The Syrian Refugee Struggle No One’s Talking About

shutterstock_258671000Yesterday’s New York Times ran a story about how migrants rushing to cross Europe, though resourceful and adaptable, are facing a new threat they can’t evade: winter. But there is another thing that the girls and women among the migrants cannot avoid, and that is their monthly menstruation. Few among us would grab extra underwear and sanitary pads when fleeing our homeland with our dearest life possessions on our backs, and we do not yet know enough about the lived experiences of this mass of migrating humanity and the specific challenges facing the adolescent girls and women among them. That’s why it is essential to understand what governments, and the humanitarian response community, are doing to meet the menstrual-related needs of this population.

Mentioning menstruation in light of the many trials and dangers confronting the migrants (i.e. hostile armed guards, large walls being rapidly constructed at borders, crossing oceans in shaky rafts, the arrival of winter) may appear to be at best, irrelevant, and at worst, unimportant. I would argue that it is neither.

When large masses of humanity are displaced or on the move, privacy is a rare commodity, and material items are limited to what can be carried on one’s back. It is very difficult to imagine how girls and women are able to manage menstrual blood flow as they walk endlessly across fields or alongside train tracks without easy access to toilets for changing sanitary materials, or water for washing blood off their hands and bodies. It is similarly hard to imagine how they can avoid humiliating menstrual stains on their limited clothing supply when packed onto platforms in train stations not designed for huge numbers of people to live in for extended periods, or when crowded onto boats for days or hours at a time. It is also unclear where girls and women are supposed to purchase or find the sanitary supplies they need when on the road for days or months at a time, frequently in towns or cities hostile to their presence. Or pain killers to relieve menstrual cramps as they march, and help them to endure. Few news reports so far have spoken to this issue, although we hear reports of facilities being established in border areas, with occasional mention of the provision of water.

When generous volunteers show up at train stations and border crossings with boxes of donated goods, the handouts often include food items, clothing, soap and other essential items in short supply. It is less clear if people think to include sanitary pads, tampons or other materials needed by menstruating girls and women on the move. This might include changes of underwear, soap and buckets for washing out stains. We do know that some members of the public have risen to the occasion, including women’s groups in the U.K. and Germany who have been gathering sanitary pads and other items needed for menstrual management to distribute to the migrants. However, as we recently learned, sanitary pads are not one of the approved goods that girls and women can purchase with vouchers in the refugee camps in Jordan.

Although half the world’s population is female, ongoing taboos hinder open discussion about this very basic physiological function, and strong coordinated responses are required to meet the needs of girls and women in a given crisis, be it migrants crossing Europe or displaced people across sub-Saharan Africa. While we talk openly about building latrines in displacement camps to prevent the spread of infectious disease, we talk much less comfortably about how to assure that girls and women have private, safe spaces for managing their periods, and the sanitary materials they need, so that they can engage in activities essential for their survival—such as standing in line for food, or continuing their trek to freedom and safety across foreign lands.

This issue is not new or novel to the migrants crossing Europe, and there are growing efforts to speak more openly about menstrual management in order to assist girls and women in emergency contexts. When renewed fighting erupts in South Sudan or an earthquake strikes in Pakistan, the humanitarian response community arrives and focuses on assuring access to water, basic sanitation and shelter. They sometimes also address the needs of menstruating girls and women, either indirectly through the building of latrines, or directly through the building of separate toilets for girls and women, the construction of private washing stations, or the handing out of kits that include underwear, soap, buckets and sanitary pads or cloths.

However, the emergency community still lacks standardized measures for assessing girls’ and women’s menstrual-related needs, and for monitoring responses to assure they are effective. So for example, was only one kit handed out to a family with five daughters and are there enough supplies of cloths, underwear and pads for all the girls and women of reproductive age in the family? Are the latrines constructed in a location that girls and women can access safely? And is there water located inside the stalls to assure they can rinse out menstrual stains without embarrassment?

While there is growing interest to engage on menstrual management in emergencies, as exemplified by the work being done by Oxfam, Save the Children and UNICEF, these efforts still face challenges since there is a lack of standardized guidance and no coordinating mechanisms in a given emergency.

Fortunately, more attention is being paid to developing systematic responses to menstrual management in emergencies. The International Federation of the Red Cross has begun studying the effectiveness of the distribution of the kits containing materials intended to enable menstrual hygiene management and to assure the right contents are incorporated for a given emergency. More recently, the International Rescue Committee and Columbia University initiated a project in which they will partner together with the larger humanitarian response community to develop a streamlined toolkit for improving response to menstrual hygiene management in emergencies.

There is still a long way to go in ensuring girls and women can manage their menstrual periods with dignity, safety and privacy in difficult circumstances of displacement and mass migration. However the simple act of overcoming the taboo to openly talking asking about menstrual management needs in such circumstances would be a great place to start. It opens the door to actually doing something.

If you’d like to donate to an organization responding to menstrual hygiene needs in humanitarian emergencies, try The International Rescue CommitteeOxfamSave the Children or UNICEF.

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Photo via Shutterstock


Marni Sommer is an associate professor of sociomedical sciences at the Mailman School of Public Health at Columbia University, and a public voices fellow with The OpEd Project. She has conducted research with girls on menstruation in Tanzania, Ghana, Cambodia, Ethiopia and Pakistan, and publishes books for girls in low-income countries about puberty and menstruation. 


  1. Amal Killawi says:

    We’re talking about it! Earlier this year, we collaborated with NuDay Syria, a Syrian relief organization based in Boston, to launch a crowd funding campaign to provide feminine hygiene care to Syrian women and girls. Our campaign concluded with more than $20,000 in donations and 421 supporters. The campaign provided 2050 women with feminine hygiene kits. Hygiene kits were also provided for 203 elderly and disabled Syrians, another often marginalized group. We hope to launch another campaign in the near future. Link to our campaign:
    Thank you for this piece and for addressing a need that is often overlooked.
    Amal Killawi

  2. Menstruation is such an important topic. It is easy to forget that having access to tampons, pads and even clean underwear is a luxury for some. Thanks to the organizations who are helping the refugee women – and thank you for shining light on this topic!

    We shared it on our feminist website:

  3. Two words: menstrual cups. These things can be made cheaply using modern manufacturing techniques, they’re reusable so the ongoing cost and convenience becomes moot, and then the camps don’t have thousands of used pads and tampons to dispose of. Give one to every female of the appropriate age, and let them keep their vouchers for the other many things they need.

    • Agreed but how are they supposed to sterilize the cups in difficult environments such as refugee camps?
      Plus, not everybody likes to carry about an object in their vagina (I myself hate tampons, and they hurt).
      Menstrual cups are overrated.

      • They can be boiled, in any situation where there is water, a pan, and a heat source. Or washed with bleach, if there is, say, a toilet and means to clean it. But even without any of that, a cup washed clean in water would be a sight better than no cup, one towel which must be washed and dried before re-use, or a bundle of rags. If you can’t clean a discreet silicone cup, how on earth do you wash and dry a towel?

        There are of course preferences in these things, and choice is so important – but if I were a refugee, my cup is one of the first things I’d pack.

    • Personally I know 2 women who were using menstrual cups and both of them suffered later on infection of the uterus. The latter has only found out after she got pregnant, which resulted in constant bleeding, hospitalisation, antibiotics treatment and drugs to keep the baby, with giving birth in 27th week of pregnancy. No matter howm much they polute our inviroment, disposable pads are still the safest and best product for menstruating women, especially for those in enviroments such as mentioned above.

    • One thing to consider is that menstrual cups, like tampons, are hugely taboo in many countries. As others have commented, Days for Girls International provides women with reusable cotton pads that require very little water to wash! They are also launching the Thread of Hope Fund to provide refugee women with the opportunity to make and sell these kits to make money for themselves! It’s amazing what this organization is accomplishing, especially since it’s only been around for 8 years!

  4. Cotton pads. I will donate to a cause to distribute cotton pads. They are reusable for upto 5 years. Sterilisation is not a problem only water if accessible. They are cheap to make and fairly cheap to buy. Far more sustainable and economical and accessible for these women in need. I will do some research to see if I can’t do something.

    • We are actively working on a solution! The lack of water in Syria makes it difficult for the women to wash cloth pads, but we are actively searching for ways to make this a possibility. I have been working to start a team of volunteers in Lebanon to help supply Syrian women that have come there with cloth kits, as they do have a water supply. Please contact if you would like more information!

    • Vicky Bratsch says:

      Absolutely. Washable reuse able! Days for Girls organization does this. Includes 2ziplock bags for washing the flannel liners.

  5. Claudia Wakim says:

    Menstrual cup`s like LadyCup or Diva might take the ease of such things as the constant need of new tampons or pads. Maybe one has to consider not one-time items like mentioned above, but cups that can be re-used hundred times. And these menstrual-cups can stay with the woman/girl without causing TTS or some other infection-related desease.

  6. I have been twice to the Serbian / Croatian border. We have an endless supply of sanitary pads for women that are freely offered, as well as wet wipes (and baby diapers). Women will only accept sanitary pads if offered by other women, and in relative privacy. Tampons are not well received for cultural reasons, and I would not even recommend for fear of toxic syndrome. Anything reusable such as cups is a no no as water is limited to drinking water, and again we come against cultural limitations. Pain drugs for cramps? Firstly the Czech volunteer team has no accreditation for distribution of any drugs, and secondly, believe me, it is not the first and foremost of the medical worries. At official camps with more of an infrastructure (such as Opatovec on the Croatian side) there are better hygienic facilities with showers. Before the Autumn cold set in we also distributed underwear, however at this moment in the cold no one is ready to remove clothes out in the open. This is most likely not openly discussed also because the Syrian and Afghani refugee women themselves would not consider it a topic they would openly discuss with strangers…

    • candice3224 says:

      Soolaima, thank you very much for the work you are doing for the refugees. I’m sorry, but I can’t help but add: if there wasn’t for the wars and conflicts in Syria, Libya, Afghanistan, Iraq and other countries, there wouldn’t be the desperation of the refugees. Yes, I do personally think the United States has caused a lot of the conflicts by trying to overthrow the relatively secular governments, but the bottom line all these wars and conflicts are caused by patriarchal society. The United Nations stands by and lets these conflicts continue. Here in Canada, we tend to believe most of the refugees are relatively modern. Maybe we are naïve in Canada, but whether the refugees are relatively modern or very traditional, they are all fleeing wars and conflicts.

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