Katie Morris – “It turns out that humanitarians also care for their own.”

The Mahama Refugee Camp, located on the border of Rwanda and Tanzania, opened in early 2015 in response to increasing numbers of Burundian refugees fleeing growing tensions in Burundi. In this post, Katie Morris, a 2014 PFMH/MSPH alumnus, reflects on World Humanitarian Day and the work of her emergency response health team in the Mahama Refugee Camp.

[22 August 2015]

This past Wednesday, August 19th, was “World Humanitarian Day.” Perhaps there is no better place to celebrate than in the new Mahama Refugee Camp, on the southeast order of Rwanda and Tanzania, where humanitarians in their color-coded t-shirts, caps and vests are anything but hard to spot as they buzz around building shelters, feeding mothers, collecting information on adolescents, and contemplating the impending later shortage problems. They’re a diverse group – mostly Rwandese or Burundian, over worked, under paid, dehydrated, and stressed. You’d have no clue though, unless you looked at their timesheets, budget lines, cracked lips, or nightly sleep cycles. Instead, their faces show smiles and compassion, their work reveals endurance and aptitude.

Over the past 2 weeks, my team of humanitarians have more than earned their red vests and caps. They’ve taken an arid plot of land scattered in lumpy brush and sloped down towards a river, and made it into a functional health post. A team of 2 doctors, 3 nurses, and 3 Burundian medical students has cared for more than 1,000 sick patients in the first week of operation.

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At the end of July, Mahama Camp was stretched beyond its capacity with 32,500 Burundians settling within its cramped borders. UNHCR camp management decided to hold the newly arriving Burundian refugees in the transit centers on the border for a couple weeks while NGOs expanded capacity for shelter, food, water, and health care in the camp.

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The organization I work for took on the challenge of the health post, located in the new area of the camp and designed to address the outpatient health needs of 10,000 new arrivals and reduce the growing burden of sick patients crowding the camp’s only health center. Since August 10th, around 900 new refugees are bused into the camp from the transit center each day. There are estimated to be around 17,500 Burundian refugees waiting in the transit centers, anxious to get away from the horrors they experienced trying to leave their homes, hopeful they will be reunited with loved ones, and desperate for the basic needs promised upon reaching Mahama Camp.

On Wednesday (World Humanitarian Day) it was my turn to take the triage shift for the incoming convoy of new arrivals. Of course, being one of those days where nothing seemed to be going the way it should, the convoy was delayed and they weren’t expected to arrive until 6 or 7pm – the time we are usually en route to our office back in the nearest town, having closed up the clinic. That evening, as my colleagues were all packing up for the day, I was trying to find a way to change my attitude into a better one, so that I too could wear my red vest and cap without people knowing how exhausted, anxious, and frustrated I felt.

It turns out that humanitarians also care for their own. Instead of getting into the land cruiser that was waiting to take them back to the office and onto their homes after their already-12+ hour work days, my staff decided that they were going to stay and help me and a colleague receive the new arrivals in a gesture of pure solidarity. Our team, in our uniforms of red, wandered across the bush to wait for the dust storm that would signify the incoming convoy of new arrivals.

The buses started arriving moments before sunset and the timing was just right to catch the expressions of the boys, girls, women and men as they disembarked with arms full of blankets, high energy biscuits, and oddly shaped bundles of worldly belongings. They were herded into corridors for the police to check their bodies and belongings, and then directed to a line where they would wait for porridge and a place on the floor of a hanger to sleep. That’s the instant my attitude changed.

Their expressions in that moment of disembarking revealed the emotions that I realized I would be experiencing if it was me in that convoy. Their faces showed exhaustion, fear, hope, hunger, excitement, resignation. I think that for them, it was a point that “shit got real.” They had traded their lives of insecurity in Burundi for the status of refugees in Rwanda and anxiously awaited confirmation they had made the right choice. But for me, this was the point that I realized that they were not the “1,000 new arrivals” or even “Refugees” as their new ID cards proclaimed. These people are individual humans feeling the same emotions that any one of us would feel in their same situation. I am so grateful for the short glimpse of their expressions that night, against the setting sun, because it enabled me to share in their humanity and completed the picture of why those humanitarians in their color-coded caps and vests continue the endless work they started.

That night, after tending to several feverish children and an older woman having a panic attack, our team in red piled into the Land Cruiser after a 16 hour work day and had a dance party along the bumpy road–grateful for the humanity we all shared, humanity that manifested itself in emotional vulnerabilities, goofy dress codes, and Rihanna dance tunes.

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http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61489-1/fulltext

Be a Man-Respect Women! Challenging Gender Norms in Bosnia and Herzegovina and across the Balkans

Arielle Juberg – Bosnia and Herzegovina – August 10, 2015

Arielle Juberg, a current PFMH/MSPH graduate student, conducted her practicum with the Young Men Initiative, a program in the Balkans that seeks to promote healthy lifestyles, reduce violence among young men, and prevent gender-based violence.

As a New Yorker, I’m used to keeping track of my time. Six hours of sleep, three hours at work, one hour on the subway; my days are neatly broken up into separate responsibilities and activities. When I read that Public Health and Humanitarian Assistance (PHHA) students were required to spend eight to twelve weeks in an international practicum, I tried to convert this into my hours-and-minutes mode of thinking. Unlike most other certificates at the Mailman School, which measure practicum activity by the hour, the PHHA certificate measures the weeks that students spend completing public health research abroad. Logistics may account for part of this difference; it can be difficult to quantify ‘working hours’ when your job is interrupted by electricity outages or long trips through rural areas. Within a week of my arrival in Bosnia and Herzegovina, I realized that the difference between measuring ‘hours in the office’ and ‘weeks in the field’ is more than just numbers on paper. If we are seeking to contribute positive changes in another country and culture, we must seek meaningful and genuine interactions with individuals and communities outside the environment.

I arrived in the city of Banja Luka in May with few contacts and fewer leads on a place to live. With only ten weeks in the city, renting an apartment seemed unnecessary, while a long hotel stay would be extravagant. Luckily, I found a room to rent with a family whose members included a toddler (I’ll call him Ben). On my first weekend in Banja Luka, Ben, his mother, and I walked through the city. Banja Luka is the second-largest city in Bosnia and Herzegovina, with an estimated population of 200,000. The city is well-known for its parks and green spaces. We wandered into one of the parks so Ben could play. Almost immediately, he noticed a shiny blue tricycle by the playground. Ben is currently infatuated with anything with wheels and quickly claimed the tricycle as his own.  As he happily rode around the playground, the owners of the tricycle, who may have been 3 and 5 years old, took notice. First, they followed him, yelling for him to stop peddling. Next, the older one attempted to stop the bike and pull Ben off. He yelled at his brother to punch Ben. Finally, the younger one cemented himself in front of the bike, grasped the handlebars, and thrusting his head forward, snarled at Ben.

How did a 3-year old and a 5-year old learn to yell, intimidate, and punch? Why were these the first actions they took when faced with the loss of their tricycle? Even as an adult, their immediate and aggressive behavior frightened me. While it may be inevitable that children argue over toys at the playground, their behavior reflects the acts they’ve witnessed and the lessons they’ve been taught.

In many countries, including Bosnia and Herzegovina, boys are brought up to be tough, dominant, and strong. Showing emotions signals weakness, and dominance is determined through violent acts like yelling, bullying, and fighting. I saw this clearly reflected on the playground; when confronted with a problem, even toddlers resorted to physical and verbal violence. This pattern continues as boys get older, with the violence and its consequences growing more dangerous. Young men can be both the perpetrators and victims of violence. In a recent survey, young men in Sarajevo, the capital of Bosnia and Herzegovina, reported troubling levels of violence; 46% had punched, kicked, or beaten another young man in their life, 44% had humiliated a peer, and 46% had participated in a group fight in the past [1].

The harmful effects of a dominant masculine ideology go far beyond young men. Just as boys are taught to be strong and forceful, girls are rewarded for submissive and gentle behavior. These conflicting gender roles have been identified as one of the root causes of gender-based violence. Women may experience physical, sexual, or psychological violence when they disagree with a male member of the household or appear to challenge his authority. In a setting where violence is an established means of settling disagreements and establishing dominance, searching for a ‘reason’ for a specific violent act misses the point. When violence is a social norm, the least empowered members of society will always be vulnerable.

How do you change an established social norm? The Young Men Initiative, coordinated by CARE International with local NGO partners, seeks to reduce both interpersonal and gender-based violence by promoting gender equality and a positive, non-violent model of masculinity. The program has been implemented throughout the Balkans, including Bosnia and Herzegovina, Croatia, Serbia, Kosovo, and Albania. Through a series of interactive workshops led by facilitators, young men in high schools grapple with topics surrounding gender, gender norms, and violence. Early results show how the program can push back against established norms. In Kosovo, 69% of participants initially agreed that physical strength was a man’s most important quality; after the program, only 42% agreed with the statement- a statistically significant result [2]. Beyond the classroom workshops, the Young Men Initiative has launched Budi Muško (Be a Man) clubs in the high schools. The clubs, which include both young men and women, focus on combatting peer violence and gender-based violence while promoting knowledge of sexual and reproductive health. Budi Muško members plan awareness campaigns, host public events, and learn how to work with their peers concerning these topics. Through these clubs, young advocates work together towards a common goal and most importantly, take ownership of the campaign. In the future, they will be the leaders who work for a more equitable and non-violent society in the Balkans.

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Be a Man Club members from Banja Luka, Bosnia and Herzegovina raise awareness about the dangers of drunk driving (photo by Perpetuum Mobile)

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Be a Man Club members in Belgrade, Serbia (photo by Center E8)

This is what I’ve learned about going abroad to work for eight to twelve weeks. You may fly to your destination without knowing a soul, but you quickly develop close relationships. While I was in Banja Luka, I could help to protect Ben from the bullies who would punch and hit him for taking a ride on a tricycle. But I wasn’t there for too long, and I can’t protect him as he grows up. By targeting norms surrounding masculinity and violence, the Young Men Initiative can change the society that Ben grows up in. Tricycles will continue to be appealing, and children will undoubtedly still argue over toys at the playground, but violence doesn’t have to be part of this experience.

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Be a Man Club members from Mostar, Bosnia and Herzegovina participate in an event for International Men’s Health Week (photo by Youth Power)

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Be a Man Club members in Sarajevo, Bosnia and Herzegovina (photo by Association XY)