The Syrian Refugee Struggle No One’s Talking About

Yesterday’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.