendly. I tour wards of women suffering from all sorts of gynaecological problems; there are some rape victims, and many men who have suffered gunshot wounds or car accidents. In addition, Dr Gaima deals with many unique cases he says he never saw in his many years of practice in Italy – an indication, perhaps, of the total lack of health care most Somalis endure. As we do the morning round people reach out their hands to him. Dr Gaima has a kind and cheerful word for all his patients.

I am surprised to find out that Australia for UNHCR is the sole donor to the hospital as part of UNHCR’s ongoing support. In addition to this hospital, Australia for UNHCR also funds three health posts in the IDP camps and health services at Hadiya hospital. These services are the only free medical services provided to IDP’s, refugees, asylum seekers and poor locals.

To me the hospital represents a sliver of hope in this tough, dangerous country. I promise Dr Gaima and his dedicated staff that Australia for UNHCR will continue providing Australian donor support as long as we are able.

Naomi Steer

Please visit www.unrefugees.org.au/EastAfricaCrisis to find out how you can help UNHCR provide humanitarian assistance and food relief to those fleeing drought, famine and conflict in Somalia.

The Best Place and Worst Place to be a Mum

According to a recent report, Australian mums are ranked number 2 in the world – second only to Norway out of 168 countries.

In the 2011 Mothers’ Index Rankings¹, Australian mums scored high on key indicators such as health, education, economic and political status and children’s well-being. This should not be surprising in a country that provides universal health-care, free education and has a stable and growing economy. The story is the same for most developed, industrialised countries with the exception of the US - but that’s another story!

But what about countries that don’t have these same advantages? The 10 lowest ranking countries are in a reverse image of the top 10, performing poorly on all indicators. Conditions for mothers and their children in these countries are devastating.

Take Somalia for example:

•  The Maternal Mortality Ratio (which measures the number of maternal deaths per 100,000 live births) is 1,200 per 100,000 live births compared to 8.4 per 100,000 live births in Australia²;
• The Infant Mortality Ratio is 142 in 1,000 births compared to 4.7 per 1,000 in Australia^2;
• It is estimated that the proportion of births taking place in health facilities is just 9% with nearer to 100% in Australia².

Improving maternal health is one of the 8 Millennium Development Goals adopted by the international community in 2000. Under MDG5, countries are committed to reducing maternal mortality by three quarters between 1990 and 2015.

Since 1990, maternal deaths worldwide have dropped but the rate of progress is far behind other MDG goals. For example, the global mortality ratio declined by only 2.3% per year, well below the annual decline of 5.5% required to achieve the MDG5².

Women in developing countries face many challenges but refugee and displaced women face even more. A fundamental right of any woman is to have control over her reproductive health and by extension to be able to give birth in a safe and clean environment.

A group of Somali women wait outside
a medical centre in Bossaso

So what can be done? The good news is that there are relatively simple interventions that can have a huge impact on the well being of mothers and their children.

Infection, which is a number one contributor to morbidity in both mothers and children after childbirth, can be eliminated if good hygiene is practiced and if early signs of infection are recognised and treated in a timely manner.

Complications such as preeclampsia (hypertension and high blood pressure) can be detected by trained birthing staff and managed before the onset of convulsions and other life threatening complications.

Severe bleeding after birth (which can kill a healthy woman within two hours if she is unattended) can be treated immediately after childbirth effectively reducing bleeding.

Australia for UNHCR’s Safe Mother and Baby Program, which we have implemented in Myanmar, Chad and now Somalia, aims to provide effective interventions to address each of these key areas effecting refugee and displaced women and their children.

The Somali project is being run at Galkayo Hospital in the Puntland region of Somalia. Galkayo is one of the few operational hospitals in all of Somalia. The Safe Mother and Baby Program is the only one of its kind being implemented across Somalia and it is one area where Australian donors are making a huge difference for the well being of mothers and their children.

Central to the program is the very simple but also very effective  Clean Delivery Kit – a plastic bag containing a clean razor blade, a plastic sheet, a swaddling cloth, soap and a piece of string. Each of these key items is designed to help a birthing mum and her helpers deliver a baby in clean and hygienic conditions. Where it has been introduced it has been able to significantly reduce mortality rates.

Australia for UNHCR is also funding the training of traditional birth attendants and community outreach workers to educate women about the need for regular check ups during pregnancy to avoid complications such as preeclampsia. It has also funded medical outpost clinics and mobile health clinics to provide early intervention and referrals when conditions first emerge.

In order to improve women’s access to hospitals – the safest place to give birth – Australia for UNHCR is raising funds to provide two ambulances, upgraded facilities and equipment in the Galkayo hospital and salaries for trained Doctors and midwives.

Issues around the situation of refugees and displaced people can sometimes appear insurmountable. The Safe Mother and Baby Program which has at its heart the Clean Delivery Kit is an example that big problems sometimes do have simple solutions.

Naomi Steer

Visit www.unrefugees.org.au/MaternalHealth to find out more about UNHCR Programs. To show your support for refugee women this Mother’s Day go to www.unrefugees.org.au/MothersDay.

1. Save the Children “State of the World’s Mothers”, 2011

2. WHO Publication Maternal Mortality Fact Sheet 348, November 2010.