Psychosocial Support for Refugees by Refugees in Cairo Egypt

1. “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) Psychosocial Support for Refugees by Refugees in Cairo Egypt

2. Brief presentation about Cairo, Egypt including: • Problems of refugee children and families. • Overview of local initiative the Psycho-Social Training Institute in Cairo (PSTIC) that provides mental health and psychosocial support by refugees for refugees. INTRODUCTION

3. NUMBERS OF REFUGEES IN EGYPT 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

4. REASONS REFUGEES COME TO EGYPT 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.

5. 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.

6. 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: • Problems for families due to urban context that can affect their children. • Special problems for children due to urban context. • Issues for vulnerable child groups like unaccompanied children, and children with special needs ie: protection, health, education etc.

7. POVERTY • Same issues as POOR Egyptian urban families crowded housing, poor hygiene and sanitation, diseases like TB… • Refugees cannot work legally. LACK OF EXTENDED FAMILY SUPPORT • At home, communities and extended families raised children together. • In Cairo, nuclear families isolated and more reliant on self yet limited resources. Problems for families due to urban context that can affect their children

8. Change in Male / Female Roles • In home country, most families had working fathers and mothers had full responsibility for caretaking of children and household. • In Cairo, little work for men. • Women are domestic workers. Long hours. Little time with children. • 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. FAMILY RELATIONS

9. NO OUTDOOR PLAY • In home country, play spontaneous with other children in rural area, or street. • In Cairo, little availability of physical activity and play. (Example: Opera House) • Families fearful of children playing outside due to discrimination, racism, street violence and verbal abuse. • Families concentrate on school and future. • Minimal parental awareness about importance of physical activity and play. Parents rarely organize play. • Play is TV. Special problems for children due to urban context

10. HEALTH • Poor availability of health care Limited UNHCR / Cost / National care not available easily. • Poor diet. Little awareness about need to for balanced diet. • 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. • Cognitive development may be affected by minimal stimulation. (Example: 6 and 4 year olds / NO language skills.)

11. LIMITED EDUCATION • Not allowed to attend Egyptian schools. • Refugee schools only primary. • Basic education. Classes crowded. • Only now have exams from Sudan with curriculum. • Secondary and university most often must be paid by family. • Iraqi children better opportunities. Families more able to pay for private schools. Yet, middle or upper class families high expectations and much disappointment. • Much pressure from families to do well in school.

12. HOPE Little hope for future opportunities. RISK TO LIFE Safety risks due to being home alone. Fall from balconies, gas explosions, fires. Desire for a better life leads to illegal border crossing to Israel or other countries. Children Shot. Killed. Wounded. Imprisoned.

13. UNACCOMPANIED MINORS • Many unaccompanied minors sent to find an education or work by desperate families who spent all their savings to send the children. • Communities take them in despite having few resources. Can be poor care, exploitation, abuse. SPECIAL DEVELOPMENTAL NEEDS • No special education services so children at home. INADEQUATE PROTECTION • UNHCR limited services and no support by Government services so little protection for child abuse. Issues for vulnerable child groups

14. 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.

15. 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. • UNHCR and other UN organizations • 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. • CBOs and created community services ASSESSMENT OF HELPING SERVICES PRIOR TO PSTIC

16. 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. CAIRO UTILIZES THE IASC MHPSS guidelines

17. 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 awareness raising of issues • Activating social networks through groups Community and family supports Level 2: Raising community and family supports Advocacy for basic services that are safe, socially appropriate and protect dignity Basic services and security Level 1: Social considerations in basic services and security

18. BEGAN Psycho-Social Training Institute in Cairo (PSTIC) GOALS Increase capacity of refugee communities, families and individuals to effectively help themselves and each other with psychosocial and mental health issues. 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. Increase the referral and support to refugees with mental illness needing treatment. Increase the capacity of organizations assisting refugees at all levels of assistance to integrate support for psychosocial well-being directly into their services.

19. 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) 3 hours a month of individual field based supervision by local professionals. Capacity building of Directors of organization PSTIC ACTIVITIES

20. 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.

21. 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 • 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 OUTLINE OF COURSE CONTENT

22. 1. Community basedassessment by refugees about refugees. 2. Community based psycho-education and awareness workshops and discussionsto build knowledge and self-help skills within refugee communities to understand, prevent and respond to psychosocial and mental issues including: How to cope with life as a refugee, How to make informed life decisions, Understanding and managing distress, Effective coping strategies, Living with traumatic experience Healthy child rearing practices Managing family conflict Understanding risks and managing substance abuse Health education etc. INTERVENTIONS BY PSYCHOSOCIAL WORKERS

23. 3. Outreach to “vulnerable” refugees in their homes and communities. 4. Support Groups for adults, families and children including: 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

24. 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.

25. Essential that PSTIC and its activities are sustainable. Refugee populations always have psychosocial issues! PSTIC partnered with: • Terre des Hommes to provide solid administrative base from which to operate, gain support and raise funds. • 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) • UNHCR for hopefully long term donor funding. SUSTAINABILITY

26. 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.

27. CNN doc See also link: http://edition.cnn.com/video/#/video/international/2010/11/23/ia.help.egypt.refugees.bk.a.cnn?iref=allsearch