Safe spaces for women in challenging environments
Authors: Şevkat Bahar Özvarış, Hedvig Hricak
Journal: The Lancet Global Health (2019)

For women in high-income countries, it is a promising sign that the European Congress of Radiology—one of the world's largest meetings of medical professionals—this year featured a new and well attended programme addressing the need for greater gender equality in the workplace. The programme, entitled Women in Focus—Be Inspired, aimed mainly to examine the reasons for gender imbalances in academic and leadership positions and to encourage women to identify and pursue their priorities, whether career-based or personal objectives. However, one of the programme's sessions, Safe Spaces for Women in Challenging Environments, was a sobering reminder that, for millions of women worldwide, the struggle for basic human rights eclipses the goal of gender equality, and that these women must not be forgotten. The session described a pioneering project in Ankara, Turkey, that provides health-counselling centres for refugee women and girls. Through a simple, community-oriented framework, this project brings hope to shattered lives by rebuilding confidence and empowering women to support each other across the boundaries of race, culture, and tradition. At present, the number of forcibly displaced people is the highest ever recorded globally, with around 25·4 million refugees worldwide, the majority of whom are women and children.1UNHCR—The UN Refugee AgencyFigures at a glance.https://www.unhcr.org/en-us/figures-at-a-glance.htmlDate accessed: April 8, 2019Google Scholar, 2Global Fund for WomenSpotlight on Turkey: women on the ground discuss growing crisis, threats.https://www.globalfundforwomen.org/women-discuss-crisis-in-turkey/Date accessed: April 8, 2019Google Scholar Turkey alone hosts about 3·6 million Syrian refugees, and the need to support women displaced by war is well established.1UNHCR—The UN Refugee AgencyFigures at a glance.https://www.unhcr.org/en-us/figures-at-a-glance.htmlDate accessed: April 8, 2019Google Scholar, 2Global Fund for WomenSpotlight on Turkey: women on the ground discuss growing crisis, threats.https://www.globalfundforwomen.org/women-discuss-crisis-in-turkey/Date accessed: April 8, 2019Google Scholar, 3Directorate General of Migration Management (Ministry of Interior, Republic of Turkey)Migration statistics: temporary protection: distribution of Syrian refugees in the scope of temporary protection by year.http://www.goc.gov.tr/icerik6/temporary-protection_915_1024_4748_icerikDate accessed: June 11, 2019Google Scholar Women in crisis situations are especially susceptible to sexual and reproductive health problems—frequent causes of illness and death in women worldwide—and also face heightened risks of sexual violence and exploitation.4Inter-Agency Working Group on Reproductive Health in CrisesMinimum initial service package for reproductive health: advocacy fact sheet.http://iawg.net/wp-content/uploads/2015/09/MISP-Advocacy-Sheet-IAWG-FINAL-Nov09.pdfDate accessed: April 8, 2019Google Scholar, 5UNHCR—The UN Refugee AgencyWomen.https://www.unhcr.org/women.htmlDate accessed: April 8, 2019Google Scholar, 6Inter-Agency Working Group on Reproductive Health in CrisesMinimum initial service package for reproductive health.http://iawg.net/minimum-initial-service-package/Date accessed: April 8, 2019Google Scholar One of the most important international documents recognising refugees' sexual and reproductive health needs and rights is the Minimum Initial Service Package, (MISP), developed through the Inter-Agency Working Group on Reproductive Health in Crises.6Inter-Agency Working Group on Reproductive Health in CrisesMinimum initial service package for reproductive health.http://iawg.net/minimum-initial-service-package/Date accessed: April 8, 2019Google Scholar MISP focuses not only on preventing maternal and newborn deaths and illnesses and planning for comprehensive sexual and reproductive health care, but also on preventing sexual violence and managing its consequences. Since 2015, Hacettepe University Women's Research and Implementation Centre in Ankara, Turkey, has established three women's health-counselling centres for refugees that offer services within the scope of MISP.7Hacettepe University Women's Research and Implementation CentreStrengthening access to sexual and reproductive health and sexual and gender based violence services for syrian and other refugees thru women and girl safe spaces (WGSS)/women health counselling units project.http://www.huksam.hacettepe.edu.tr/English/HUWRICProject180618.pdfDate accessed: April 10, 2019Google Scholar This initiative (entitled Strengthening Access to Sexual and Reproductive Health and Sexual and Gender Based Violence Services for Syrian and Other Refugees thru Women and Girl Safe Spaces/Women Health Counselling Units Project) receives technical support from the UN Population Fund and financial support from the European Civil Protection and Humanitarian Aid Operations.7Hacettepe University Women's Research and Implementation CentreStrengthening access to sexual and reproductive health and sexual and gender based violence services for syrian and other refugees thru women and girl safe spaces (WGSS)/women health counselling units project.http://www.huksam.hacettepe.edu.tr/English/HUWRICProject180618.pdfDate accessed: April 10, 2019Google Scholar Together with its partners, the UN Population Fund encourages humanitarian actors, policy makers, and donors to become more aware of and to implement MISP. A key strength of the counselling centres established by Hacettepe University Women's Research and Implementation Centre is that they employ refugees in caring for the refugee community: of the 34 personnel employed at the centres, 23 are refugees. The staff include project coordinators, social workers and psychologists who speak Arabic, Iraqi doctors and nursing staff, Syrian women working as cleaning personnel and translators, Turkish female security personnel, and 15 female Syrian refugees acting as health mediators. The health mediators are the pillars of the programme's success, serving as bridges between their community and the centres, and as role models for other refugee women. These mediators are chosen from among refugees who have used the centres' services and formed long-term, trusting relationships with the staff. Their education levels are above average in their community, and they receive additional training on topics relevant to the centres' work. The centres offer refugees individual counselling and training on sexual and reproductive health concerns (eg, sexually transmitted infections and family planning), as well as health services such as prenatal and postnatal care, contraception, and referrals to other institutions. Individual counselling and psychosocial support are also provided for women struggling with gender-based violence or other difficulties. Gender-based violence prevention activities include education about types of gender-based violence, child marriages, protective social mechanisms, national policies, and relevant local services. Legal counselling on refugee rights is offered, and visits to public institutions are organised to elucidate available public services and how to apply for them. The centres also provide much-needed opportunities for female refugees to socialise. Women who visit can meet each other and communicate with the Arabic-speaking staff, and can also engage in various activities, such as group outings to the city, yoga, and courses on drama, jewellery design, and the Turkish language. Furthermore, as refugees often face harmful discrimination from their host community, the centres organise meetings to improve cross-cultural understanding. Despite the modest number of staff employed by these centres, their work has touched many lives: they have so far provided more than 28 000 sexual and reproductive health services and more than 12 000 services for gender-based violence. Perhaps even more telling of the profound value of these centres are the words of one refugee who joined their staff: "I would feel so lonely when I stayed at home, doing nothing. After I started to visit this centre, I felt psychologically relieved and my mood improved. I feel that I have changed. It is the first time I have ever worked. I feel so different." The successes of these centres show that culturally sensitive, community-oriented health care, education, and support can bring positivity into the lives of many women who have been affected by conflict and displacement. We hope that this example will inspire more people to become involved in supporting women in a similar position. We wish to thank Deniz Akata of the Department of Radiology, Hacettepe University Medical School Hospitals (Ankara, Turkey), and Ada Muellner of the Department of Radiology, Memorial Sloan Kettering Cancer Center (New York, NY, USA) for assistance in drafting the manuscript. HH serves on the Board of Directors of Ion Beam Applications and receives annual compensation for this service. The project described in this Comment is technically supported by the UN Population Fund and financially supported by the European Civil Protection and Humanitarian Aid Operations, neither of which had any role in the preparation of the manuscript.