Survey results Health and violence endured by refugees
Survey results: Health and violence endured by refugees during their journey across Europe and in Calais, France Malika Bouhenia, Epicentre Jihane Ben-Farhat, Sandra Cohuet
Calais • Population: 70 000 • Unemployment: 20% • Former center for Kosovar refugees, informal settlements since 2002 • March 2015: “Jungle” opened • MSF-OCP: OPD in Calais and mobile clinics in Dunkirk 2 Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France
Photo credit: Denis Charlet / AFP 4 Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France
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Survey objectives • Primary objective Assess health status and access to care for refugees since their departure • Specific objectives Describe sociodemographic characteristics Describe routes taken to arrive in France Describe violence endured since departure Document future plans of refugees arriving in Calais 6 Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France
Methods • Survey: 23 Nov - 7 Dec 2015 • Geospatial simple random sampling – Target sample size: 402 • Questionnaires in 9 languages: – Arabic, Farsi, Pashto, Urdu, Kurdish, Amharic, English and French 7 Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France
Results: Inclusions 462 randomly selected Exclusions: 24 refusal 13 Tigrinya 400 men 8 25 women Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France
Sociodemographics Female % 95%CI 5. 0 3. 2 -7. 7 Marital Status 95%CI Occupation in country of origin Student 19. 2 15. 4 -23. 8 Single 67. 8 62. 6 -72. 6 Retail 15. 7 12. 3 -20. 0 Married 31. 4 26. 7 -36. 5 Agriculture 13. 3 9. 9 -17. 6 Divorced 0. 5 0. 1 -2. 2 Construction 9. 6 6. 7 -13. 6 Widow 0. 3 0. 0 -1. 6 Engineering/IT 4. 1 2. 3 -7. 2 Teacher 2. 7 1. 5 -4. 9 Soldier/Police 2. 6 1. 4 -4. 6 Medical 0. 7 0. 2 -2. 0 None 15. 0 11. 4 -19. 6 Other 17. 0 13. 3 -21. 3 Highest education level completed 9 % None 19. 4 15. 4 -24. 2 Primary 20. 7 16. 4 -25. 7 Secondary 35. 0 30. 0 -40. 3 Tertiary 24. 9 20. 5 -29. 9 Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France
Origin of respondents Most common origin by country Ethiopia 1. 5 Kuwait Eritrea 3. 2 6. 9 Other 6 Sudan 33. 3 Syria 7. 3 Iran 10. 7 Iraq 12. 8 10 Afghanista n 18. 2 Country Sudan Darfur Kordofan Afghanistan Pashtun zones Mazar-i-sharif Azari Iraq Kirkuk Mosul Syria Deraa Aleppo Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France % 95% CI 80. 0 3. 4 71. 2 -86. 6 1. 4 -8. 4 44. 4 11. 5 6. 8 32. 6 -57. 0 5. 6 -22. 2 2. 7 -16. 4 21. 3 8. 8 10. 5 -38. 4 3. 4 -20. 9 47. 0 31. 2 27. 5 -67. 4 14. 3 -55. 2
Respondent date of arrival in Calais 140 120 Number of arrivals 100 80 60 40 20 0 Feb 11 Mar Apr May Jun Jul Aug Month (2015) Sep Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France Oct Nov
Routes taken to arrive in Calais NB: Thickness of lines proportional to number of refugees crossing a given border 12 Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France
Travel time to arrive in Calais Origin Length of journey in days Median (IQR) Africa 399 (110 -741) Asia 90 (54 -372) Middle East 46 (20 -96) Overall 13 100 (41 -498) Country (if ever in the country) Length of stay in days Median (IQR) France (before Calais) 1 (1 -4) Italy 9 (3 -20) Greece 3 (2 -10) Libya 180 (60 -490) Germany 3 (1 -5) Turkey 7 (3 -30) Hungary 1 (1 -5) Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France
Medical problems during journey % Location of medical problem Calais 62. 3 France before Calais 7. 5 Libya 8. 4 Greece 7. 7 Turkey 7. 1 Type of medical problem Upper respiratory 44. 4 Lower respiratory 19. 1 Gastro-intestinal 7. 4 Trauma 6. 6 No access to care when needed Calais 39. 3 France before Calais 41. 3 Libya 69. 2 Greece 54. 1 Turkey 74. 2 14 95% CI 55. 0 -69. 0 4. 6 -12. 1 5. 1 -12. 7 4. 6 -10. 9 37. 6 -51. 4 14. 3 -25. 0 4. 6 -11. 9 3. 4 -12. 5 31. 0 -48. 2 18. 5 -68. 5 38. 9 -88. 8 26. 8 -79. 1 48. 3 -89. 9 Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France 61. 4% (56. 1 -66. 4) reported at least one medical problem during their journey
Violence during journey 65. 6% (60. 3 -70. 6) reported experiencing at least one act of violence during their journey 15 Location of violence Libya Calais Iran Bulgaria Type of violence Assault and battery Tear gas Repeated violence with forced detention Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France % 95% CI 30. 8 25. 3 9. 9 6. 9 25. 1 -37. 2 19. 9 -31. 6 6. 4 -14. 9 4. 4 -10. 7 45. 7 26. 9 39. 9 -52. 2 21. 4 -33. 4 14. 2 10. 1 -19. 6
Type of violence by location Number of violent acts 120 Other Repeated mental violence with forced detention Knife Firearm Repeated physical violence with forced detention Detention Tear gas 100 80 60 40 20 16 Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France da n Su ry ga Hu n ce ee Gr ga ria Bu l n Ira ya Lib Ca lai s Fr an ce be fo re Ca lai s 0
Violence rate by time spent in country 17 Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France
Planned next steps for refugees • 8. 3% (5. 5 -12. 3) applied for asylum in Schengen-zone Europe • 81. 5% (76. 3 -85. 8) planned to go to UK – Of whom 51. 5% (45. 4 -57. 6) already had family in UK 18 Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France
Discussion • • • 19 Population : Mostly single men, few Syrians Length of journey variable Minor health problems but poor access to care Violence common during journey and on arrival in Calais Limits of survey: selection and recall bias, exclusion of exclusively Tigrinya speakers Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France
Conclusions • • 20 First quantitative survey among refugees by MSF Not representative of all refugees in Europe Helps with advocacy Could serve as model for similar surveys Malika Bouhenia, Epicentre, Refugee health and violence survey, Calais, France
Acknowledgements • • • Saif Abdallah Klaudia Porten Serge Balandine Matthew Coldiron Survey respondents and survey staff MSF teams in Calais Thanks for your attention
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