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Below you will find a copy of the main stories that
appeared in the February 2005 edition of the QWHN News.
RESPONDING TO THE HEALTH NEEDS OF
REFUGEE WOMEN
The 20th century can be
seen as one of great accomplishment with achievements such as space
exploration, the microchip and computer technology, and the advancement of
health sciences that enable transplantation of organs, improving the life
of many in western countries.
However, it can also be
seen as a century of turmoil and conflict with war and disputes occurring
in most decades and the rise of terrorism often creating further
destruction amongst civilian populations. The outcome of these conflicts
and disputes has been millions of refugees and displaced persons.
WHAT IS A REFUGEE?:
Under the United Nations Convention, a refugee is defined as “a person who
has a well founded fear of persecution on the grounds of race, religion,
nationality, membership of a particular social group or political opinion,
is outside the country of his nationality and is unable, or owing to such
fear, is unwilling to avail himself of the protection of that country, or
who, not having a nationality and being outside the country of his former
habitual residence, is unable or, owing to such fear, is unwilling to
return to it.” (Allotey, 2003: 1).
Australia has offered
protection to over 620,000 refugees and displaced persons over the past 50
years and today is one of 16 countries with a program for the resettlement
of refugees run in cooperation with the United Nations (Victorian
Foundation for Survivors of Torture, 2004).
WOMEN AT RISK: It
has been extensively documented that the health needs of refugees are
often more complex and numerous than those of migrants and the Australian
born population (Allotey 2003 54; VFST 2004; 13). Many refugees have also
spent considerable time in countries of asylum where they are regarded as
unwelcome and burdensome aliens.
Women are often the most
seriously affected refugees and their needs often go unnoticed. Due to
their vulnerability, the UN High Commissioner for Refugees has created a
subcategory of refugee visa status for “Women at Risk” (VFST, 2004).
A MULTITUDE OF ISSUES:
War or conflict has a
particular impact on women in the following areas: Sexual crimes—resulting
in psychological trauma, risk of sexually transmitted infection, HIV
infection, pregnancy and ostracism from their community.
The disruption of
infrastructure including health,
education and
transport and the redirection of government funding to military purposes
increases the burden on women as primary carers.
The effect on women’s
daily life due to loss of partner results in changed roles and dislocation
from community and extended family supports (Wareham 2003).
These factors are further
influenced by women’s experience in the settlement environment of the host
country which can include loss of family and social supports due to
absence of family members, guilt about family remaining in refugee camps
or areas of conflict, limited access to religious institutions and
their cultural
community. The stress of learning a second language, adjusting to a new
culture
and the different
role of women in that culture, and undertaking the practical activities to
establish their new life further adds to the difficulties refugee women
face ( VFST, 2004; Allotey, 2003).
PSYCHOLOGICAL, REPRODUCTIVE AND NUTRITIONAL ISSUES:
While the health issues
for refugees are varied and complex, three areas that affect women in
particular are psychological health, reproductive issues and nutritional
issues.
Many women arrive as
widows or unmarried mothers often caring for an extended family including
children, grandchildren, younger siblings, nephews and nieces. The loss of
partner and family support can impact on their mental health and wellbeing
due to the change in their traditional role and the burden of
responsibility in adapting to the new role as head of the household.
Further impacting on this
is the adjustment to a new culture and often a new language. Social
isolation is another factor that can exacerbate mental health issues as it
is often difficult for women, especially those without partners, to attend
language classes or find work due to their parenting responsibilities.
There is also the psychological impact of previous experiences of sexual
crimes. (VSFT 2004; Allotey, 2003)
The issues of
reproductive health include sexually transmitted diseases and poor access
to maternal health services resulting in fertility problems. Female
Genital Mutilation can result in ongoing problems such as pain and
infection, and can affect fertility, childbirth and continence.
As health services have
often been minimal as well as disrupted by war these women have not had
access to basic health screening such as pap smears or mammograms, or to
family planning services.
Nutritional issues result
from living in a war area or refugee camp where there is a scarcity of
food compounded by inequitable distribution discriminating against women,
especially women without partners (Palmer & Zwi, 1998). These issues can
be further complicated on arrival in their host country due to lack of
preferred food and unfamiliarity with purchasing, storage, preparation and
cooking facilities (VSFT, 1998). Health issues resulting from inadequate
nutrition include iron deficiency anemia, and early identification is
important.
Refugee women often
experience difficulty accessing health care services due to language
barriers, economic constraints, cultural differences and uncertainty with
regard to the host country’s model of health delivery. Settlement issues
such as housing and education often take priority over health for the
newly arrived women. Exacerbating this can be a mistrust of health
professionals and government authorities.
QUEENSLAND INTEGRATED REFUGEE COMMUNITY HEALTH CLINIC:
The Queensland Integrated
Refugee Community Health (QIRCH) Clinic was established as a result of a
need identified by the refugee community and health and community workers.
The QIRCH clinic is auspiced by the Queensland Program of Assistance of
Survivors of Torture and Trauma (QPASTT) in partnership with Queensland
Health, Mater Health Services, Sisters of Charity & Holy Spirit Health
Services, and Brisbane Inner South Division of General Practice. More
than 20 community agencies came together in the establishment of the QIRCH
Clinic.
The aim of the clinic is
to provide culturally sensitive health services to newly arrived refugees
with complex health problems, to orientate newly arrived refugees to the
Queensland health system and to build the capacity of health services and
the community to provide appropriate ongoing health services to this
group.
The clinic is staffed by
Community Health nurses and volunteer general practitioners. All health
professionals working at the QIRCH Clinic are upskilled in the area of
refugee health and are familiar with health issues that are not commonly
seen in this country. Some health issues identified at the QIRCH clinic
include Post Traumatic Stress Disorder, parasitic diseases, injuries
resulting from torture and trauma and women’s health issues such as
urogenital fistula resulting from complicated child birth and lack of
obstetric services.
Professional interpreters
are used for all appointments unless the client requests otherwise.
Initial health assessments are attended and interventions commenced. In
relation to women, this includes addressing fertility issues, family
planning and preventative health screening in an open and relaxed
environment.
Where necessary,
referrals are made to appropriate specialist clinics and ancillary health
services such as dental clinics, physiotherapy, counselling services and
continence clinics.
All appointments are
thirty minutes to an hour allowing the health professionals ample time to
explain procedures and address concerns expressed by the clients. Once the
immediate health needs are attended to and any necessary investigations
performed, the client is referred to a general practitioner in their
community.
When referral is made to
another health service, including medical specialists, outpatient
departments, GPs and ancillary services, QIRCH clinic staff offer
education with regard to specific health issues and how to provide a
culturally sensitive consultation process.
While the refugee
experience is difficult for all, women are amongst the most vulnerable.
Psychological,
reproductive and nutritional issues are some of their most pressing
concerns. The QIRCH clinic provides a culturally and gender sensitive
health care setting to provide maximum support and assistance to this
vulnerable group.
Alison Stewart, General Practitioner
Lyn Duncan, Clinical Nurse
Queensland Integrated Refugee Community Health Clinic
REFERENCE LIST
Allotey, P., Ed. (2003)
The Health of Refugees: Public Health Perspectives from Crisis to
Settlement.
Melbourne, Australia. Oxford University Press
Palmer, C., & Zwi, A.
(1998). Women, Health and Humanitarian Aid in Conflict. Disasters
22(3):236-249.
Victorian Foundation for
Survivors of Torture, VFST. (2004). Towards a health strategy for refugees
and asylum seekers in Victoria, Melbourne.
Wareham, S. (2003)
Speaking Notes. “Women and War”. Medical Association for Prevention of War
(Australia).
PUNITIVE IMMIGRATION POLICIES IMPACT ON WOMEN'S HEALTH
There are families
living with zero – minimal income support and inadequate access to
health care due to restrictions imposed by visa requirements or whilst
they wait for deliberations from the Department of Immigration,
Multicultural and Indigenous Affairs, and this can have a serious impact
on their health, especially the health of the women.
Luse Naborisi was a
Fijian mother of 4 and the president elect of the Townsville Multicultural
Support Group Inc. (TMSG) 2003-2004 . The pressure of her family’s visa
status meant that she constantly minimised her own health needs for other
priorities. A diagnosis of bowel cancer in January 2004 was too late as
secondaries to her liver were already in progress. She passed away July
2004 without the comfort of her mother who was denied access to visit or
to attend her funeral.
Luse’s determination,
bravery and focus on her family’s needs are typical of women in general
but it is important that, in acknowledging the bravery and strength of
women like Luse, we don’t minimise or ignore a system that creates the
situation where women seeking residence in Australia are expected to
ignore their health needs while they wait for decisions about their
residency or visa status.
Luse’s family is one of
many families whose health is severely affected by their ‘statelessness’
in Australia. We have a ‘no fault’ clause in our Family Law when couples
separate and the same could be applied to separation of country. An
application to live in Australia should not be judged as a reason to
punish or deny essential human rights and needs.
Asylum seekers on
Temporary Protection Visas rarely come to Townsville. However, there are
people here on bridging visas awaiting decisions for applications for
permanent residency, wives of permanent residents and families of students
who may be restricted in the numbers of hours they are permitted to work,
are restricted in accessing Medicare and other community supports, are
restricted in the income support they are eligible for from Centrelink,
which in turn impacts on affordable housing options. Substandard
accommodation is accepted or overcrowding occurs.
It is the women of these
households who are primarily affected by the demands and stress of
overcrowding or of substandard accommodation, and this pressure impacts on
their physical, mental and emotional health.
Women living in these
circumstances are intent on ensuring other members of the family survive.
They put at risk their own health – denying themselves regular meals,
medical visits or the opportunity to attend community and social
occasions. They may actively avoid social contact to avoid the
embarrassment which comes from having little material support to
contribute to the occasion.
It is an additional
concern when relatives are denied entry to the Country to visit and offer
support to sick relatives due to the visa status of the family member here
in Australia. Again - a punitive irrational measure.
Communities experiencing
these difficulties in Townsville include the Pacific Islanders, some
Papuan New Guineans, Tokelauans and other isolated cases from Countries
all over the world.
Women around the world
demonstrate enormous strength in responding to inequitable and unjust
systemic laws. The price they pay is too severe. In Australia, we need to
encourage and support women living in these circumstances to seek early
medical assistance. Also, we need to advocate for their applications for
residency and to lobby for changes to unjust and punitive policies.
Meg Davis
Coordinator Townsville Multicultural Support Group Inc.
TRAFFICKING IN WOMEN: A SERIOUS HEALTH PROBLEM
Trafficking in women and
children for sexual servitude is an area of great concern for me. It is a
serious health issue for a high number of women in Australia, not only for
those who are trafficked, but for the other sexual partners of those who
use trafficked women. These women are forced to service large numbers of
men and are subject to physical and mental violence. They are often
obliged to have sex without condoms and so have an increased risk of
sexually transmitted infections including HIV/AIDS. Pregnancy and forced
or unsafe abortions and the use of drugs and/or alcohol in order to cope
with their abuse combine with the lack of access to health care to
exacerbate their health problems.
My interest in working
against Trafficking began in 1994 when I saw vulnerable women standing
along isolated stretches of an Italian autobahn. My companions, who
seemed to barely notice the women, told me they were from Albania and had
come to Italy for work; they were dropped along the road by their pimps.
Soon after I returned to Australia the Grail, an international women’s
group I belong to, established a network on trafficking to help Eastern
European women avoid the traps of traffickers. I then realised that the
women I had seen on those Italian autobahns would have been among those
tricked by traffickers. I wondered what had been their fate and I
determined to do what I could to work against trafficking.
Finding ways to actually
do anything practical in Sydney was not easy, however I joined the email
list of The Coalition against Trafficking in Women (CATW-Australia)-
www.catwa.com.
I was glad to hear
two of its members, Sheila Jeffreys and Mary Sullivan, speak at the
Townsville International Women’s conference in 2002. These strong
feminists are very active in Melbourne which is also the base of Project
Respect -
http://mc2.vicnet.net.au another group which works against
trafficking. From these organisations I learnt much about the situation
and realised the scope of the problem in Australia.
The US State Department's
2004 Trafficking in Persons Report lists Australia as a destination for
sex slave trafficking. Their team found more than 60 cases of trafficking
networks, and more than 300 women forced to work as sex slaves in
Australia. Both CATW-Australia and Project Respect calculate the number
far higher than 300.
The Australian
newspaper’s shocking reports in 2003 of the death in the Villawood
Detention Centre of a Thai woman, Puangthong Simaplee, heightened
awareness of the issue of trafficking. Since other Grail members and
friends wanted to know more about trafficking I organised a seminar which
highlighted the causes of Trafficking –clarifying that it is caused by the
demand for sexual service by the users - rather than resulting from the
poverty of the used; and explaining the significant differences between
people smuggling and trafficking.
Those at the seminar
decided on several actions – to find and share more information about
trafficking and to write letters, with questions that needed answering, to
Federal and State politicians and Local Council members. We also
approached Kathleen Maltzhan from Project Respect about other actions we
could take. Because most trafficking networks are linked to organised
crime we needed to better understand which actions will help, not harm,
the trafficked women. She has agreed to meet with us early this year.
As a result of the
seminar and prior to the federal election I was asked to speak at a
meeting organised by Women and the Australian Church (WATAC) to question
politicians from each of the parties about their trafficking policies.
Members and candidates from Federal Labor, Democrat and Greens parties
attended. The Liberal Party did not attend but referred us to its Action
Plan to Eradicate Trafficking in Persons (www.australia.gov.au/),
which was formulated after a Joint Parliamentary Committee Inquiry. This
Inquiry received submissions from many concerned groups and individuals.
Unfortunately it seems to fail to appreciate the size of the problem
maintaining that “Australia is a destination country for a small number of
victims of trafficking.”
Australia has signed the
United Nations
Trafficking Protocol to Prevent, Suppress and Punish Trafficking in
Persons, especially Women and Children
which supplements the
Convention against Transnational Organized Crime
introduced in 2000. The Protocol criminalises trafficking as a human
rights abuse and requires signatories to use Legal, Social, Educational
and Cultural means to address demand and to ensure victims are given
permanent or temporary visas, which are not tied to witnessing against
traffickers. However Australia has not yet introduced legal measures to
ensure we comply with the Protocol. Both Project Respect and CATW-Australia
believe it will be more difficult to introduce measures to reduce demand
now
that prostitution
has been legalised in some Australian States.
The National Council of
Women of Australia stated in its submission to the Parliamentary Committee
Inquiry that “the widespread influence of sexual services both legal and
illegal is undermining our communities and promoting attitudes to women
which lower respect for all women and destroy personal relationships.”
This view seems to me to
be reflected in the federal government’s concern with values education.
Legislation to pass, and enforce, the laws needed to ratify the
Trafficking Protocol will surely help to build communities with strong
values where women and men respect human rights for all. Please join me in
doing what you can to put an end to the degrading trade that is
trafficking.
Mary Robertson
The Grail
LESBIAN HEALTH SURVEY RESULTS
During 2004, Marg
Piggott, a student of Swinburne University in Melbourne, conducted a
large-scale survey of lesbian health issues.
Lesbian women from 21
countries participated in the survey with highest representation coming
from Australia, United States, Finland, Canada and England. The study
examined the impact of growing up in homophobic and woman-devaluing
societies upon the well-being of adult lesbians. Results of the survey
demonstrated that societal homophobic and misogynistic practices are
related to increased depression, lowered self-esteem and psychosexual
difficulties for lesbians. Lesbian women from all countries were affected
to some degree by societies’ negative attitudes and beliefs about women
and homosexuality. Lesbians who were more open about their sexual
orientation and had more contact with the lesbian community were less
likely to experience symptoms of depression, had better self-esteem and
reported less psychosexual difficulties than other lesbians. The results
of this survey highlight the personal and social impact of homophobia and
misogyny. Cross-cultural comparisons demonstrate the pervasiveness of such
practices and the impact for lesbians from all countries.
For further information
or more specific survey results contact Marg Piggott on (03) 9802 7584 or
margpiggott@ozemail.com.au
If any QWHN readers have been involved in other research projects carried
out on Women’s Health issues that may be of interest to members—please
forward details for possible inclusion in future editions of the QWHN News
to
qwhn@bigpond.com.au
HELP
FOR WOMEN VICTIMS OF TSUNAMI
Following the devastating earthquake and tsunami in the Indian Ocean on 26
December 2004, members of the Queensland Women's Health Network have been
particularly concerned about the plight of women survivors and their
children. The following interview was conducted in Aceh by journalist
Sari P. Setiogi of
The Jakarta Post
on 10 January 2005.
Activists are calling on women across the country to help ease the
suffering of women and child victims of the quake-triggered tsunamis in
Aceh and North Sumatra. Speaking at a press conference with the State
Minister for Women's Empowerment and the United Nations Development Fund
for Women (UNIFEM), women's activist Debra Yatim said that surviving the
tsunami was not the end of the problem for many Acehnese women and
children. She spoke of a woman and her two-month-old baby who were
miraculously found alive after a couple of days floating in the sea after
the disaster. "She wanted to breast-feed her baby as she was told it might
be the safest way considering there is almost no clean water available in
Aceh with which to mix baby formula at the moment," Debra said. However,
after being deprived of food and having a lack of proper rest, she was
producing less and less breast milk, she added.
Women's issues, however, were not touched upon at the recent emergency
summit on the Asian tsunami. "There was no discussion on the solution for
women-related problems that might appear after the tsunami," said UN
ambassador of Millennium Development Goals (MDG) Erna Witoelar. The
problems might include stress, sexual harassment and human trafficking. In
a hope to overcome the problems, the Office of the State Minister for
Women's Empowerment has set up an aid emergency centre, focusing on aid
that might be needed by women and children. "We provide them with
underwear, sanitary napkins and diapers for babies, something that might
be missed by other institutions," said State Minister for Women's
Empowerment Meutia Farida Hatta Swasono. She also called on all Indonesian
women to help each other. "It was a massive natural disaster and we should
work together to manage the recovery process until all women and children
there are able to have their normal lives back. There should be a
sisterhood," she said. The minister's office has arranged three main tasks
of the centre for the next six months in a bid to protect women victims in
the affected areas. The office also pledged to set up trauma centres in
Aceh as well as shelters for women and children to help them recover from
the trauma of their ordeal as well to reunite them with their families, if
possible.
"I also highlighted the threat of child trafficking at this time of
emergency, as many of them might have lost their parents. These young
children are vulnerable and helpless," Meutia said. She added that her
office would also set up child protection centres in refugee camps to deal
with child-related problems. "The centres will be responsible for
registering children, supplying them with basic needs, tracing and
reuniting them with their families," said Meutia.
The office has also organised some 380 child psychologists for counselling
children in Aceh. In the long term, it will provide some 1,000 shelters
for women with vocational skills to help them move on with their lives.
Sari P. Setiogi, The Jakarta Post
(10 January, 2005)
Website:
www.unifem.org
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