CHOUCHA CAMP, Southern Tunisia -- “My father died when I was three years old. Armed bandits killed him one evening as he was coming home. Every night I remember this scene before falling asleep,” says Mariam Ibrahim, a 20-year-old Somali who grew up amid civil war. She left Somalia at the age of 16 and was smuggled all the way to Libya hoping never to see Mogadishu again. “I didn’t know if life would be easier elsewhere,” she recalls, “but I wanted to run away from the kingdom of death.”

Today, Mariam is one of 170,000 refugees of the Libyan conflict who were able to cross the Tunisian-Libyan border. She was nine months pregnant when she arrived in Choucha refugee camp accompanied by her husband. Mariam has since given birth to her first child, a girl, in a tent set up by the Red Crescent.

Since the breakout of violence in Libya one month ago, over 389,000 people have fled the country. This figure includes more than 200,000 third-country nationals, making this one of the largest migration crises faced since the first Gulf War in 1990. Choucha Camp has been the first stop in Tunisia for people fleeing Libya. The International Organisation for Migration (OIM) has begun to repatriate migrants, but as of 28 March, 8,570 people were stranded at the border. This includes 1,720 Somalis and 856 Eritreans who are of concern to agencies as they cannot be repatriated due to ongoing conflict in their country.

Pregnant women and babies at risk

The conflict in Libya has put women and their babies at risk because of the sudden loss of medical support, compounded in many cases by trauma, malnutrition or disease, and exposure to violence. Women fleeing war may have to give birth on the run, without even the most basic items for clean delivery. In any refugee situation, one in five women of childbearing age is likely to be pregnant.
UNFPA’s immediate response to the Libyan crisis has been to ensure the provision, storage and distribution of reproductive health kits to various medical centres at the border area, including at Choucha Camp.
The UNFPA Country Office in Tunisia conducted an initial assessment and began taking action as part of the interagency team on the ground to provide a humanitarian response. Working with the National Family and Population Board (ONFP), UNFPA set up a tent equipped with necessary materials to provide reproductive health services, where midwives provide systematic pre-natal care for all pregnant women, assisted deliveries, post-natal care and family planning.

Identifying refugees in need of immediate help

Bochra Ben Teib, 54 years old, has been a midwife in Tunisia for 35 years. A few kilometers from her hometown in Eastern Tunisia, she discovered an unimaginable situation some weeks ago. “With my husband, we came to bring blankets and food to the first refugees who had fled Libya,” she recalls. “I noticed that there were many pregnant women among all the people here. I immediately wanted to help them.”
Working with UNFPA, Bochra goes from tent to tent to distribute hygiene kits, which also allows her to spot urgent cases. “During these first visits, I was able to identify at least 40 cases that needed an immediate medical or psychosocial intervention,” she says. “For more urgent cases, we accompany the patient to one of the two temporary hospital set up in the camp.”
Bochra was able to quickly create trusting relationships with the women in Choucha camp, many of whom have been affected by war more than once in their lifetime. “Progressively, women started to trust us. Now they spontaneously come to us to get examined,” she says. “A young pregnant woman who had just arrived in the camp was immediately referred to us by women in the community. She was suffering from anemia and could have lost her baby.”

Providing psychosocial support

UNFPA also provide psychosocial support for families and individuals affected by the crisis at the camp, and helps protect women against gender-based violence. Ameni Touhami, one of 13 psychologists trained and deployed by UNFPA, noticed an amazing solidarity among the refugees during her visits to the different tents in the camp. “Somali women would direct me towards members of the community who were in distress,” she says. “I was able to intervene quickly in cases which needed immediate attention. For example, I assisted a young woman who had been in the camp for several days when she learned of the deaths of her husband and baby who had stayed behind in Libya.”
UNFPA’s work is far from being over in Choucha Camp and its surroundings, as the refugee population grows and families are being moved to different areas. The migrants are distributed in the camps according to nationality, with two different areas allocated for families and single men. “The major psychological risk in this situation would be the occurrence of multiple cases of post-traumatic stress,” says Ameni Touhami. “If these cases happen in large numbers, the situation could become very difficult.” UNFPA plans to conduct regular assessments in order to establish demographic profiles of camps population. Such assessments will enable the Fund to better respond to the immediate needs of refugees.
Mariam and her husband left Tripoli with their belongings in three plastic bags. Men in uniform had ransacked their small apartment and threatened to return to finish their “work.” “We knew then that there was no life possible for us in Libya,” she says. Mariam’s daily life in the camp now consists of long queues waiting for food and water, often amid sand storms. Thankful for the visits from UNFPA doctors and psychologists, Mariam hopes that her newborn daughter will not be a war child like herself.

-- Kerim Bouzouita, UNFPA/Tunisia, with support from Adnen el Ghali and Alexandra Sicotte-Levesque