By Saah Charles N'Tow
Introduction:
I recently returned from the Buduburam Refugee Camp in Ghana. The trip was
sponsored by the Black River Project (BRP), as part of a collaborative effort
with the Liberian Professionals in Rhode Island (LPRI). While the Black River
Project focuses on refugees’ health, Liberian professionals in Rhode
Island focuses on refugees orientation and adjustment to their new environment.
The trip to Ghana was an opportunity for both organizations to work together
to improve the conditions of the refugees living at the camp in Buduburam,
as well as to help improve the chances of speedy adjustment for those approved
to be resettled in the United States. Originally I was scheduled to travel
along with Paula Persechini-Pettiti, Executive Director of BRP but due to
unavoidable circumstances, she was unable to travel at the time. I was therefore
entrusted with the responsibility to represent the interest and concerns of
BRP during the visit.
The
main objective of the trip was to ensure that adequate preparation is made
for the coming of four Harvard University undergraduate interns to the camp.
The interns are expected to provide support to work at the camp’s clinic.
My task therefore was to gather and provide information to the interns and
put in place whatever necessary systems of support they might need to make
their stay meaningful. I was also to ensure that authorities and camp residents
understood why the interns are coming, and of the significance of having an
institution like Harvard University taking interest in the lives of Liberian
refugees on the camp. Another objective was to gather current information
about conditions on the camp and make recommendations as to how they could/should
be addressed.
Upon
arrival in the camp, I made immediate contact with members of BRP’s collaborating
partner, SHISFD: a local NGO entirely managed by refugees. SHISFD is the acronym
for “Self-Help Initiatives For Sustainable
Development”.
Together, we plan an itinerary for the rest of my stay. The itinerary included meetings with the following:
1.
Mr. John C. Thompson, Settlement Manager
2.
Mr. Francis Hinneh, Chairman 0f the Liberian Welfare Council
3.
Mr. Ishmael McGill, Chief Physician Assistant, St. Gregory Catholic Clinic
4.
Mr. Moses K. Bah, Chairman of the Central Education Board.
I am pleased to report that following our visit, everyone expressed excitement and appreciation to the Black River Project, Harvard University and SHIFSD for making this possible. There is however still a need for BRP to make formal contacts (as a matter of courtesy) with authorities of the UNHCR, Gomoa Buduburam Catholic Clinic, the National Catholic Secretariat and administrators at St. Gregory Catholic Hospital in Apam to inform them about the Interns. SHIFSD has already sent letters to the following individuals for the same reason:
1.
Dr. Charles
Takyi, Chief Medical Officer of Apam Catholic Hospital
2.
Mr. Fridoli
Tepeh-Mensah, Associate Community Service Officer UNHCR
3.
Dr. Lioc
Dufermont, Chief Medical Officer, Gomoa Buduburam Catholic Clinic
4.
Mr. John
Sackie of the National Catholic Secretariat (NCS)
The traditions of Africa lay emphasis on courtesy and respect, even if one
find him/herself repeating things that have already been done.
In
fulfillment of my final task, I have compiled a report that summarizes, the
history and current activities on the camp. It is by no means exhaustive,
but it may augment previous or simply provide new information. It relies heavily
on four sources ~ A rapid assessment study completed by SHIFSD, the
Buduburam Report compiled by journalist Abass Dulleh of Exile News
(a local paper reporting on refugees activities), the UNHCR’s Quantifiable
Standards of Assistance to Refugees and my personal observations, conversations
and interaction with residents of the settlement. My very special thanks
to SHIFSD for the warm reception, hospitality and courtesy accorded me during
my visit. I am also very grateful to the Black River Project (BRP) for the
opportunity to participate in such a worthy undertaking. Although there is
another Settlement at Zansole, my visit was entirely focused on Buduburam.
Throughout this document, the words “settlement” and “camp”
are used interchangeably. In separate document, I have compile information
regarding lodging and other relevant matters to the Interns, their productivity
and convenience in Ghana. There is also additional information, like statistics
gathered from the clinic that would be made available. Finally, I have made
several recommendations for the kind consideration of BRP. I am cognizant
of the size and focus of BRP’s operation and am aware that BRP may not
be able to directly address all the areas mentioned. Nonetheless, I am hoping
that BRP would consider helping to make the necessary links and connections,
where possible for local groups like SHIFSD to provide for their people.
Current Situation: The Buduburam Refugee Settlement is situated in
Buduburam, Gomoa District in the Central Region of Ghana. It is located approximately
45 kilometers from the capital, Accra. The Settlement was established in 1990
to host Liberian refugees who came to Ghana to seek asylum owing to the armed
conflict in Liberia. Originally, the Settlement was created on a 140-acre
parcel of land to cater to 5,000 refugees. However, due to the protracted
armed conflict, the refugee population in the settlement is currently at approximately
52,000 residents and has overflowed to nearby villages, including Kasoa, Awutu
and Feeteh. The increase in the refugee population has impacted adversely
on the scarce facilities and infrastructures at the camp. The attendant consequences
of the inadequate and overburdened facilities at the camp are a major concern
and challenge to humanitarian organizations and aid providers. Women
and children account for over 65% of the refugee population. A very large
percentage of the population, especially the vulnerable groups, including
women, children, elderly, disabled, sick, etc, are unable to support themselves.
The general standard of living at the settlement is below the poverty line.
Due to the relatively calm of the Liberian situation following the signing
of the recent Accra Peace Accord, some Liberians have started to make preparation
for the journey back home. Yet, the majority remains skeptical about the sustainability
of the peace process. With the history of more than 14 years in exile and
dozens of failed peace accords, these refugees have selected to wait and see.
On the other hand, there are still others who have formed roots in Ghana,
through marriage and have decided against returning to Liberia. Just before
my departure, a ship bound for Liberia was being loaded. Travel by car is
considered risky, since the best routes pass through what is considered “active
combat zones” in the Ivory Coast. There is a general feeling of fear
that the UNHCR will once again withdraw support from the residents like they
did in 2000, after the elections of 1997 in Liberia.
Background:
The first
batch of Liberian refugees arrived in Ghana in 1990 on board a Ghanaian military
vessel bringing Ghanaians citizens who were fleeing from the war. Having been
rejected in several African countries, it is difficult to believe refugees
on board the vessel could be allowed to dock in Ghanaian without the assurance
of support. UN secretary General Kofi Anan therefore made a special offer
that any country accepting would be given humanitarian support by the United
Nations. Thus when they arrived, the refugees officially began receiving assistance
from the UN refugees’ agency from 1992 to 1997. In 1997 the UN carried
out a voluntary repatriation exercise during which 3000 of the refugees returned
to Liberia. In June 2000 the UN suspended all forms of humanitarian and material
assistance to the refugees using the out come of the 1997 elections as its
reason. The Liberian refugees were left vulnerable without assistance in all
forms - food, water, medicine, education, etc. The agency however continued
(even now) to support economic and political refugees from Sierra Leone, Togo
and, Nigeria in who are residing in Zansole and Buduburam.
In 2002 the UN refugee agency announced the resumption of relief and material
assistance to the refugees whose population at the time was estimated at 30,000.
Under the new assistance program, the UNHCR opened sub-office on the camp
to provide legal aid to the refugees who may have fallen into trouble and
to follow up cases to ensure that refugees were given due process. The UNHCR
also gave assurances for the construction of a new school, as well as to provide
support the refugee clinic, and to engage in a wide range of other assistance
programs on the camp. Finally, under the new assistance program, counseling
would be provided on Wednesdays.
Camp
Management:
A Settlement Manager assisted by a pool of Liberian professionals, runs the
camp. The Ghanaian government through the office of National Disaster Management
Organization (NADMO) appoints the Settlement Manager. He is responsible for
the overall supervision of the residents and activities on the camp. He is
assisted by a Welfare Council, whose leadership until recently was elected
by the residents. It is the Camp Manager now appoints the chair of the Welfare
Council. While the Camp Manager work to protect the interest of the Ghanaian
government, the council is expected to ensure that this is done with the welfare
of the residents in mind. The work of the camp’s leadership is supported
in varying ways by a host of public, private and other organizations, both
camp-based and external, including the UNHCR, churches, international and
local NGO.
The
Buduburam Refugee Settlement is divided into 12 Zones. Amongst the 12 zones,
the actual settlement property is divided into 9 zones and the remaining 3
zones are outside the property and within the village. The entire administration
of the settlement has been decentralized with over 90 volunteer workers. The
division of the settlement into zones was done arbitrarily with no record
of geographic information. Albeit the availability of some data relating to
the identity of structures on the settlement, there is no map or even a sketch
to show the location of each structure, including the dwelling homes, community
schools, churches, clinics, etc. Without adequate geographic information,
it is difficult to verify the total acreage of the land occupied by the refugees
and the usage of the land.
There is reportedly no comprehensive and/or effective registration information
tracking system of the camp’s residents. Not all residents of the settlement
are refugees and many Liberian refugees registered under the settlement are
not residents of the settlement. A fairly large number of registered
refugees reside outside the settlement in Kasoa, Awutu and even in Accra,
Tema and Kumasi. In October 2003, the UNHCR and the government of Ghana conducted
a joint registration of the refugees in the settlement. However, this exercise
would soon become obsolete if an effective registration system is not in place
to monitor the constant influx and departure of refugees. An effective registration
system will be vital very vital to the future repatriation of the refugees.
The registration conducted by the UNHCR recorded 42,000 refugees, but conversation
with the Welfare Council Chairman, Mr. Hinneh revealed that an addition 10,000
refugees registered after the process was officially concluded.
The
United Nations High Commission for Refugees (UNHCR) is the lead organization
providing assistance and protection to the refugee community in the settlement.
Ideally, the UNHCR (complimented by other NGOs, CBO, etc) is supposed to ensure
the provision of water and sanitation, food and health care, electricity and
security, sports and entertainment, and all amenities that would enable refugees
to live with dignity and safety in the country of asylum. Unfortunately, the
lack of adequate funding and resources make the current situation of programs
of assistance to the refugee population in the settlement is challenging,
though not insurmountable. This is further compounded by the developing attitude
to Liberians around the question of repatriation. Many in authority have begun
to ask when would the Liberians return? Refugees on the other hand are saying
that while return is inevitable, it is clear that the country is not ready
to absorb all it returning citizens. Some estimate that there will be at least
2-3 years of waiting and preparing for the ultimate return. The challenge
for them there is “what do they do while they wait?”
Sanitation:
The
settlement suffers two major problems relating to sanitation: limited or no
latrine facilities for families and poor refuse collection and the lack of
a functional waste management system.
The
inadequacy of affordable or free toilet facilities in the settlement has compelled
residents to utilize an area of woodland on the outskirt of the settlement,
commonly referred to as the “Gulf”. Although, dangerous for many,
including children, especially young girls, residents continue to use the
gulf as a space to answer nature’s call. The shades of tree and its isolation
from the camp make the gulf a suitable place for rapists, murderers and child
molesters to ply their detestable trades. There have been several reports
of small children disappearing and found murdered later, after they had gone
to the gulf to ease themselves. Women (young and old) have been raped while
attending nature’s call in the gulf. Nonetheless, the gulf remains the
best choice for the thousands who are unable to afford the fee to use the
European built camp toilets. But the Gulf is being threatened by the rapid
expansion of the camp, as more houses are built in parts of the gulf. Consequently,
many have begun to transform their backyard into toilet facilities, by digging
holes, which they cover after use. Unfortunately, it is sad to note that where
one backyard stops, the front of another begins.
One
distinct feature of the settlement is the unmistakable stench of sewage. The
improper waste water (often sewer) disposal practice in the settlement, insufficiency
and poor maintenance of drainage; poor garbage collection and disposal system
and the conspicuous absence of trained volunteer sanitation workers to manage
the sanitation activities, have compounded the mounting sanitation crisis
in the settlement. The refugees have been carrying out periodic cleaning up
exercises intended to give the camp a face-lift. The UNHCR and the Assembly
in whose district the camp is located have assisted this effort. The Paramount
Chief of the Gomoa District, Akempim donated three refuse containers to the
refugees and the UNHCR donated a refuge truck. Besides, the European Union
has built several toilets in the camp. The settlement lacks properly maintained
drainage facilities. The sewage system, constructed in the 1990s is filled
with rubbish and other filths due to the lack of maintenance. As a result,
mosquitoes and other dangerous insects feed on them and transmit diseases
to and amongst the refugees: the sanitation problem at the camp has been causing
health hazards and cholera diarrhea water borne diseases and other tropical
diseases.
In
its quantifiable standards of assistance to refugees, the UNHCR identified
the following gaps in its services to refugees residing at Buduburam:
·
The need for additional latrines (to meet standards, in principle some 1,880) and numerous bathhouses will need to be constructed, following further assessment
·
The settlement would need to be frequently fumigated against vector infestation
·
The need for additional refuse collection points to be constructed. To meet standards, some 790-collection points would be required...
·
A waste disposal system will have to be established and maintained jointly with the District authorities
·
Soap will have to be distributed to needy refugees
Despite the above acknowledgement, the UNHCR has yet to address most, if not all of the gaps listed.
Recommendations:
1.
Given the serious security and health risk involved around
the limitation of latrines, it is my recommendation that BRP persuades UNHCR
Ghana and camp’s authorities revisit the idea of charging refugees for
the use of latrines. Even with the proposed increase, many refugees will continue
to use the gulf, because of the fees charged for usage latrines on the camp.
This being a policy issue, I believe that BRP can pursue this matter with
the appropriate authorities, both in the US and in Ghana.
2.
The sustainability of a good and sound sanitation system depends to a large extend on the population involved. It is my recommendation that BRP considers supporting the effort of SHIFSD to launch an environmental awareness and training program, with the aim to increase the understanding and capacity of residents to keep their environment clean. Such effort will significantly reduce the risk and spread of diseases transmitted by mosquito and other insects.
Water
The scarcity of water is a major problem in the settlement. Reasonable
quality (not systematically tested) water is sold, while many resident depend
on rain or water from makeshift wells for survival.
Water
is not provided to the population by the UNHCR and there are no functional
borehole and pumps in the settlement. Those who can afford it buy water from
commercially operated mobile tankers as well as potable water in plastic sachets.
This therefore leaves a considerable number of refugees without safe water.
As the result, many refugees have had to walk long distances in the scotching
sun to fetch for water on the outskirts of the settlement. The settlement
has only three hand pumps donated by the Church of Jesus Christ. Some residents
of the settlement have complained that the water is salty, but are managing
with what’s available so far.
Currently, the worst affected area is zone-10 extension (former area-U). The area hosts 2400 refugees of the 52,000 population of the camp. The area has only one tiny hole, which is 12-feet deep. Those who drink from water from the hole have to form long queues and wait for the hole to draw water from the ground. According to residents, on the best days, it takes about 1-2 hours to fill a three-gallon container. Residents dug the hole one and a half years ago. It is bounded by gardens and situated only a few yards from one of the toilet houses built by the European Union. The residents use the water to drink, bath, wash, cook and water their gardens. There are nearby reservoirs where water is being sold but apparently most of the residents cannot afford money to pay for it. According to the co-chairman of zone-10, Mr. Benjamin E. Witherspoon, prior to the digging of the hole, residents made several attempts to locate the water table but to no avail. “And we have been trying to dig some more but it was not been possible due to the hardness of the ground” he said.
Recommendations:
In view of the foregoing, it my recommendation that (Independently or in partnership with the relevant agencies and local partners like SHIFSD), emphasis be placed in the following areas:
1. BRP should encourage the construction of a minimum number of shallow wells (at least three) or water towers to provide safe and affordable water in areas of the camp where there are high concentration of residents.
2. Through training, BRP should work to increase residents’ sensitivity to the need for conservative use and management of water.
The
health care system on the camp is grossly inadequate at best and simply terrible
at worst. There is currently only one functional clinic, a joint venture between
the UNHCR and the Winneba-based St. Catholic Hospital on the camp. Unlike
other provisions, services at the clinic are available to nearly 82,000 (52,000
refugees and 30,000 locals) and is offered at a cost to residents.
The
Clinic is seriously understaffed, with one qualified physician ~ Dr. Lioc
Dufermont, a Frenchman. A Liberian physician assistant, Mr. Ishmael McGill
along with a small number of Liberian nurses and health care workers (mostly
women), assists him. The National Catholic Secretariat of Ghana manages
the clinic sponsored by the UNHCR. Bed occupancy rate of the 11-bed clinic
frequently exceeds 100%, with many patients spending the night on examination
table or being turned away due to overcrowding.
It
is reported that 95% of the children under 5 in the settlement have been vaccinated
against measles. The UNHCR reports that so far, 1,438 children and 1,000 adults
identified to be suffering from micronutrient deficiencies, with 225 children
seriously malnourished (although the actual number is expected to be considerably
higher). No service at the clinic is free and there is no waiver system for
the needy refugees, especially the vulnerable groups. Accordingly, the biggest
concern around health care on the settlement is the usability of the clinic.
With an average admission of 1,466 during the 1st quarter of 2004
(less than 3% of the total target population), there is no wonder why many
residents see the clinic and its modern facilities as mere cosmetics intended
to paint a good picture for camp and UNHCR authorities. Some clinic authorities
are reportedly concern that residents are avoiding the clinic because of the
fees.
There
are reportedly many Liberian nurses and midwives on the camp who are unable
to legally practice. Despite the exponential need for their services, they
must obtain a local license/work permit to practice (only within the limits
of the camps). In order to obtain the license/work permit, they have to pay
about US$150 and an additional 80 cedes to the National Nurses and Midwives
Association. Unable to meet such requirements, many have resulted to unregulated
home practices. As a consequence, some of these practices have often resulted
to loss of life. There are a number of private clinics and scores of pharmacies
within the neighboring communities of the settlement that provide health services
on a cash basis. There are no community primary health care programs
in the settlement to direct and coordinate epidemic control, essential drug
services, public health education, nutritional survey and awareness.
The
UNHCR has provided the clinic with an ambulance, but until late April, residents
were expected to pay 65,000 cedes to use it. Many residents recall the experience
of one school’s administer who had to watch his daughter die in his arm,
because he could not afford the money to pay for his daughter’s transportation
in the ambulance. There is an unconfirmed report, that since late April, the
ambulance service is being offered free. A new annex 350 million cedes annex
was recently constructed by the UNHCR to expand and upgrade the clinic’s
capacity.
The population of the camp includes a significantly large number of sexually active residents. Accordingly, there is an alarming rate of HIV/AIDS related and other sexually transmitted infections, especially among young mothers and teen-agers. There are no drugs available to treat HIV/AIDS. Sources at the St. Gregory Hospital in Winneba report that most deaths from the camp are HIV/AIDS related. Although there are attempts by local refugees organizations to provide health information around prevention, it is hard to sustain such programs without the requisite funds. The busy nightlife on the camp with nightclubs and prostitution make the threat of the spread of HIV/AIDS and other Sexually Transmitted Infections more urgent.
Recommendations:
In view of the above, it is my recommendation that BRP considers the following:
1.
Continue exploring opportunity to Invest in HIV/AIDS Awareness training and campaign – through partnerships with Wendy (California), SHIFSD and the Ghanaian Red Cross. This would increase the capacity of the residents to deal with the issues, as well as sensitize them to the day-to-day benefits of safe sexual practices
2.
Support effort to lower or eliminate fees for the clinic. This can be achieved through the provision of medicine and other needed supplies, as well as by persuading the authorities to take the appropriate actions. It is worth noting here that the UNHCR recognizes this as a major gap in health care provision to refugees on the camp.
3.
Support the utilization of local Liberian health care workers, by working to ensure the reduction or elimination of the high cost of licensing fees.
4.
Provide training to clinic staff
5.
Mobilize for at least two more doctors to assist the work of the current doctor and replace him when his term ends.
Education: There are forty-three registered schools under the supervision of the central education board. Most of these schools are run by religious organizations, private entities and community-based NGOs. There is very limited secondary school and territory education. Reportedly, the enrollment for the 2003/04 academic-year was estimated to be around 14,966. Of this figure 7,000 students dropped out of the school system. This considerably dropout rate is due to the inability of parents to pay school fees. Also, existing classrooms in various schools are highly congested. The estimated student/classroom ratio is 50:1 and in very few instances up to 130:1. Inadequate instructional materials and lack of school administration further compound the problem. Student/teacher ratio is reportedly 90:1. However, more than 70% of teachers are untrained. A Central Board of Education, run entirely by the residents, coordinates the activities of schools on the camp.
Prior to the full withdrawal of support in 2000, the UNHCR built the Buduburam Secondary Senior Secondary and the Buduburam Junior Secondary School. But seeing that the school was inadequate to meet the changing needs of the growing refugee population, many church and other organizations began building other schools. The Lutheran Church runs an elementary school on the camp; the Christian Interdenominational Assembly or CHREDA has built an elementary school. Other individuals and agencies have also set up schools on the camp. Additionally, Archbishop Dr. Augustus B. Marwieh in 1997 established the Agency for Holistic Evangelism and Development (AHEAD). This church related project provides vocational training such as Community Health, Business, Journalism, Agriculture, etc. to the refugees amongst others.
Education is not free. Students have to pay tuition and other fees to remain in school. For example, the Buduburam Refugee Secondary High School had been running on a private basis. At the moment, students in the high school section are paying ¢750,000 (USD $95) for a calendar year while students in the lower class pay ¢500.000(USD $65.00). This is why some parents cannot afford money to send their wards to school. As a result, a lot of school dropouts are found roaming around the camp’s video centers, night chubs and other entertainment centers. Many kids living on their own or who serve as breadwinners for their family are vulnerable to exploitation and varying types of abuses, including child labor, prostitution and crimes. Wayward children as young as 10 are seen pushing wheelbarrow while others especially girls go around to wash clothes for living.
A social analysis survey conducted by the UN refugee’s agency and the National Catholic Secretariat in January 2000 found that child labor was prevalent on the camp. According to the survey, the problem ranges from the lack of access to Medicare and educational opportunities especially for children. The survey stated that the first group of these children comprises 214 children struggling for survival and that the children could be considered as orphans because they were separated from their parents as a result of the war. The second group of people according to the survey numbers about 567, who arrived in Ghana, but were abandoned and had to fend for themselves as result. Rev Osei- Agyemanf, the General Secretary of the National Catholic Secretary stated during a program on the camp “ the situation developed as a result of the Liberian war where the children aging between 7 and 15 years managed to seek refuge in Ghana. These minors having nobody in Ghana to look after them had to struggle on their own. The survey also projected that an average of 20 adolescent females aging between 13 and 20 years would get pregnant monthly. Secretary Agyemang said “we drew the attention of the UNHCR to the situation and they supported our request for funds to address the [problem]”, which led to the United States Government donating $23,000 for Adolescent Mothers’ Care in December last year. Another recent UNHCR survey identified 4000 children to be out of school. The agency has registered 2000 of the number and is supposed to absorb them in the various schools in the camp. The agency said it is in the process of registering the remaining 2000.
Recommendations
In view of the above, it is my recommendation that BRP (directly or in partnership with SHIFSD and other partners) considers the following:
1.
Mobilizing technical assistance and assistance for the development of a centralized curriculum for all camp schools
2.
Providing quarterly or bi-annual training for teachers and schools’ administrators
3.
Subsidize teachers’ pay as a way to decrease school tuition and fees
4.
Introducing Afternoon school session, as a way to reduce class size and load for teachers.
Conclusion
There are several aspects of life on the camp that are beyond the scope of this report. However, it was the key areas of focus of the Black River Project that drove our approach to the task. The observations and recommendations contained in this document are intended to sensitize the reader to certain basic needs of the residents. If nothing else, it is my hope that this document will highlight the needs for external organization to invest in projects and activities that would empower the residents to fend for themselves. Whatever support or assistance rendered must be with the view to increase the residents’ abilities and /or capacities to address their changing situation. Also, it is important that BRP works to strengthen her local implementing partner, SHIFSD. While there are other local organizations working on grounds, SHIFSD is emerging as one of the most serious and organized of the lot. Having recently completed an evaluation of her activities, the organization is working to make the necessary changes to meet the demands of today’s nonprofit world. The success of organizations like SHIFSD therefore will help to rekindle the hope of the local people, since many, if not all of them have lost hope in the UNHCR and other organizations. Although peace is seemingly returning to Liberia and the need to return home is a growing reality, the question now is “what these refugees do why they wait for the ultimate return?
About the Author: Mr. Saah Charles N'Tow is a young Liberian Poet and Writer. He lives in Rhode Island, USA. He can be contacted at: sntow@cox.net
