The Key to Relief in Somalia: Women


January 06, 1993|By ROBERT S. LAWRENCE

Watch carefully the television pictures tonight of refugees i Somalia and you'll notice something interesting: A large majority of them are women, together with children and the elderly. These groups account for a disproportionate share of Somalia's refugees.

This is nothing new. Women typically account for between 80 percent and 90 percent of refugee populations. Now, as American troops establish operations throughout Somalia, they need to apply a lesson learned painfully in other relief situations. For their efforts to succeed, they must work closely with local women.

Doing so is not always easy, especially in cultures where men expect women to be deferential. But experience in the world's trouble spots shows it is nearly impossible to make relief operations successful without involving local women at every turn.

I recently chaired a conference organized by the Institute of Medicine of the National Academy of Sciences that examined the special health-care needs of women refugees. Experts at the meeting agreed that the best way to ensure that the refugees actually get food is to put women in charge of distributing it. When men are given this responsibility, there is a much greater chance the supplies will be diverted to military forces.

The food itself must be prepared with women in mind. Food that is sufficiently nutritious for men may be inadequate for pregnant and lactating women, and for their children. Meals must offer ample amounts of protein, calcium, iron and vitamins. While any food is better than no food, long-term feeding programs should try to include fruits and vegetables.

Relief workers and refugee women also must be able to prepare the food properly under difficult conditions. Experienced relief workers speak of ''crazy beans'' that often are donated for refugees. These beans must be cooked an entire day. They are useless and a cruel hoax for refugee women who lack water, firewood and cooking implements.

Refugee women usually take the lead in caring for everyone else, especially for children and the elderly. But first the women themselves must be physically and mentally up to the task. A woman who is seriously ill or too overwrought by grief to function cannot care for herself, much less for anyone else.

So basic health services are essential for refugee women, and they must be provided in a way that accommodates the women's daily routines and religious beliefs. Women may not take advantage of a health clinic if it is far from where they gather water, cook food and perform other chores. They also may stay away if the center is staffed only with men. The need for female health-care providers is especially acute in Muslim countries such as Somalia.

Mental-health problems are less obvious than starvation, but refugee women often need mental-health services urgently. In Bosnia, some young women refugees were held captive by soldiers and raped repeatedly for weeks at a time before being released. Others witnessed the capture or murder of their husbands, brothers and children. Some of these women, understandably, are now incapacitated by depression. They need help.

Many relief workers already know from long experience how important it is to give local women a prominent role in relief operations. The United Nations High Commissioner for Refugees has initiated a promising program, called ''People in Planning,'' that encourages relief workers to study the traditional gender roles of refugees and to incorporate this information in their plans.

The United Nations and private relief organizations cannot assist refugees, however, unless they have been invited by the host country. With few exceptions, the country is run by men and the situation has degenerated so badly that ''women's concerns'' are dismissed as dispensable while lives are at risk. That view is common but wrong.

The power of host-country authorities can be seen in Bosnia, where a million people need international assistance to survive the harsh winter. Relief workers there are operating under tight constraints imposed by local officials, just as they did in similar situations in Thailand, Hong Kong, Jordan, Honduras and elsewhere.

All Americans can take pride in the bravery and compassion shown by our forces in Somalia. But the lesson of other refugee situations is clear. To accomplish the most good, we must work closely with the local experts: women.

Dr. Robert S. Lawrence, director of health sciences at the Rockefeller Foundation, chaired an Institute of Medicine meeting the health-care needs of women refugees.

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