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Mapping journeys of adolescent service users in Gaza

GAGE researchers in Gaza have been mapping the services available to adolescents by making use of open source online mapping software. This work contributes to GAGE’s overall objective to measure the impacts of empowerment programmes with and for adolescents from refugee populations and host communities.

The team mapped available empowerment services aimed at improving adolescent well-being (through the various change pathways as set out in the GAGE conceptual framework) by conducting key informant interviews with service providers. They consequently organised focus group discussions to reflect with adolescents in and outside of mapped empowerment programmes to reflect on the accessibility, quality and relevance of these services.

Gender segregated group discussions highlighted interesting findings around restrictive gender norms, poverty and quality of services. In this blog, GAGE field researchers in Gaza reflect on their experiences working with adolescents and learn how boys face different and similar barriers than girls.

The GAGE Gaza research team, from left to right: Dr Bassam Abu Hamad, GAGE Regional Director; Haneen Rizik, freelance researcher; Iman Abu Hamra, freelance researcher; Riyad Diab, freelance researcher and Ahmad Nao’oq, freelance researcher. 

Discussing family issues and a culture of silence which prevents adolescents from seeking help, the research team had the following reflections.…

Iman: The biggest issue girls face is that they don’t have anywhere to go to talk about “family issues”. That is the social norm here in Gaza – “what happens here in the house, should remain there” … Self containment and isolation are the best coping mechanisms.

Haneen: In our community when girls seek mental health support, they think she is mentally ill. Then rumours start to spread between neighbours. This will affect her marriage chances,  so girls usually don’t go to the services unless compelled to. Girls are more concerned that her (future) parents-in-law are going to say: “that she is a crazy woman”.

Dr Bassam: Even so, girls more often than boys go to ‘soft’ psychosocial support services – focused often on mental health / psychosocial support through play, debriefing and diversional activities. Boys think it is for children – like “play time”. They tend to think that they are too old for that – “we are men now”. It is their ego that stops them from going.

The research also found that menstrual hygiene management concerns can lead to school drop out and feelings of shame and embarrassment for adolescent girls….

Iman: What I found most shocking was that girls don’t have an appropriate place at the school where they can clean themselves. The toilets are too dirty. When they menstruate they stop going to school for the first two days.  But when they don’t come to school it is an issue. The teacher will call her father or mother and then the whole community will know that [the girl is having her period]. They [schools] are not flexible in this regard and girls regard that as an violation of their privacy.

Iman: Sometimes the girls are not prepared for the changes happening during adolescence. They told me they were shocked or severely embarrassed when they experienced their first menstruation. Families don’t talk about these kinds of things.

The GAGE participatory service mapping showed that girls and boys face different barriers to accessing medical services… 

Dr Bassam: For me, this is about the “culture of silence” in Gaza. Look, for example, at violence. 51% of all married women between the ages of 17-50 years old has been exposed to a form of violence. That is 36% of adolescent girls and women are exposed to physical violence. But, less than 0.6% of these 36% of girls and women sought services. This is what the “culture of silence” does. Even if she reports [the incident] girls and women often get blamed –  for her clothes, her body language… and if she reveals what happens maybe her father will ask her to leave the school. We tend to blame the victim rather than support her…

Iman: You are right. What girls told us is that they don’t avail themselves of ‘invasive’ services. For example, a blood test is OK, but a physical examination is not. Until you are married you won’t go to see a gynaecologist no matter how serious your problem is. What happens is that girls lie – they say something is not wrong with them -they get married and then she can go. This to me shows the extent of oppression girls in Gaza face. Her whole life she is exposed to risk. For example, a girl will not ask for help in the face of violence on the part of her brother or her father. It is normalized.

Riyad: Boys say they face different barriers. They told us they mistrust health providers. People are being discriminated against. They said, if you have good connections,then they treat you better, otherwise you are ignored. You need “wasta” [connections]  or even to provide an under the table payment”. They also said pretty girls get better care than them, and medicines are scarce.

Unemployment emerged as a key issue for both adolescent boys and girls in the GAGE research, although adolescent girls and young women are experiencing some positive change in communities and the workplace…. 

Riyad: It all has to do with the economic situation for boys. Many want to work but there are no work opportunities and that makes boys feel frustrated. They lose hope:they take Tramadol [an  addictive opioid painkiller] and the crime rate has increased” Also, suicidal ideations, attempts and actual suicidal rates are increasing despite the lack of official figures.

Iman: But there are many more restrictions for girls. Women should not stay out late, then they [the community] start to question her – where was she going? What was she doing? They criticise her… She will be stigmatised…. One of the girls mentioned that her family refused to have her work as a hairdresser because she used to work late. During Eid and when there is a wedding, many girls and women come to the shop late. But now they found a job for her close to home and now it is not a problem – her brothers can just come and check up on her..

Dr Bassam: NGOs try to find job opportunities that are perceived to be safe and culturally appropriate. For female nurses, for example, sometimes they have night shifts, so the ambulances will pick up the nurses. The Ministry of Health arranges that.

Haneen: Girls told us they have limited space to help their families financially. They help through to reducing their spending rather than trying to earn money. They are often not able to work because of restrictive social norms and limited job opportunities

Dr Bassam: Yet, the role of women as breadwinners is increasing in Gaza. More women now work as housekeepers. It is becoming more acceptable.

Our research team found that mobile phones can help reduce isolation for girls who are confined to the home but their usage of certain apps may also be controlled by their parents and older brothers.…

Riyad: Boys noticed that girls have limited agency. “Girls don’t go to services”, boys in my focus group discussions said, “because of the household chores they have to do”. They notice that because of the burden a girl faces at home, they are deprived of services.

Iman: I agree, but girls have some room to interact with others despite their limited mobility: most girls here use mobile phones. It combats isolation:the world comes to them. Two of the girls use the phone to secretly search for information about puberty and sexual relationships. They are too shy to ask anyone they know about these issues.One said: “I know it is better to ask my parents, but sometimes parents don’t tell”.

Haneen: But, girls are not really trusted with WhatsApp and Facebook. She might look up stuff – that is what they are afraid of. Normally, one night before the marriage night, other girls from the family start to tell her about sexual relationships. The husband often says: “your family is supposed to tell you about that.” The girl will be blamed by the husband if she is not aware about this.


Read about the work of the Gaza research team in the Adolescent perspectives on services and programmes in conflict affected contexts: A participatory research toolkit