Box 6.3 Refugee outreach workers in Damascus
UNHCR developed new methods for reaching out to Iraqi refugees in Syria’s capital city, Damascus, mobilizing refugee women to identify and assist vulnerable fellow refugees living among the city’s more than two million inhabitants. The ‘Outreach Volunteer Initiative’ which started in 2007 is a model which could be replicated in urban settings elsewhere.
The exodus from Iraq
The outflow of refugees from Iraq following the US-led military intervention in 2003 intensified sharply in 2006, reflecting an upsurge in sectarian violence in Iraq. The refugees fled mainly to neighbouring countries, with the largest numbers settling in and around the Damascus and the country’s second-largest city, Aleppo. Only some of the refugees came forward to be registered by UNHCR. That number peaked in 2008, by which time UNHCR had registered more than 200,000 Iraqi refugees, or around 55,000 families—mostly in Damascus. Many, but not all, were well-educated and came from urban areas in Iraq, where they had previously held good jobs and enjoyed a relatively high standard of living.
A very large proportion of the refugees had experienced or witnessed egregious acts of violence in Iraq, and suffered emotional and physical consequences. In 2009, more than 30 per cent of the Iraqi refugees registered with UNHCR were assessed as being particularly vulnerable—up to 50 per cent when medical conditions were included. Many reported having survived torture and/or sexual or gender-based violence in Iraq.
In Syria, the refugees were safe but faced other problems: social isolation, a lack of supportive community structures, shifts in gender roles within families, deterioration in socio-economic status, and deepening poverty. The psycho-social well-being of many refugees was affected, notably men who often expressed feeling ‘not useful’ any more.
Almost 10 per cent of the families UNHCR registered in Syria reported mental health and psychosocial difficulties, such as symptoms of anxiety, depression, and other mood disorders, as well as physical exhaustion or pain. In some extreme cases, their suffering led them to harm themselves or others. Suicide attempts, child abuse, and other forms of domestic violence were reported.
Adapting to a new situation
Unlike many other situations of mass influx, the refugees were not accommodated in camps. UNHCR had little prior experience in dealing with large populations of refugees in urban areas and no blueprint to follow. The agency struggled to find the best way to make contact with the refugees, determine their needs, understand their intentions, and identify the most needy. Its difficulties in reaching the widely dispersed urban refugee population, combined with an underresourced psychosocial sector, few NGO partners, and a limited community-based support system, meant that UNHCR’s office came under pressure from large crowds of refugees who approached it every day.
Following the International Conference on addressing the humanitarian needs of Iraqi refugees and IDPs convened by the High Commissioner in April 2007 to draw attention to the crisis, international interest grew and UNHCR was able to mobilize substantial resources, rapidly scale up its activities, deploy more staff to the field, and develop innovative programmes to address the specifically urban characteristics of the situation.
One of these innovations was the establishment of a network of outreach volunteers and support groups composed of qualified refugees. Others involved setting up refugee community centres for social and recreational activities, and mass information campaigns addressed to refugees—using mobile phone text messages. UNHCR also opened an ambitious one-stop-shop facility on the outskirts of town, where the diverse needs of refugees could be attended to, from registration to counselling to food distribution.
Reaching out to the most vulnerable
But the most vulnerable refugees did not necessarily come forward for help. UNHCR realized that it would need support from within the refugee community to make contact with them. The Outreach Volunteers Programme, created in September 2007, was aimed at identifying vulnerable refugees in urban settings.
The initiative started when UNHCR invited some Iraqi refugee women to a focus group discussion, and proceeded to recruit volunteers to seek out vulnerable and hard-to-reach refugees. By 2009, UNHCR had engaged 76 volunteer caseworkers, covering 38 neighbourhoods in and around Damascus. The volunteers dealt directly with up to 7,000 cases per month, mainly through counselling, home visits, and by providing community support and services. Only a relatively small number of refugees had to be referred to UNHCR for follow-up action.
The volunteers were selected according to their willingness, ability, and acceptability to the refugee community. Preference was given to the recruitment of refugee women, who had easier access to at-risk households, in particular those headed by women.
All in all, 135 volunteers were given orientation on UNHCR’s mandate and code of conduct, training in communication and on effective ways to offer support and engage their community. They signed an agreement committing themselves to confidentiality and non-discriminatory approaches to refugees. Although they did not receive a salary, they did receive a small sum to cover transport and telephone expenses.
The functions of the volunteer workers included identifying and visiting particularly vulnerable refugees; providing counselling and practical assistance; facilitating refugee access to services; identifying and mobilizing community resources; improving UNHCR’s understanding of the refugee population; and supporting UNHCR’s public information work. In addition, the programme helped to restore hope and dignity among the refugee community at large, and among the volunteers themselves, who were not otherwise authorized to take up employment in Syria.
Strengthening national capacities
The volunteers played a particularly important role in addressing psychosocial difficulties among the refugees. Normally, UNHCR would address such problems by referring individuals in need of care to local mental health practitioners. But this was not possible in all cases in Damascus, as the Syrian mental health sector was under-resourced, with just 89 psychiatrists in the country for a population of around 22 million in 2010. The minimum ratio recommended by WHO is 25 times that number.
In 2008, in a further innovation, UNHCR established a Psychosocial and Mental Health Programme, which relied on resources within the refugee community to help other refugees, and also included a national capacity-building component.
By 2011, 17 of the 135 refugee outreach volunteers had been trained by the Psychosocial and Mental Health Programme in psychosocial support and first aid, and were helping to identify vulnerable refugees, provide counselling to refugees through home visits, and liaise with existing local mental health and psychosocial services. A larger group of refugee volunteers managed an Outreach Counselling Centre, set up by UNHCR in a refugee-hosting neighbourhood of Damascus, where 16 different psychosocial and recreational activities were available to refugees.
The national capacity-building element of the programme helped to strengthen local mental health and psychosocial support services, through training and curriculum development. Senior mental health professionals received training in working with refugees, and they in turn were able to support nonspecialized front-line staff.
With the extra capacity provided by refugee volunteers and the enhanced national capacity, UNHCR’s Psychosocial and Mental Health Programme had benefited over 6,000 refugee families by the end of 2011.
UNHCR does not view refugee outreach workers as a panacea. In Syria, their work was not easy to monitor, and there was significant turnover as refugees departed for resettlement. The preference for engaging refugee women, while justified under the circumstances, also raised questions in the context of the application of UNHCR’s Age, Gender, and Diversity Mainstreaming policy.
Nonetheless, the initiative proved to be a valuable means of reaching out to the refugee population. An internal evaluation found that it not only helped to bring a sustainable form of assistance to the most vulnerable refugees but also empowered the volunteers themselves, strengthened refugee representation and advocacy, improved relations within the refugee community, and between the refugee community and UNHCR.