Young People in Refugee Situations
people often have an easier time adapting to a new situation than their
parents do. They learn how to "work the system" quickly. In trying to
understand their special circumstances and meet their needs, it is helpful
to remember the following:
background characteristics of young people, including their religion,
cultural upbringing, place of origin (rural or urban), and level of
education will, to some extent, define their needs. However, basic RH
The primary principle in working effectively with young people is to promote their participation. Although this principle applies to the provision of RH services in adult populations, it is particularly important for young people. As a group, young people often have a "culture" of their own, with particular norms and values. They may not respond to services designed for adults. They are at a stage in life where they need to develop a sense of control over their bodies and their health. At the same time, since they are young and relatively inexperienced, they need guidance that is both sensitive and reassuring. The best way to encourage young people to participate is to develop a partnership between them and the providers with proper regard for parental guidance and responsibilities. Services will be more accepted if they are tailored to the needs as identified by young people, themselves.
Other principles to remember:
In the absence of information specific to the young people, providers must assume that many of the common problems cited above may be worse in the refugee situation. The disruption of health and education services and general state of disorder imply a lack of protection and supervision, increased sexual violence, and a greater need to exchange sex for food, shelter, safe passage and protection. It is important to obtain information about a young person's history of STDs and pregnancy status, unsafe abortion, rape and other forms of sexual abuse. Health care providers should also be aware of a young person's knowledge about and access to any form of contraception, and his/ her beliefs, attitudes, perceptions and values.
More specifically, it is important to gather information about:
This information can be gathered through camp records, interviews and
focus group discussions and possibly through simple survey techniques.
(Some further guidance is found in Appendix One
Responding to the RH Needs of Young People
Young people need basic information about sexuality and reproduction. They also need to learn how to protect their reproductive health. In many refugee settlements, formal education ends after primary school. Therefore, information about reproductive health must be communicated in creative ways. Any organised activity for youth -- sports, video showings, handicraft "clubs" -- may provide an opportunity for disseminating important health information to participants.
It has been proven that sex education leads to safe behaviour and does not encourage earlier or increased sexual activity. (See UNAIDS document in Further Reading.) Therefore, young people should be informed about STD/ HIV/ AIDS and early pregnancy, and appropriate advice and supplies should be made available to them. Young people need to develop certain skills to be able to make informed, responsible decisions about their sexual behaviour. They need to be able to resist pressure, be assertive, negotiate, and resolve conflicts. They also need to know about contraceptives, such as condoms, and feel confident enough to use them. Peer counselling and peer education can be very effective in strengthening these skills and attitudes.
Young girls who do not attend school and who are destined to marry immediately after the start of menstruation may be particularly difficult to reach. However, their society may allow a community worker to visit the girls at home and discuss health matters relating to preparations for parenthood.
Rape may be the reason an adolescent first approaches health services. Many victims of rape and sexual abuse are girls, but boys are also vulnerable to sexual violence. Young people who have been sexually abused need immediate health services and access to a safe environment.
In refugee situations, adolescent girls and boys may be forced into selling sex simply to survive. Refugee-community members should be involved in identifying ways to protect girls and women from sexual violence and coercion. One possible protective measure is to ensure that women administer the distribution of food and shelter. (See Chapter Four -- Sexual Violence.)
If an adolescent is pregnant, it is vital to provide her with good antenatal care, since young women, especially those under 15 years of age, are prone to complications of pregnancy and delivery. Many young pregnant women will resort to unsafe abortion. They will need special care if complications from an unsafe abortion develop. Information about family planning must be readily displayed and available to help keep unwanted pregnancies to a minimum. (See Chapter Six -Family Planning).
Adolescent boys engaging in homosexual intercourse should be taught how to prevent STD/ HIV. However, IEC messages related to STDs should not label this behaviour in a way that may stigmatise the boys (e. g., as homosexual), but should refer to the behaviour as "men having sex with men" or "same-gender sex".
Psychological trauma resulting from refugee experiences may make young people reluctant to seek services related to their sexual health. But they do need to know that these services are available to them, that they will receive care and support if they want it, and that they will not be judged or punished in any way. Information about the services could be displayed in places where young people gather or provided through other activities or social services.
Psychosocial support and counselling should be provided by trained counsellors
whenever needed, but particularly in cases of sexual abuse and unwanted
Ideally, a person with experience in RH services for young people should participate in the needs assessment and planning of the programmes. Young people from all age groups should be identified, as quickly as possible, to help design the programmes and eventually to take a leadership role.
When an assessment of current needs and available resources has been made, the group of service providers and young people who are assembled to develop the programme can consider the project objectives and develop the corresponding activities. Planners should define simple mechanisms for collecting information that can later be used to measure the project's impact. That information will also guide any modifications made to the programme. Young people should be involved in evaluating and modifying the programme.
RH services for young people are more effective and acceptable when they are linked to other activities or settings, for example recreation or work. Youth centres, developed in some refugee settlements, offer a place for young people to learn, play and receive health services. In other refugee settings, young people have access to health services during special hours, usually after school or after work. Young people need their own physical spaces for social interaction. These may be the best venues for providing health services.
RH programmes should be monitored to ensure young people have access to health services and health care providers are caring for young people without stigmatising them.
To be sure young people are attending health services and being targetted
with health information, many RH indicators should be measured by age
and sex break down. See Chapter Nine for select
indicators for young people.
"A Picture of Health: A Review and Annotated Bibliography of the Health of Young People in Developing Countries", WHO, Geneva, 1995.
"Action for Adolescent Health: Towards a Common Agenda", recommendations from WHO, UNFPA, and UNICEF, 1997.
"Coming of Age: From Facts to Action for Adolescent Sexual and Reproductive Health", WHO/ FRH/ ADH/ 97.18, Geneva, 1997.
"Counselling Skills Training in Adolescent Sexuality and Reproductive Health: A Facilitator's Guide", WHO, Geneva, 1993.
Children: Guidelines for Protection and Care", UNHCR, Geneva, 1994.
"Technical Report of the WHO/ UNFPA/ UNICEF Study Group on Programming for Adolescent Health", WHO, Geneva, 1997.
"The Impact of HIV and Sexual Health Education on the Sexual Behaviour of Young People: A Review Update", UNAIDS, Geneva, 1998.
with Young People in Sexual Health and HIV/ AIDS: A Resource Pack",
AHRTAG, London, 1996.