Community Based Psychosocial Support Projects for Refugees and Displaced Persons

Module 9 Community Based Psychosocial Support Projects for Refugees and Displaced Persons Download this module: www.transact.nl

Module 9 Community Based Psychosocial Support Projects for Refugees and Displaced Persons 9a Content and Comments This module had been written by an experienced women s group that focuses on the development of post-war psychosocial programmes for refugees and displaced persons. The emphasis is on refugee women, without forgetting that part of the refugee women has also been sexually violated. There is also some special attention for other vulnerable groups within the refugee population. This training is meant for care workers and volunteers who would like to set up concrete support for refugee populations. The philosophy of this module is that, yes, refugee women have had very harsh experiences and do face many problems, but no, it does not mean that they are completely helpless. Instead of being treated like patients they should be supported to regain control over their own lives. Although the module stresses that some of the women suffer from traumatic stress and might need individual counselling, the emphasis is on the development of grass-roots community initiatives that can, in many cases, prevent more psychological distress, and encourage women to take back control over their own lives. Go to module 2 for information on Individual Counselling of Sexually Abused Women. This module is a practical introduction on how to set up psychosocial projects, using the experience of those women who have gone down this road before. 9b Objectives To develop ways to support and/or strengthen community initiatives for psychosocial care, especially for refugees and displaced people, in particular those who survived sexual violence. To understand the principles of psychosocial care and support. To explore various aspects and forms of psychosocial help and support. To explain who can run a psychosocial project. To understand the role of NGO s in contributing to changes in a community. To understand which aspects of psychosocial help and support are applicable under various circumstances. To learn to develop strategies of psychosocial help and support. To practice development of various psychosocial programmes. To define and foresee possible problems in the set up of psychosocial programmes. To become sensitive to special needs of refugee and displaced persons. To become sensitive to the special needs of survivors of sexual violence. To share experiences about different types of psychosocial help. Admira Module 9 3

9c Suggested Training Schedule Day 1 In minutes 9.1 Introductory Circle 30 9.2 Presentation: What Are Psychosocial Support Projects? 45 9.3 Exercise: Types of Psychosocial Support Projects 30 9.4 Presentation: Why Psychosocial Help? 30 9.5 Exercise: Thinking About Psychosocial Help and Humanitarian Aid 45 9.6 Presentation: The Aims of Psychosocial Projects 45 9.7 Exercise: Aspects of Psychosocial Support 45 9.8 Presentation: Strategies to Develop a Psychosocial Project 15 9.9 Exercise: Thinking About Vulnerable Groups Among Refugees 30 9.10 Presentation: The Practical Side of Developing Projects 30 9.11 Exercise: To Develop a Plan for Psychosocial Interventions 60 9.12 Closing the Day 15 Day 2 9.13 Starting the Day 30 9.14 Presentation: Developing Project Evaluation Methods 15 9.15 Exercise: Planning Evaluation 30 9.16 Presentation: Special Problems Connected to Psychosocial Work 30 9.17 Presentation: The Problems of Refugee Populations and Additional Stress 30 9.18 Exercise: Refugees Control Over Their Lives 30 9.19 Presentation: Psychosocial Care for Survivors of Sexual Violence 30 9.20 Exercise: Support for Women Survivors of Sexual Violence 30 9.21 Exercise: Our Working Experiences 90 9.22 Closing Circle 30 9d Ideas and Suggestions for Trainers 1. This module is about community based psychosocial support projects. It is recommended that at least one of the trainers and possibly both have been involved with setting up and running psychosocial projects and can give examples or make corrections from their own experience. 2. Find out before day 1 of the training how many of the participants have experience with the work. Try to find a balance in the working groups between experienced and less experienced participants. See if you can give the more experienced participants a role in the programme. 3. It is very well possible that questions come up about how to solve existing individual problems, as this module deals with many possible problems that refugees might face. Try to stick with the training and keep limits; make an inventory of important issues that cannot be addressed extensively in this training, and if necessary organize a follow-up training or supervision and coaching. 4. The participants will take home a lot of information that they need to think 4 Admira Module 9

about, and put into practice. We recommend that a single day, or half-day follow-up session is organized after some weeks, to share experiences, successes, progress and new questions. If so, it is possible to give the participants home assignments, or instructions for the kind of report they are to hand in. 5. This training focuses mainly on a cognitive and practical level. If you wish, and if there is time, you can include some physical exercises, or relax in between (See module 14 The Body Remembers: Dealing with Feelings). 6. Part of the training on Day 2 is about care for survivors of sexual violence. At least one of the trainers should be familiar with this subject. If not, you can invite an expert to assist with this part. In that case, take more time. Please note that some of the participants may be survivors themselves, and the subject may stir up strong feelings 7. The last part of day 2 is an exercise in working with a case. Deal with the case like you are used to. 8. In this kind of work empowerment is an important value. Please read module 10 Empowerment and Building a Supportive Environment. 9e Training Material Flip-chart, markers Overhead projector and sheets Sheets of paper, markers Handouts Admira Module 9 5

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9 Content of the Module on Community Based Psychosocial Support Projects for Refugees and Displaced Persons Day 1 9.1 Introductory Circle (30 min) All participants say their names, what they do professionally or as volunteers, and what brings them to this seminar. It is important to find out how many of them already have experience in working with refugees, and what kind of experience. The trainers also introduce themselves, and explain the content and the rules of the seminar. 9.2 Presentation: What are Psychosocial Support Projects? (45 min) Let us start by explaining psychosocial support projects by introducing a refugee family: Mrs. B, age 42, lives in a small refugee camp in the country next to her own. She is there with her three children, one boy and two girls, aged 13, 11 and 9, and her mother who is 72. When enemy troops invaded her village, they took away her husband and an older son aged 17 at gunpoint. She has not seen or heard from them since. She and her husband were farmers, and owned a modern house, several outbuildings, a car and two tractors. Her mother has been blind for twenty years. They all live in one room in an old army barrack. The daughters have not gone to school for several months, as the refugee school is too far away for them to walk. The boy has problems adapting to the new school, and on several occasions he was found roaming outside with some older boys and did not come home. Mrs. B. is not feeling well, she was diagnosed with anaemia, but she may have a more serious illness. In one glance we can see that this family needs support on multiple levels. They need health care and education for the children; the mother has suffered the trauma of seeing her husband and son abducted at gunpoint, and now she has to face the fact that they are probably dead. She has three children to take care of and an invalid mother. One of the children reacts to the situation by skipping school and is in danger of becoming part of a gang of boys. She worries about their house, about returning. The situation in the refugee camp that is overcrowded and isolated causes a lot of tension between the inhabitants. Under war and post-war situations, many types of stress are usually present simultaneously. Here, it concerns people who, in general, have not been clients of mental health care before, who are used to having enough coping abilities to face normal life events. Now, their whole system is overburdened by problems. Apart from that, most of the people around them face similar problems. The health care system, the educational system and mental health care facilities, if present, are overburdened as well. Even though the family members are all traumatized in different degrees it is too simple to just see them as PTSD patients. The result of direct trauma is often described under the label Post Traumatic Stress Disorder (PTSD). There is much debate on the part of mental health Admira Module 9 7

professionals on the use of this diagnosis in situations of war and organized violence. On the one hand it is not reasonable to attach such diagnoses to whole populations, as they lose their value as working tools if described indiscriminately. Moreover, refugees and displaced persons do not particularly appreciate further stigmatization through such labelling. They are not mentally insane, but suffering from war. The careless use of diagnoses can lead to individualization of a problem, which is basically political. On the other hand, under-diagnosing by not recognizing the symptoms or their significance may lead to overlooking of suffering of large numbers of people. This failure may support the development of long-range chronic reactions. (Inger Agger, 1995) Obviously it is not possible to offer every individual refugee therapeutic counselling, as there are thousands. For some refugees it might be useful or necessary to get individual help but at the same time it is obvious that people depend heavily on community initiatives that strive to enable them to sort out what has happened to them and which steps to take next. Important here is to neither see refugees as merely helpless victims, nor to see them as people who can cope on their own, but to, together with them, sort out the balance between stressors and protective factors. (Sheet 1) General psychosocial stressors: 1. Economic hardship 2. Social disruption (separation from family, disappearance of family members, downward change in social role) 3. Physical/psychological violence 4. Ethnic persecution 5. Loss of home/country/family/friends 6. Danger/abuse during flight 7. Reception on arrival after flight 8. Settlement in collective centres or private accommodation 9. Uncertainty about the future General psychosocial protective factors: 1. Individual coping abilities 2. Family strength and unity 3. Social network 4. Ideological/political/religious consciousness The aim of psychosocial support projects is to work as much as possible on the reduction of stress, as well as on strengthening and using protective factors. The answer to the situation of refugees is not an either/or solution, but a and/and approach, where all possible resources, refugees themselves, volunteers, professionals from NGO s and from governmental institutions work together to create a system of grass-roots projects on all necessary levels: health, education, mental health, practical and economic help, and special facilities for children, single mothers, elderly, disabled etc. 8 Admira Module 9

9.3 Exercise: Types of Psychosocial Support Projects (30 min) Objectives: To think about different types of projects. Method: Brainstorm session in small groups. Material: Large sheets of paper, markers. Steps: 1. The group splits up into small groups of 4-5 people. Ask them to sit around a sheet of paper and try to generate as many ideas as possible that come to their mind about various types of psychosocial support - without comments or discussion. 2. Hang the papers on the wall so everybody can see. 3. Open a discussion: Which of the ideas could be used for a project to help refugees? Can these types of support be grouped into some categories? How can these categories be named? Do similar projects already exist in your community? In what way do these projects reduce stress and strengthen protective factors? Explanation: Encourage all participants to produce as many ideas as they can, and not to censor themselves for fear of being criticized or ridiculed. Even silly or foolish ideas are good (it usually happens that such ideas are most creative and liable to be modified into very useful forms). 9.4 Presentation: Why Psychosocial Help? (30 min) A war in any region has a great impact on people s physical and mental health, especially of those who are refugees and displaced persons who survived physical, psychological, social and/or economic destruction. Almost all of them have survived severe war trauma, e.g. (sheet 2): Ethnic persecution Loss or missing of close family members, homes and property Loss of social network, separation from family members Fear of destruction of ethnic, religious or cultural identity Experiencing life threatening situations, mortal fear Witnessing family members being tortured, mutilated and killed in front of their eyes Being captured and imprisoned Being tortured, sometimes including sexual torture and rape Surviving combat situations Witnessing people being killed, having killed Being injured or permanently disabled We may not, however, presume that all war victims suffer from severe psychological trauma. Different people react to traumatic war situations differently, and the severity of traumatic disorders depends on many factors Admira Module 9 9

(sheet 3): The extent of human and/or material loss The length of time of being exposed to traumatic events Personality factors Coping skills Support from social and family networks Religious beliefs Many victims are able to manage a new situation without serious psychological problems, but those who have serious problems in dealing with trauma do need professional help in order to prevent serious psychological disorders, preferably immediately, if not possible, later. Even those who do not need professional help to cope with traumatic events need other kinds of psychosocial support because it is a known fact that post-traumatic stress disorders (PTSD) can still appear after long periods of time, and prevention programmes are very valuable to avoid these and other possible disorders, which may cause serious and long-term negative consequences. Psychosocial projects aimed at the prevention of traumatic stress disorders appear to considerably lower the risk of further long-term psychological problems. There are numerous definitions of psychosocial help; we like to work with the following definition (sheet 4): The overall purpose of psychosocial emergency assistance is to promote mental health and human rights by strategies that enhance the existing psychosocial protective factors and decrease the psychosocial stressor factors at different levels of intervention (Agger, 1995). People who have survived severe war trauma (refugees, displaced persons, physically and/or sexually abused, wounded...) need various levels of intervention (sheet 5): Diplomatic and political interventions (international and local) i.e. interventions by international community such as negotiations facilitated by international forces, a peace-making process, peace agreements between countries, military actions. Diplomatic pressure on local government to improve living conditions of refugees, including: 1. Basic needs (survival) - food, water, clothes, accommodation, heating, hygienic items, medical care 2. Psychosocial needs (practical help, health care, mental health interventions, educational and grass roots initiatives). Public Outreach work. 10 Admira Module 9

9.5 Exercise: Thinking About Psychosocial Help and Humanitarian Aid (45 min) Objective: To understand the differences between various types of support for the refugee and displaced population. Method: Open group discussion. Steps: Use the material from a former exercise and initiate an open group discussion on the following questions: Which types of NGO s projects could be developed for refugees and displaced persons? In which different forms can we find humanitarian aid? And psychosocial projects? How are they different? What are advances of humanitarian aid? What are advances of psychosocial work? Which type is more appropriate for which circumstances/cases? Can you think of organizations in your community, which have humanitarian and/or psychosocial projects? How much do you know about their work? Do they only provide humanitarian aid or are they also active in public work and lobbying for change? Which types of projects are more likely to lead to changes in a community? Why? Explanation: The facilitator should emphasize the importance of psychosocial work in a community, and explain the connection between types of projects preferred by NGO s and the politically awareness of these organizations. It is important to underline that one particular project type is no better than another they are all important - but that NGO s that work on psychosocial projects and especially public outreach work are essential to generate changes in a society. 9.6 Presentation: The Aims of Psychosocial Projects (45 min) It is very important to recognize that psychosocial assistance, which is very valuable for refugees and all people who suffer from war trauma, can be provided by governmental institutions, local and international NGO s or grassroots initiatives. The number of local professionals, who are supposed to work with the people is only sufficient to cover less than one percent of the estimated needs for psychosocial assistance to the traumatized people (Agger, 1995). Regarding the limited number of professionals in the field of mental health, and in order to improve psychosocial aid to people in war torn communities, it is necessary to educate more people to participate in projects aimed to support a traumatized population. All experiences with working with people who suffer from war trauma show that lack of professional interventions can have long-term negative consequences for the psychological, health and social status of refugees and displaced persons, as well as for the whole society (increased alcohol and drugs addiction, physical, psychological and psychiatric disorders, suicides, increase of violence). Admira Module 9 11

Psychosocial strategies, aiming to help and support refugee and displaced population -as well as those who are not in this status, but suffer from severe war trauma can take various forms: Practical help This includes helping and supporting refugees and displaced persons by realizing (part of) their basic human rights. There are several ways (sheet 6 and Handout 1): Assistance to obtain various documents regarding property, health care status or refugee status. Support when leaving for third countries. Tracing missing family members. Contacting various governmental institutions and NGO s. Providing concrete information about financial aid or jobs. Opening telephone lines which offer relevant information. Offering shelter (place where they live, get material things as well as all types of support they need). Organizing day-care and free-time activities for children. Finding/ creating small income-generating projects (handcraft etc.). Health care Health care is or should be included in the basic needs level of intervention, but since health is such a broad concept (according to the WHO, health is defined not only as absence of illness, but as well-being on physical, psychological and social level) it should be part of psychosocial educational, prevention and treatment programmes. The aim of such projects is to improve the health status of refugee and displaced populations. They exist in various forms, for example (sheet 7 and Handout 1): Public lectures in refugee camps on various health topics (e.g. gynaecological issues, reproductive rights, psychosomatic problems, nutrition). Mobile gynaecological clinics. Specialized gynaecological clinics and shelters for women survivors of sexual abuse and violence. Prevention programmes for adolescents concerning different types of addiction (drug, alcohol abuse, smoking), contraception and sexually transmitted diseases. Telephone info services or counselling centres with free information about various health issues. Producing and distributing leaflets, brochures and other handouts. Mental health This is the most frequent form of psychosocial prevention and treatment projects of various governmental and non-governmental organizations. Regarding the extent of war trauma and impact it has on the whole population, especially refugee and displaced persons, this type of intervention is extremely important. It includes organizing (sheet 8 and Handout 1): Hotlines (information and counselling). Public lectures, panels and workshops led by professionals. Family visits and support. Individual counselling (organized in camps or somewhere else). Group counselling (groups led by professional facilitators, self-help groups). Psychotherapy on dealing with war trauma. 12 Admira Module 9

Education This is a very important part of psychosocial work, but not too common as many projects do not recognize the need for education. Refugees do indeed need to obtain many specific skills and much knowledge, since many of them will not return home for quite a long time, or ever again. Some of them do not speak the language of the country they are settled in or need to learn more about local cultural habits, some need additional skills in order to find a job, and some need general information. There are different possible ways to educate the people: courses, workshops, panels, lectures, leaflets, brochures, etc. Possible topics and forms are (sheet 9 and handout 1): Local language or foreign languages. Multi-ethnic workshops and panels in local communities to share information about their culture, religion and customs. Women s human rights (right to live without violence), refugee rights. Self-organizing and grassroots initiatives. Computer skills. Additional professional courses (e.g. typing, hairdressing). Raising children, baby care, puberty and adolescence. Partner relations. Communication skills, conflict-resolution skills. Income-generating activities. Public outreach work This type of intervention is focused on general problems connected with a refugee and displaced status and includes various strategies to promote and protect refugees human rights, aiming to improve the refugee and displaced person s position and life conditions in the community. It involves public campaigns, lobbying and advocacy groups for (sheet 10 and handout 1): Awareness about refugee rights. Changes in local and international legal systems (e.g. big campaign of various women s and human rights groups for treating rape in war as a war-crime). Public pressure on governments to provide decent accommodation and living conditions. Right to education for refugee and displaced children (next to primary education). Right to health care (next to primary health care). 9.7 Exercise: Aspects of Psychosocial Support (45 min) Objective: To think about different types of psychosocial support. Method: Case study in small groups, plenary discussion. Material: Handout 1 and 2. Steps: 1. Read the story to the group, and divide them into four groups. Each group Admira Module 9 13

should concentrate on one of these four aspects of psychosocial help/support: Practical help Health care, Mental health care Education 2. After 15 minutes, have one member of each group report briefly which types of support they think Ana needs. 3. Discuss the following questions: Which ways of support are included? How do they contribute to improve her situation? Is everything mentioned applicable in a real situation? Do you need any support or information from other organizations? Do you have experience with women in similar situations? Handout 2 Ana (36 years old) recently arrived at a transit refugee camp. She had to flee with her three-year-old son and six-month-old daughter. Her husband stayed behind to try to protect the village. She is completely desperate and worries about him, because every day she sees on TV that the area she came from is being bombed, and people are killed. She is accommodated in one small room with eight adults, all of whom she never met before. Some of them are old and ill. The people are distressed because her baby cries all the time. She has had no information about her husband and her parents who stayed behind for some time now. Her future is unpredictable, she is afraid they will be sent even further away any time now. 9.8 Presentation: Strategies to Develop a Psychosocial Project (15 min) The necessary steps to develop a psychosocial project (sheet 11): 1. Do a needs assessment and monitor the situation in the field. 2. Make a proposal and start fund-raising. 3. Develop a plan for psychosocial strategies and interventions. 4. Develop project evaluation methods. 5. Arrange additional training of professionals and volunteers. 6. Implement the project. 7. Evaluate. We will discuss these steps one by one. Needs assessment and monitoring of the situation in the field When planning a psychosocial intervention programme, it is necessary to have full understanding of the problem situation. This way you can estimate work priorities and target population, and develop and implement an appropriate project. In the field of psychosocial interventions there are numerous projects based on insufficient information and an inadequate needs assessment, with unclear or unreal goals, tasks and methods, without appropriate evaluation or without evaluation at all. 14 Admira Module 9

This phase requires lots of work, effort, flexibility and inventiveness. It involves being present in the field, contacting the population in need, as well as collecting and sharing relevant information with NGO s and governmental organizations/institutions in order to get deeper insight of the real needs. All this requires a lot of time, but is worth it, since the result of the whole project depends on quality of work in this phase. With regard to the target groups, the focus should be on the most vulnerable members of the refugee population (how many are there, where do they live, etc.). 9.9 Exercise: Thinking About Vulnerable Groups Among Refugees (30 min) Objectives: To raise awareness of the fact that within refugee populations there are some groups more vulnerable than others. To think about how the needs of these groups can be included in psychosocial projects. Method: Discussion in small groups, discussion in the plenary. Material: Flipchart. Steps: The participants split up into small groups (4-5 women). Each group discusses the most vulnerable groups of the refugee and displaced population, in their community. This exercise can also be modified in the way that each group discusses one particular target group (e.g. children, women, elderly people) to identify how these groups are more vulnerable than others. Each group presents their conclusions to the large group. After all presentations, open the discussion: Are all potential target groups recognized? Do all members agree on the importance of working with these specific subgroups? (e.g. do all feel it is important to work with elderly women?) Notice the differences in perception between the groups and between members of the groups! How do your personal experiences, age, status of life or personality influence your perception (to think of particular groups as more vulnerable)? Are you motivated to work with the groups that you find most vulnerable? Why or why not? How are your preferences in working with certain kinds of people and your personal life/position connected? Do you want to help people who are in a similar situation as yours? Or just the opposite? Explanation: If the participants do not come up with the following of people the trainer may choose to add them: Children - especially orphans, whose family members are killed in war, missing or separated. Women - especially those who survived rape or/and any kind of violence, loss of family members, pregnant women, single mothers. Admira Module 9 15

Men who were in concentration camps, who were wounded, disabled. Elderly people - who were raped, terrorized. Minority people people belonging to a minority that is discriminated in the host country. People with a chronic illness. People with special needs (physically and/or mentally disabled). 9.10 Presentation: The Practical Side of Developing Projects (30 min) Developing a proposal and fund-raising After an estimation of needs, the next step is to develop a concrete project for psychosocial intervention. It should include detailed description of target groups, a project purpose, project goals, activities, methods, the anticipated outcome and the project budget. In order to implement the planned project, it is necessary to ensure funds, which requires a skilled management team, diligence, planning, writing and presentation skills and frequent contacts with possible funders and donors. Developing a plan for psychosocial strategies and interventions Part of the work is to make a detailed action plan for the implementation of the project. This phase requires analysis of various aspects (write on flipchart): Resources needed and resources already existing Necessary materials Time-table of project implementing Working staff (qualifications) Method to share information with involved NGO s and GO s Form of follow-up 9.11 Exercise: To Develop a Plan for Psychosocial Interventions (60 min) Objective: To practice development of psychosocial programmes. Steps: 1. After a general explanation the participants split up and form a. b. or c. groups of four to five participants. (15 min). Each group writes a detailed plan for a psychosocial programme according to assignment a, b, or c. (30 min): a. Already existing target groups that their organization works with (if they are members of an NGO). b. Any particular subgroup they would like to work with. c. Examples given by a trainer (short story about a current problem in their community). Developing a plan should consist of (write on flipchart): Already existing resources Resources and materials needed Working staff qualification Evaluation form 16 Admira Module 9

2. After all the groups have finished, take as much time as needed to discuss each plan (step by step, emphasizing all the good ideas, but also potential problems of a plan). Encourage each participant to give feedback and suggestions on how to improve a plan. (15 min) 9.12 Closing the Day (15 min) Ask the participants to comment on what they liked about this day, and if they have suggestions for the next day of training. Admira Module 9 17

Day 2 9.13 Starting the Day (30 min) Ask the participants whatever they have been thinking about since day 1 of the training, did any new ideas come up, or new questions. 9.14 Presentation: Developing Project Evaluation Methods (15 min) One of the most important parts of all projects is to measure the project outcomes. Good evaluation is crucial to be able to estimate whether the work was successful enough in meeting (particular) needs of the target group, as was planned before deciding on the project. Evaluation methods should be planned in advance, to ensure the most objective approach. Proper evaluation generates valuable information about failures and achievements. The two main focal points for evaluation are the working process and the project outcome. The methods used to measure success can either be objective (concrete and measurable criteria) or subjective (estimation and self-estimation). Common tools for evaluation are: (sheet 12): Interviews (individual and/or group) Group feedback (oral and/or written) Different types of questionnaires, scales or tests (for beneficiaries and/or working staff) Objective data (e.g. tests of knowledge and skills, number of women employed, children s schoolwork or frequency of anti-social behaviour...) 9.15 Exercise: Planning Evaluation (30 min) Objective: To learn about the importance of evaluation and possible methods (For more extensive material on the techniques of evaluation go to module 15 Programme Evaluation). Method: Discussion in small groups, plenary. Material: Flipchart. Steps: 1. Use the outcomes of the exercise before this one. The groups now plan evaluation strategies for the plans they have developed before. The participants should really think of detailed and sufficient ways to evaluate the activities they have planned. They should keep in mind the following points (write down on flipchart): Purpose of evaluation (for donors or internal use, does it concern the whole project or a part/phase of it). Criteria of evaluation (objective or subjective). Evaluation methods (e.g. group or individual interviews, evaluation forms and scales). 2. Discuss results in plenary. 18 Admira Module 9

9.16 Presentation: Special Problems Connected to Psychosocial Work (30 min) Long-term experience with psychosocial help and support for refugees and displaced persons gives us an insight into the many problems that come with this type of work. It is very useful to understand the main omissions and obstacles in order to, if possible, solve or avoid some of them. Most common are (sheet 13): An insufficient number of existing psychosocial projects. An insufficient number of helpers (not enough helpers in a region, those already working are overwhelmed by work or suffer from burn-out). The unequal representation of projects in various regions. The absence of a NGO network (many NGO s may unknowingly work on the same issues, some activities over-lap, some issues are not covered at all). Projects that are not based on a real estimation of needs, but concerned about marginal or insufficient aspects (e.g. teaching computer skills to women whose basic existential needs are not met). Inadequate financial means with regard to the expected outcome. Incomplete evaluation or no evaluation at all. Insufficient level of expertise with the staff (some helpers are not educated enough, some staff educators are less educated and qualified than staff). No feedback from psychosocial projects by NGO s or GO s. 9.17 Presentation: The Problems of Refugee Populations and Additional Stress (30 min) Refugees have usually survived multiple traumatic experiences, and can be severely hurt in many ways. It is possible to diagnose many of the symptoms of individual refugees as PTSD, post-traumatic stress disorder. What we must remember here, is that most of the people who are in distress now were perfectly healthy people before. If they have developed psychological problems these are partly due to the trauma of war, and partly a reaction to the situation they have to face as refugees. We must stress that symptoms of traumatic stress are a normal human response to an extremely abnormal and stressful situation. Labelling possible psychological problems as a disorder stigmatizes refugees as being somehow sick, it may put too much emphasis on the need for therapy (which some refugees do need) and not enough on the very real problems of being a refugee, the circumstances that can cause new traumatic stress. One of the biggest psychological problems for any human being is to be completely powerless - not to be able to control one s life and to make independent decisions. Factors of additional stress and traumatization can be: (sheet 14) Additional stress for refugees (1): Inadequate accommodation (refugee camps or private accommodation): Not enough water, electricity or heating Too many people in a small space Not enough camps to accommodate all Accommodation for a short period of time (having to move from one accommodation to another) Admira Module 9 19

Lacking basic things to lead a dignified life Tension between people who share accommodation Isolated private accommodation (this can be worse than living in a refugee camp, since the refugees lack contact and information, for instance about humanitarian aid, support programmes, legal help etc) (sheet 15) Additional stress for refugees (2) Social problems: Having to adapt to the local community where they are settled (e.g. third countries) Having to adapt to cultural differences in camps (living with people of various nationalities or religions, with different backgrounds, e.g. urban and rural people in the same room) A hostile host community Social isolation (especially in private accommodation) Separation from family members Having no social network Unemployment and low or no income (sheet 16) Additional stress for refugees (3) Psychological factors: Insecurity about refugee status The future is completely uncertain (there is no telling what the future brings, as no one can say when and if they can return; a large number of refugees lives in temporary accommodation for years on end) Tension in the family (e.g. disturbed family relations, separation -voluntarily or not-, divorce, some family members have stayed behind or return home before others, new baby in poor conditions) Changes in daily routine (e.g. people stay in instead of going to work as they used to, some women who have never been employed are now forced to work - without documents - in order to provide for their basic needs) Additional psychological distress (fearing for absent family members, nostalgia and homesickness, longing for friends and community members) Depression, feelings of helplessness, powerlessness, grief Psychological responses to different problems that form a vicious cycle (problems cause stress, stress causes psychosomatic disturbances, sleeping disorders including nightmares, eating disorders, concentration problems, these reactions have a negative influence on the capacity to face problems) Many international humanitarian organizations only take care of people s basic material needs and disregard many other circumstances that make it more difficult or even impossible for the people to overcome their traumatic experiences. Experience shows that, besides main project aims, other benefits of psychosocial projects may be in protecting refugees and displaced persons from journalists and other people hunting for the most horrible stories, by mediating between refugees and camp visitors. Also, NGO s are members of various local and 20 Admira Module 9

international networks with numerous other psychosocial services that can offer other types of support than this NGO. Together they can offer more complete services to those in need. Besides the main activities of a psychosocial project, a major goal of a NGO should be to influence various governmental institutions, as well as local government and local communities, to change particular laws and legal practice, as well as to raise public awareness on the issue and put pressure on those who can contribute to the improvement of the status of refugees and their quality of life. Some NGO s also collect data and information on various aspects of the issue (e.g. real number of refugee and displaced persons, living conditions in particular accommodations) and spread it to interested international organizations and media. It is known that NGO s usually have information that local governments try to hide. Also, often it is much easier for refugee and displaced persons to contact a member of a NGO staff, than it is to reach highly positioned governmental officers or members of a foreign organization (e.g. a raped woman prefers a local woman volunteers with basic intrinsic motivation and interest in her as a person). Also, a very important task is to be an information resource for the beneficiaries about further institutional or NGO support. This way it is possible to offer more comprehensive help/support to refugee and displaced persons. 9.18 Exercise: Refugees Control Over Their Lives (30 min) Objectives: To raise awareness about the degree of control that refugee or displaced women have over their lives, and discuss different views on the degree of control of refugee women. To think about how the participants viewpoints may have to do with their personal attitude in life. Method: Individual thinking exercise, plenary discussion. Material: Individual writing paper, flipchart. Steps: 1. Introduction: Sometimes we may underestimate the problems of refugee women, and fail to see that helplessness is partly caused by being traumatized or extreme fatigue. On the other hand: when we work with refugee women we can be so impressed by the difficulties they face that we see them as completely helpless and victimized. However, in order to support them it is important to deem them capable of solving at least part of their problems by themselves. Regarding refugees as helpless and completely out of control of their lives does not help them at all. Or, as the saying goes: don t give them fish, teach them to fish. If care workers and helpers have a positive attitude and are able to stimulate refugees to take their own responsibility it will greatly enhance their capability to regain control over their own lives. Admira Module 9 21

2. Each participant imagines being a refugee or displaced woman, with all the problems she faces. They write down as many problems as they can think of. 3. Then, they divide the problems into three categories: (Write on flipchart); 1. Problems they feel they can control (like problems with the language of host community, this they can learn) 2. Problems they feel are partly in their control, partly out of their control (like loneliness) 3. Problems they feel are completely out of their control (like knowing when they can return to their homes) 4. Write down on the flipchart all the possible problems identified by the participants, grouping them into the categories as they did. After this, start a group discussion on the following questions: How many problems are in control, partly in control and out of control? Is the majority of problems considered to be out of control? (If yes, why? Do you think refugees are completely helpless?) Are some of the same or similar problems placed in different categories? Are some problems put into all three categories? Why are they perceived differently by different participants? What makes some of the participants think that they can control a particular problem? What would they do in order to solve a problem? How do the other participants feel about these solutions? How could some of the other problems mentioned become more controllable? What can a refugee woman do to take more control over these problems? Do participants who put more problems into the category in control have similar attitudes towards their own real life problems? Do you think that the way you see your own problems influences the way you support refugee women? 5. Identify various types of the problem on the list and try to think of various types of psychosocial projects to help to solve these problems. 9.19 Presentation: Psychosocial Care for Survivors of Sexual Violence (30 min) Rape and other types of sexual violence are the most frequent, and at the same time, the least often reported crimes. It can happen to any woman, regardless of her age, race, nationality, social status or country she comes from. It occurs in every part of the world, in every war, but also in peacetime. Sexual violence is very often committed against refugee and displaced women, who have even less protection than women from stable communities, with a home. Sexual violence can occur during a war in her country, during imprisonment, during her flight, in refugee camps, in the country where she finally resettles. It can also happen to men in camps and prison, as a form of torture. Rape is a violent and forceful act with the aim to gain control and power, not only over the woman, but also over her community. Very often it is not acted out on impulse, but planned in advance. Sexual violence, especially rape, is an extremely frightening experience. It can 22 Admira Module 9

affect the life of a survivor in every segment, in her self-esteem and her respect for her body, in her capacity to enjoy herself (especially sexually), in her beliefs, vision of the future, it can damage her relationships. Major reactions to rape can be feelings of shame, humiliation, anger, guilt, fear, depression, psychosomatic disorders, insomnia (restlessness, nightmares), eating disorders, addictive behaviour, helplessness and passivity. For survivors of sexual violence there should be sources for help and support, like counselling, information in the form of leaflets and brochures with information in their own language. All organizations and community initiatives for psychosocial care should be aware that many of the women and some of the men who use their facilities have experienced sexual abuse. All women refugees may be survivors of sexual violence, but there is no way to know by the way she looks or behaves. After some years of experience it has become clear that organizers and care workers should be very cautious in offering special help for survivors of sexual violence. Most experienced workers know that it is a bad idea to develop projects aimed at raped women only. Most survivors will not show up for projects that are too obviously advertised as projects to help women who have been raped, and if they do, they run the risk of being stigmatised. However, every project for refugee, displaced or minority women should pay attention to the fact that some of them are survivors of sexual violence, and the care workers should be trained to be able to talk about it. One of the reasons why some women are very reluctant to talk about the event is that they have reasons to be afraid of what the people around her will do if they know. We have to realize that in many cultures a husband, father, son or other relative will blame the victim for what happened. It should be understood for most women rape is a very sensitive issue. A survivor will need to trust a person before she opens up and tells her story. Some survivors need more than a year of individual counselling sessions to speak about what has happened, and some will never admit it, even when asked directly. Survivors should be invited to tell their story, but never pushed. In some cases women are ready to testify in cases of legal prosecution, especially now that rape is acknowledged as a war crime. But a woman who testifies needs solid support, in order to not be manipulated by various international human rights organizations and local NGO s or journalists, to whom she is not a person but a rape case. It has happened that the testimonies of survivors who were interviewed for international media were published in the local press as well, causing new humiliation to a courageous woman who had already been deeply humiliated by the rape. Sometimes women are pushed into testifying many times to various human rights organizations who visit a refugee camp, all of them collecting the same data on sexual violence - this should be avoided. Survivors of sexual violence deserve to be protected as much as possible, and must know what can happen before they decide to whom they will tell their story. Admira Module 9 23

9.20 Exercise: Support for Women Survivors of Sexual Violence (30 min) Objectives: Raising awareness about ways to approach the problem of sexual violence. Method: Open group discussion. Steps: Initiate an open group discussion with the following questions: How do we recognize which refugee women are possible survivors of sexual violence? What are good ways to approach them (e.g. individual counselling or support group, counselling hot-line)? Who would they trust enough to reveal their stories (e.g. medical professionals, professional helpers or para-professionals, male or female, younger or older, women from host community or from refugee population, local or international NGO staff)? Should journalists be allowed to interview them (if not, why; if yes, under what conditions)? How could documentation and collecting testimonies be organized? What is the cultural background of the refugee populations in your country, how are they expected to treat a rape victim? How can we protect women survivors of sexual violence if they decide to testify? 9.21 Exercise: Our Working Experiences (90 min) Objectives: To translate the issues that were raised in this training to the work of the participants. To create an opportunity to review the work situation or the future work situation and present problems that could be solved among the trainers and participants. Method: Shared thought in couples, plenary discussion, presentation of cases, incident method. Steps: 1. The participants make pairs and discuss which of the issues raised are especially relevant for their working situation or the work they would like to do in the future with regard to psychosocial care for refugees. Ask them to rephrase questions, or state one issue in their working situation that they would like to improve. Ask for details, to be specific. 2. The issues that come up are shared in the plenary. 3. The trainer chooses which issues are discussed in the plenary, helped by the insights gained by the previous theory and exercises, and which are good material for one or more sessions of working together on a case. (For models of working on cases in groups go to module 4 Crisis Intervention and Group Work with Survivors) 24 Admira Module 9

9.22 Closing Circle (30 min) The participants share what they would like to do in a possible follow-up training, and discuss the possibilities with the trainers. Everyone thinks of a thought, an insight, or practical advice that has been most helpful and encouraging for her to continue the work. Admira Module 9 25