Transcript Psychosocial Support for Refugees by Refugees in Cairo Egypt

PSYCHOSOCIAL SUPPORT
FOR REFUGEES BY REFUGEES
IN CAIRO EGYPT
“Never doubt that a small group of thoughtful committed citizens can change
the world. Indeed, it is the only thing that ever has.” Margaret Mead
Dr. Nancy Baron
Director
Psycho-Social Training Institute in Cairo (PSTIC)
Global Psycho-Social Initiatives (GPSI)
Psychosocial Programs
American University in Cairo (AUC) /
Center for Migration and Refugee Studies (CMRS)
INTRODUCTION
Brief presentation about Cairo, Egypt including:
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Problems of refugee children and families.
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Overview of local initiative the Psycho-Social
Training Institute in Cairo (PSTIC) that provides
mental health and psychosocial support by
refugees for refugees.
NUMBERS OF REFUGEES IN EGYPT
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Actual number of refugees living in Egypt is unknown.
UNHCR (2008) reports “caseload” of 37419 refugees and
asylum seekers from 36 different nationalities.
Estimates of actual numbers of refugees and migrants range
from 500000 - 3 - 5 million
Mainly from Iraq, Sudan, Somalia, Eritrea and Ethiopia.
MAJORITY of refugees are Sudanese
PLUS estimated 70000 Palestinian refugees
REASONS REFUGEES COME TO EGYPT
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All come seeking a better life!
Some are searching for economic opportunities, education,
a better standard of living etc.
Many escaping horrors of war, violence and persecution within
their countries.
Victims of human rights violations ranging from genocide, loss
of home and property, death of loved ones, risk to life, sexual
violation, war wounds, deprivation of basic needs, torture,
religious and ethnic persecution and harassment.
Most hope that Egypt is merely a transit point to resettlement
in a safe western country.
LIFE OR IN EGYPT is long term!
Most refugees are stuck in Egypt with little hope of change.
UNHCR and IOM resettled few refugees last year.
About 900 resettled in 2009. Average of about 5%.
Iraqis however ARE commonly resettled.
Urban issues quite different to issues in camps.
Usual methods of coping used in home country like family and
community support now changed due to separation from home.
Problems include:
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Problems for families due to urban context that can affect their
children.
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Special problems for children due to urban context.
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Issues for vulnerable child groups like unaccompanied children,
and children with special needs ie: protection, health, education
etc.
PROBLEMS FOR FAMILIES DUE TO URBAN
CONTEXT THAT CAN AFFECT THEIR CHILDREN
POVERTY
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Same issues as POOR Egyptian urban families crowded housing, poor
hygiene and sanitation, diseases like TB…
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Refugees cannot work legally.
LACK OF EXTENDED FAMILY SUPPORT
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At home, communities and extended families raised children
together.
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In Cairo, nuclear families isolated and more reliant on self yet limited
resources.
FAMILY RELATIONS
Change in Male / Female Roles
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In home country, most families had working fathers and mothers had full responsibility
for caretaking of children and household.
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In Cairo, little work for men.
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Women are domestic workers. Long hours. Little time with children.
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Men at home frustrated, angry, feel inadequate.
Resentful at their household role.
Increase in: Alcohol or drug use by men, Family break-up, Domestic
violence.
SPECIAL PROBLEMS FOR CHILDREN DUE TO
URBAN CONTEXT
NO OUTDOOR PLAY
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In home country, play spontaneous with other children in rural area, or
street.
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In Cairo, little availability of physical activity and play. (Example: Opera
House)
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Families fearful of children playing outside due to discrimination, racism,
street violence and verbal abuse.
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Families concentrate on school and future.
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Minimal parental awareness about importance of physical activity and play.
Parents rarely organize play.
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Play is TV.
HEALTH
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Poor availability of health care
Limited UNHCR / Cost / National care not available easily.
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Poor diet.
Little awareness about need to for balanced diet.
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Rickets
Pre-schools locked in the house all day watching TV. No sun.
School age in schools without space for outdoor activity and
home immediately after school and locked in.
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Cognitive development may be affected by minimal stimulation.
(Example: 6 and 4 year olds / NO language skills.)
LIMITED EDUCATION
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Not allowed to attend Egyptian schools.
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Refugee schools only primary.
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Basic education. Classes crowded.
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Only now have exams from Sudan with curriculum.
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Secondary and university most often must be paid by family.
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Iraqi children better opportunities.
Families more able to pay for private schools.
Yet, middle or upper class families high expectations and much
disappointment.
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Much pressure from families to do well in school.
HOPE
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Little hope for future opportunities.
RISK TO LIFE
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Safety risks due to being home alone.
Fall from balconies, gas explosions, fires.
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Desire for a better life leads to illegal border crossing to Israel or other
countries.
Children Shot. Killed. Wounded. Imprisoned.
ISSUES FOR VULNERABLE CHILD GROUPS
UNACCOMPANIED MINORS
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Many unaccompanied minors sent to find an education or work by
desperate families who spent all their savings to send the children.
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Communities take them in despite having few resources.
Can be poor care, exploitation, abuse.
SPECIAL DEVELOPMENTAL NEEDS
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No special education services so children at home.
INADEQUATE PROTECTION
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UNHCR limited services and no support by Government services so little
protection for child abuse.
Refugees in Egypt like those from around the world are amazingly
resilient. They struggle and cope.
Most do not develop serious mental health or psychosocial
problems.
HOWEVER….
There is the need for a range of supportive interventions.
ASSESSMENT OF HELPING SERVICES PRIOR TO PSTIC
FINDINGS:
GOVERNMENT
Nothing provided.
Full responsibility given to UNHCR.
Most often do not allow NGOs working with refugees to register
so limits donor funding and continual risk of forced closure.
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UNHCR and other UN organizations
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NGOs
Few.
Overwhelmed with clients.
Difficult to secure skilled workers.
Used foreign or Egyptian workers with refugee interpreters
Based in offices and offered little community based support.
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CBOs and created community services
CAIRO UTILIZES THE IASC MHPSS GUIDELINES
Overall principle
IASC MHPSS Guidelines provide a global framework from which helping
organizations can work alongside affected communities to offer mental
health and psychosocial support across all sectors of assistance.
The underlying principle in the MHPSS services provided in Cairo is a belief
that prior to the emergencies, refugees had natural resources that offered
them support.
The emergencies shook up the natural helping systems.
Our goal is not to replace these natural systems rather, to facilitate effective
natural systems so that the refugees can sustainably help themselves and
each other.
IASC MHPSS (2007) Intervention pyramid
• Mental health care by specialized
mental health staff (psychiatric nurse,
psychologist etc)
Level 4: Specialised Services
• Basic mental health care by primary
health care workers
• Basic counselling by community workers
• Psychological first aid
Level 3: Focused (person-to-person)
nonspecialised supports
• Facilitating traditional, cultural,
religious activities
• Mobilizing and facilitating
community leadership through Community and family supports
Level 2: Raising community and family supports
awareness raising of issues
•Activating social networks through
groups
Advocacy for basic services that are
safe, socially appropriate and protectBasic
dignity
services and security
Level 1: Social considerations in basic services
and security
BEGAN Psycho-Social Training Institute in Cairo (PSTIC)
GOALS
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Increase capacity of refugee communities, families and
individuals to effectively help themselves and each other with
psychosocial and mental health issues.
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Provide a specially trained team of refugees to provide
support to refugees with problems with psychosocial
consequences in their own language and in adherence to
culture and tradition.
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Increase the referral and support to refugees with mental
illness needing treatment.
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Increase the capacity of organizations assisting refugees at all
levels of assistance to integrate support for psychosocial wellbeing directly into their services.
PSTIC ACTIVITIES
Community Based Refugee Psychosocial Workers
8 month course
Graduated 17 Trainees May 2010
NOW 2nd Training class underway.
Training includes:
 375 hours of participatory classroom and field based training
(9 weeks intensive seminar / Weekly support groups)
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3 hours a month of individual field based supervision by local
professionals.
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Capacity building of Directors of organization
PSTIC Trainees are:
Community leaders, teachers, health workers, development
workers, counselors, social workers and others with
commitments to their communities and sensitivity to
psychosocial and mental health issues.
They are employed within existing organizations and schools
that assist refugees and integrate their psychosocial work
into these organizations.
To facilitate organizations to include psychosocial workers
PSTIC assists with salaries for some Trainees for one year.
OUTLINE OF COURSE CONTENT
PERSONAL GROWTH AND DEVELOPMENT
 Understanding role, ethics of psychosocial work.
 Personal exploration about life experiences and coping
 Reflection on attitudes and stigma towards mental health issues
 Self-care
KNOWLEDGE / Overview of:
 Mental illness
 Problems with psychosocial consequences
SKILLS
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Community based assessment
Identification of psychosocial problems and needs
Utilizing effective traditional and natural methods of psychosocial intervention
Understanding when to introduce outsourced methods of psychosocial intervention
Interviewing and helping skills
Crisis intervention / Psychological First Aid
Working with communities
Public psycho-education and awareness raising seminars
Interventions with children
Advocacy
Referral
INTERVENTIONS BY PSYCHOSOCIAL WORKERS
1. Community based assessment by refugees about refugees.
2. Community based psycho-education and awareness
workshops and discussions to build knowledge and self-help
skills within refugee communities to understand, prevent and respond to
psychosocial and mental issues including:
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How to cope with life as a refugee,
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How to make informed life decisions,
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Understanding and managing distress,
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Effective coping strategies,
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Living with traumatic experience
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Healthy child rearing practices
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Managing family conflict
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Understanding risks and managing substance abuse
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Health education etc.
3. Outreach to “vulnerable” refugees in their homes and
communities.
4. Support Groups for adults, families and children including:
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Parents: Mothers / Fathers about managing stress and parenting in
difficult circumstances
Couples about controlling domestic violence
Adolescents and/or children adjustment to Egypt
Men managing life without work
Families about issues of communication etc
5. Community based Crisis Intervention for problems due to family or
communal disputes or violence or suicide or other serious issues.
6. Psychosocial Support and Basic Problem Solving Counseling for
individuals (including adults and children) and families.
7. Conflict Mediation for use with families or community members to
prevent and mediate problems.
8. Advocacy on the behalf of the psychosocial or mental health needs of
refugees.
9. Referral to professional psychological or mental health and other
services.
10. Monthly Seminars to build the interest and capacities of Egyptian
mental health professionals towards assisting refugees.
11. Public awareness campaign for Egyptian population in neighborhoods
and schools where refugees live to build understanding and reduce
discrimination and racism. PLAY CNN VIDEO.
SUSTAINABILITY
Essential that PSTIC and its activities are sustainable.
Refugee populations always have psychosocial issues!
PSTIC partnered with:
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Terre des Hommes to provide solid administrative base from which
to operate, gain support and raise funds.
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American University in Cairo via Center for Migration and Refugee
Studies (CMRS) (the university has housed and supported other
programs for refugees for 10 years)
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UNHCR for hopefully long term donor funding.
International Director/ Trainer expensive so 4 local Egyptian
Supervisors / 4 Refugee Field Supervisors (Programme
graduates) now being groomed to takeover by Year 3.
Budget supports salaries of many of Trainees. Their effective
work will continue to lead to availability of funds directly
through their organizations and/or UN.
Public awareness campaign with cascade of activities will
hopefully begin to change the way that refugees are treated
within their communities.
CNN doc
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See also link:
http://edition.cnn.com/video/#/video/internatio
nal/2010/11/23/ia.help.egypt.refugees.bk.a.c
nn?iref=allsearch