Part II: Healing the body
On this episode of our season chronicling the refugee experience, we’re focusing on bodily harm. What kinds of injuries do displaced people suffer, and what does it take to tend to those injuries — not just the ones that can be seen, but the invisible ones that might take longer to heal? This episode features a first-hand account from an internally displaced Afghan dealing with a long-term foot injury.
If you want to help those who have suffered from physical ailments while being displaced, you can learn more at the following links:
During this season of Course Correction, we’re challenging you to reflect on different aspects of the refugee experience and share your thoughts with us.
For today’s episode: Tell us about a time when you made a difference for someone with a health problem, disability or chronic pain or illness, and what the outcome was.
Note: We encourage you to listen to the audio if you are able, as it includes emotion not captured by the transcript. Please check the corresponding audio before using any quotes.
NELUFAR HEDAYAT, HOST:
All throughout March, the news from Ukraine has been devastating as Russian forces advance from multiple sides.
[SOUND OF AIR RAID SIRENS]
NEWS CLIP WITH BRITISH MAN SPEAKING:
The dawn chorus that no one wants to hear. Air raid sirens in Kiev, signaling that the full-scale invasion of a European country in the year 2022 was well underway.
NELUFAR: And caught in the middle are civilians.
[WOMAN SPEAKING IN UKRAINIAN]
We sat in the basement of the apartment building for four days. Despite the firing and it being dangerous, I decided to make our move. We just couldn’t take it anymore. The kids started coughing. I started feeling bad, but we had no choice. What are we going to do? Go try and get a doctor in Kiev now? There are some pharmacies still open, but there are no medications available. And then there was the fear of living on the ninth floor in my apartment building. So we made the decision to get out while we still could.
NELUFAR: And while attempts have been made for a cease-fire to allow civilians to flee, Russia has broken those repeatedly.
NEWS CLIP WITH BRITISH WOMAN SPEAKING:
This morning, the Russians agreed to a temporary cease-fire to allow those desperate to flee to do so. But far from stopping, the deputy mayor of the city told us, shelling has continued and the evacuation has been postponed.
NELUFAR: This means when refugees do make it across the border, they are in desperate need of both emergency care and long-term help. For women and girls, special attention needs to be paid to their safety, as displacement makes them more vulnerable to predators.
From Doha Debates, this is Course Correction, the podcast where we challenge ourselves to change the world. I’m Nelufar Hedayat. Today is part two of our special season. We’ve partnered with UNHCR, the United Nations refugee agency, to look at the refugee experience from a variety of angles. Today we’re focusing on bodily harm — not just what causes it, but how it can be treated, and what’s needed to address the injuries that can be seen and the invisible ones that take longer to heal.
When people think about refugees, they imagine people fleeing with few possessions, maybe trying to escape direct violence or a surrounding conflict zone. I know from firsthand experience, fleeing the civil war in my birth land of Afghanistan. The moment we left our home for the last time, every step we took was perilous. Because once a disruption happens, the goal for refugees becomes basic: Find food, shelter, safety. Get the essentials, and try to find more later. But to get there often means passing through violence, danger and the unknown, as refugees fleeing from Ukraine told us. Yet refugees often see their journey as one with no options, and so they’re forced to take unfathomable risks. So says Shabia Mantoo, a spokesperson with the UNHCR based in Geneva.
So their situation is very precarious. They can’t return home, because it’s too dangerous for them to do so. And they need sanctuary. They need safety somewhere else, so they cross borders.
NELUFAR: While the hardships for refugees can be great, crossing a border can mean getting out of the line of fire. For internally displaced people, they may have the additional burden of living under the threat of conflict. So even if an aid agency is within their country, the agency’s capacity to help may be diminished.
SHABIA: We have a strictly humanitarian mandate, so we do negotiate with national authorities, but it’s on humanitarian issues. So it’s to make sure, for instance, refugees can access safety, that they can move across to neighboring countries, that they can receive assistance. So we don’t deal with the political dynamics. But the biggest cause of displacement in many situations is conflict, so that does require political resolution.
NELUFAR: One of the many challenges for the internally displaced is getting proper medical care to both treat any physical injuries and help with long term rehabilitation. Ramin — that’s the name we’re giving him to protect his identity — Ramin is from the Dushi district of Baghlan Province, which is about 120 miles north of Kabul, the capital city of Afghanistan, where I was born.
[RAMIN SPEAKING IN DARI]
I was a police officer in the previous government, and one day the Taliban embedded an explosive in our vehicle, and my foot was injured. After the fallout from the fighting, we didn’t receive any salary, and I was borrowing money from every neighbor to spend on my foot. Now all the people from whom I borrowed call me for the payment.
[RAMIN SPEAKING IN DARI]
NELUFAR: Desperate, Ramin decided his best chance was to move him, his wife and two children to Kabul. There, he and his family crammed into a small space in his uncle’s home, since he was unable to rent a place of his own. Though there is relative calm on the streets, he told me how the situation there is dire for many.
[RAMIN SPEAKING IN DARI]
MALE TRANSLATOR: In the past, there were explosions, suicide bombers, and the casualties were high. But it’s not like that now. There is no war, but people are dying from hunger. People sold their children. People sell their kidneys, and people sell their blood just so they can live.
[RAMIN SPEAKING IN DARI]
NELUFAR: I asked Ramin where he’s living and what his life is like now.
[NELUFAR SPEAKING IN DARI]
NELUFAR: He told me how his injury has made each day a struggle.
[RAMIN SPEAKING IN DARI]
MALE TRANSLATOR: My foot is injured. So every night I can’t sleep, and this injury hurts me. On these winter nights, I can’t fall asleep due to pain. The situation is tough, and there is no work, and I can’t even work because I have nine plates of steel in my foot. The explosion destroyed our car, and now we are in a bad condition.
[RAMIN SPEAKING IN DARI]
NELUFAR: Ramin hopes to leave for another country, but until that time, he can only dream of a better life for himself and his family. But what he might not know is that it will take him thousands of miles away from the person he is and would have been. When you become a refugee, you almost have to annex a bit of yourself. I remember clearly realizing that I was no longer Afghan, but a British Afghan, which held promise and problems that were all very new to me and my family. But Ramin says he’s prepared to make whatever sacrifices are needed to start a new life, even if he winds up living in a place that bears little resemblance to his homeland.
[RAMIN SPEAKING IN DARI]
MALE TRANSLATOR: It doesn’t matter where I live. If someone asks me where I’m from, I will say I’m from Afghanistan. I am a Muslim. Everywhere I live, I will say I’m from Afghanistan. It’s my land, and unfortunately, it’s unsafe. But I will always be from Afghanistan.
[RAMIN SPEAKING IN DARI]
NELUFAR: Speaking with Ramin was heartbreaking for me. He’s struggling to survive an already perilous circumstance with the added burden of chronic pain. But from a medical perspective, his case is also more straightforward in terms of treatment.
The physical pain is actually the easiest bit to deal with because in a sense, you can plot what’s going to happen with that.
NELUFAR: This is Dr. Suresh Sundram.
SURESH SUNDRAM: I’m the chair and head of department of psychiatry at the School of Clinical Sciences at Monash University in Melbourne, Australia. And I’ve been working with asylum-seekers from a variety of backgrounds for the last 15-plus years. The way I think about it is that people will obviously have been in good health, or they’ll have some health problems. And those health problems, if they do have them, will persist. So these are issues such as the chronic conditions that people experience, whether they’ve got access to medications that they can take with them, whether they’re able to access the sorts of treatments that are required, for example, heart disease or diabetes or thyroid disease. But of course, over the last two years with COVID, we’ve seen awful exacerbation of these conditions. And if they can’t access those services, then those conditions are going to deteriorate and cause concern for people. Then, of course, there’s a whole set of new conditions that people might develop, which would be — whether they were refugees or in a migration journey or not, they would still develop. So these would be things like, for example, cancer or other such illnesses, which would just develop, if you like, in the normal life cycle.
NELUFAR: But apart from having a harder time accessing proper medical care, refugees and other displaced people have additional stresses put on their bodies.
SURESH: They might be subjected to deprivation of food, for example. So we have malnutrition or inadequate nutrition for people. People might be housed or forced to be in close proximity to other people, so the transmission of infectious diseases becomes much higher. People may have limited access to sanitation and clean water, so all those diseases which are transmissible through poor water quality or poor sanitation, refugees and asylum seekers have much higher rates of. And these sorts of conditions and diseases might then be transmitted with them when they come to host countries or transit countries.
NELUFAR: Dr. Sundram notes that these stresses are particularly tough on children.
SURESH: If they’re subjected to poor nutrition or other adverse health consequences early in life, that can well have long-lasting consequences.
NELUFAR: One other aspect of medical care that often gets overlooked is simply access to medical supplies and medicines. This can mean prescription drugs, but even over-the-counter items that we in the global north sometimes take for granted can be hard to find.
SURESH: Glasses and dentures and walking sticks and those sorts of pieces of equipment which really are essential for quality of life — and may, in fact, be essential for life — but which may be lost or misplaced or not be able to be replaced if people happen to lose them in the whole pandemonium of fleeing their country of origin or their home.
CANADIAN PALESTINIAN MAN:
When we speak about women in this world — women, they pay the major price. They face the major challenges, and they bear the heavy burden of conflict.
NELUFAR: This is Izzeldin Abuelaish, a Palestinian doctor focusing on women’s health. He says providing access to things like menstruation products or birth control is essential.
IZZELDIN ABUELAISH: We need to speak about women and women’s health, to think of women in their reproductive period. We need to think, “What are your needs at that time? As an adult, with all of the challenges women are facing. So it’s time to face it.
NELUFAR: Sadly, women also face the threat of sexual violence, even after they’ve accessed resources from aid providers.
SHABIA: This is a really horrible issue that women and girls may often have to contend with.
NELUFAR: Again, this is UNHCR’s Shabia Mantoo. According to the UN, a staggering one in five refugees or internally displaced women experience sexual violence.
SHABIA: When you’re displaced, you are in a precarious situation. When you’re forced to flee your home, you don’t have the same social protections often that you might have in your home and your local communities. Many also who are on the move, they are quite vulnerable to predators who might try to exploit them or harm them. So there are difficulties within their journey to safety. And then also on arrival, when they end up in another country, they may be strangers to that community, to the society. And then also, you’ve got situations when you are displaced and affected by poverty, by difficult circumstances, trying to establish a life in exile.
NELUFAR: This is something that Leena Al-Mujahed has seen firsthand. She fled violence in her home country in Yemen to live in Malaysia. Thousands like her fled to Malaysia, since it was one of the few countries that offer Yemeni people visa-free entry. But when she arrived, she saw how women were often in danger.
Women and kids, they are under a real dangerous situation, because they — sometimes, they become surrounded by people who know that their situation is not good, so they abuse them. So for the woman, because she is a refugee, she hasn’t the opportunity to work, or legally she cannot work. So they become abused many times from people around them, because they know that she cannot tell anyone, because they know that there is no country to protect them. There is no place they can go to. There is no family here to support them.
NELUFAR: Additionally, these desperate situations can sometimes force women into awful positions, says UNHCR’s Mantoo.
SHABIA: You’ve got situations when you are displaced and affected by poverty, by difficult circumstances, trying to, to establish a life in exile. There are also a myriad of other factors that might force you to resort to what we would call harmful coping mechanisms, but — things like being forced to sell your savings. To be put in a position of vulnerability where people might take advantage of that. So there are really heightened risks.
NELUFAR: The UNHCR considers sexual violence against women to be amongst the gravest of human rights violations, and stamping it out requires a multifaceted approach. This starts with partnering with local groups to help with reporting, protection and prosecution.
SHABIA: We also have hotlines established, and we would support those as well, as communication channels for survivors, for people to report or also maybe receive support in case management. And then it’s also critical to work with refugee- or displaced-women–and-girl-led organizations who are at the frontline in preventing and responding to these violations as well.
NELUFAR: One of these organizations is the Yemeni Refugee Women Association, founded by Leena Al-Mujahed.
LEENA: I started my work on 2019. I started when I was working with a lawyer here in Malaysia, and I was receiving many cases of women being abused. So I felt that time that they had haven’t the platform to share their stories, and they haven’t someone, anyone to hear them and to understand what they are going through.
NELUFAR: She says her main goal is to be a voice to advocate for women, many of whom have a limited education.
LEENA: We focus on the education and livelihood empowerment, and we support sexual violence cases, of course. So hopefully we can spread awarenesses, how many challenges they are facing to survive as women, as mothers and sisters, as daughters.
NELUFAR: All of this becomes a frightening situation when you consider that the United Nations says that more than half of all displaced people are women and children needing extra care and getting much less. It’s true enough that no matter where you come from, women have a tougher time accessing resources and face higher levels of systemic oppression. When a person becomes a refugee, if they’re women, the threats they face, the lack of resources they have access to and the ways that they are disadvantaged because of their gender — well, it all rises sharply. It’s no wonder, then, that our partners in making this season of Course Correction wanted us to highlight the issues with women and refugees.
Next time, on Course Correction:
[WOMAN SPEAKING IN DARI; SOUND OF COUGHING IN BACKGROUND]
There are all kinds of people here that live inside apartments, and I live on the street inside a container.
NELUFAR: [SPEAKS IN DARI] It sounds like there is somebody coughing in the background, a child. Are they OK?
[WOMAN SPEAKING IN DARI]
FEMALE TRANSLATOR: Yes, that is my child. It’s cold and snowing. Now we set fire to some plastics to heat our child. We gather around, but the smoke makes them cough and sick. Only Allah knows our situation.
NELUFAR: We’ll be exploring trauma and other mental health burdens in part three of our series next week.
A little breather here, then. I know some of those stories are hard to hear, but we’re sharing them with you because we believe hearing directly from refugees is vital to understanding the gravity of their circumstances. Oftentimes, we can feel powerless when we hear about struggles happening thousands of miles away. This is a good time to remind everyone that there are many aid agencies like the International Red Cross and Doctors Without Borders that are there on the frontlines helping refugees every day. Look for links to them, as well as other aid organizations, in the notes section of this podcast as well as our website DohaDebates.com.
Another way to get involved is to use your voice. Tell others about the situation, and push leaders and decision-makers to take action, not only to help refugees, but also to address the factors that are causing conflict. As a first step, something you can do is participate in our listener challenge. Each week, we’ve been asking our listeners and those following UNHCR and Doha Debates to try and put themselves in the shoes of a refugee and report back to us on what they’ve learned. This week, we’re going to focus on access to health care. Tell us about a time when you were able to make a difference for someone with a health care problem, disability, or chronic pain or illness, and what the outcome of it was. We’d love to hear from you on our social channels, on Facebook, Instagram and Twitter. We are @DohaDebates. Or you can reach out to me directly. I’m @Nelufar. We’re also featuring our list of challenges on the UNHCR and Doha Debates Facebook pages. So join the conversation there as well.
That is our show today. Course Correction is hosted by me, Nelufar Hedayat. This season we’re partnering with UNHCR, the UN refugee agency. Production assistance comes from Foreign Policy, with producers Manveena Suri, Anisa Pezeshki and Claudia Teti. The managing director of FP Studios is Rob Sachs. My thanks to Ramin for speaking to me, UNHCR for arranging the interview and to Abdul Basir for providing an English transcription. Our show is brought to you by Doha Debates, which is a production of Qatar Foundation. Our executive producers are Japhet Weeks, Amjad Atallah and Jigar Mehta. Join us for the next episode of Course Correction wherever you get your podcasts.