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RHO archives : Topics : Refugee Reproductive Health

Annotated Bibliography

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Sexual and gender-based violence

Belton, S. “Kathy Pan, Sticks and Pummeling: Burmese Women’s Methods of Fertility Management.” Presentation at the RHRC Consortium Conference 2003: Reproductive Health from Disaster to Development, Brussels, Belgium (2003). Available at: www.rhrc.org/pdf/conf_procdings_forWEB.pdf.

Bjorken, J. et al. Climate of fear: sexual violence and abduction of women and girls in Baghdad. Human Rights Watch 15(7)(E) (July 2003). Available at: http://hrw.org/reports/2003/iraq0703/.

Goodyear L, McGinn T. Emergency contraception among refugees and the displaced. JAMWA. 1998;53(5):266-270. Available at: www.jamwa.org.
This article examines the need for and availability of emergency contraception among displaced populations. Experience from refugee health programs operated by the International Rescue Committee shows that there are three major challenges to providing emergency contraception to displaced women: women's ignorance of the method, a lack of supplies, and the need for staff training. The authors call for more information on emergency contraception to be directed to refugee women, for more donor support for supplies, and for more training so that providers can offer sensitive counseling to traumatized rape and war survivors.

Human Rights Watch. The War within the War: Sexual Violence against Women and Girls in Eastern Congo. New York: Human Rights Watch; 2002. Available at: www.hrw.org/reports/2002/drc.
This report is based on research carried out in North and South Kivu provinces, an area controlled since 1998 by rebel forces fighting the government. This report focuses on crimes of sexual violence committed by soldiers and other combatants. Rape and other sexual crimes are committed by police and others in positions of authority and power, and by opportunistic common criminals and bandits, taking advantage of the prevailing climate of impunity and the culture of violence against women and girls. Few women brought charges against rapists, in part because they knew there was little chance of seeing the criminal condemned, in part because they feared the social stigma attached to being known as a rape victim. The fear of being stigmatized also kept some victims from seeking medical attention. The report concludes that brutality against civilians, and specifically sexual violence, is an integral part of the war in eastern Congo.

Human Rights Watch. Kosovo: Rape as a Weapon of "Ethnic Cleansing." New York: Human Rights Watch (2000). Available at: www.hrw.org/reports/2000/fry.
Based on testimony collected in hundreds of interviews, this report documents the systematic use of rape to terrorize the civilian population during the conflict in Kosovo. After discussing the consequences of the conflict for Kosovar Albanian women and the national and international response, the report makes specific recommendations to help the victims of these war crimes pursue justice and receive psychological and economic assistance.

Human Rights Watch. Shattered Lives: Sexual Violence During the Rwandan Genocide and its Aftermath. New York: Human Rights Watch (1996).
Detailed testimonies confirm that Hutu militia groups and the Rwandan military regularly used rape and other sexual violence as weapons during the genocide of 1994. These crimes frequently were part of a pattern in which women were raped after witnessing the torture and killing of their relatives and the destruction of their homes. Human Rights Watch calls for a stepped-up response to these crimes including (1) their full investigation and prosecution by the International Criminal Tribunal for Rwanda and the Rwandan government, and (2) increased aid directed to women's needs, especially to rape survivors.

Hynes, M. et al. “Field Test of a Gender-Based Violence (GBV) Survey in East Timor: Lessons Learned, Center for Disease Control and Prevention.” Presentation at the RHRC Consortium Conference 2003: Reproductive Health from Disaster to Development, Brussels, Belgium, 2003.

Hynes, M. and Cardozo, B.L. Sexual violence against refugee women. Journal of Womens Health & Gender-Based Medicine 9(8):819-823 (2000).
The authors review what is known about the circumstances, prevalence, and health consequences of sexual violence against displaced and refugee women, and they conclude that the research community must do more to help address it. Further research is needed on domestic violence against refugee women, the mental health consequences of violence, standardized methods to measure its prevalence, and appropriate interventions. Research underway at the Centers for Disease Control is presented, including a 1999 population-based survey of 1,358 displaced Kosovar Albanian women. Among these women, the prevalence of rape was 4.3 percent and of post-traumatic stress disorder 19.7 percent, but there was no association PTSD and rape alone.

Kagwanja, P.M. Ethnicity, gender, and violence in Kenya. Forced Migration Review 9 (December 2000). Available at: www.fmreview.org/FMRpdfs/FMR09/fmr9.8.pdf.
This article examines how Kenya used ethnicity as a criterion to determine refugee status and treatment, how this discriminatory policy influenced the administration of refugee affairs by relief agencies, and how it encouraged sexual violence against refugee women from certain ethnic groups, including Somalis. The author concludes that long-standing discrimination against Somalis in Kenya contributed to sexual violence against refugees, as did the patriarchal culture in the camps. Policies to guarantee the safety and rights of women refugees must take into account underlying ethnic or racial discrimination.

Kozaric-Kovacic, D. et al. Rape, torture, and traumatization of Bosnian and Croatian women: psychological sequelae. American Journal of Orthopsychiatry 63(3):428-433 (1995).
This study assessed the psychological status of 25 Bosnian women who had been raped and who visited a obstetrics and gynecology clinic in Zagreb. The women were divided into three groups, depending on their pregnancy status. Eleven were not pregnant. Nine were pregnant and received an abortion. Five were detained by the Serbian military until their pregnancies were too advanced for abortion; all abandoned their infants after delivery. A detailed case history of one woman from each group is presented. Because the women also endured dislocation, family deaths, and beatings, it is difficult to assign their symptoms to rape alone. The women felt shame and humiliation, tried to hide their experience of rape from doctors and their families, refused psychotherapy, and were alienated from the fetus. The authors are uncertain how to help these women since they refused psychotherapy, but doubt that testifying about their experience is helpful.

Mabuwa, R. Seeking Protection: Addressing Sexual and Domestic Violence in Tanzania's Refugee Camps. New York: Human Rights Watch (October 2000). Available at: www.hrw.org/reports/2000/tanzania/.

Martin V, Edgerton A. Protection and support of womens rights defenders lacking in Tanzania refugee camps. Refugees International Bulletin. 2002. Available at: www.refintl.org/content/article/detail/768/.
A field mission to refugee camps in Tanzania found that staff members working for sexual and gender-based violence programs frequently receive death threats and are physically attacked. In many camps, staff members also receive little on-the-ground support, including training and protection. The authors conclude that staff and supervisors lack of understanding of domestic violence, coupled with inadequate protection of staff, indicates minimal commitment and support by UNHCR and their partner NGOs to ending gender-based violence and promoting the status of women.

Nduna, S. and Goodyear, L. Pain Too Deep for Tears: Assessing the Prevalence of Sexual and Gender Violence Among Burundian Refugees in Tanzania. New York: International Rescue Committee (1997). Available at: http://intranet.theirc.org/docs/sgbv_1.pdf.
This report describes the first phase of a project to address sexual violence in Tanzanian refugee camps, in which project staff collaborated with women's representatives from the refugee community to assess the prevalence of violence. The results of in-depth interviews and a community survey show that approximately 26 percent of refugee women aged 12 to 49 had experienced sexual violence since becoming a refugee, and that some men and boys also were victims. In addition to rape, sexual harrassment and early marriage following abduction were problems. Based on the results of the assessment, project staff designed services to meet the health and protection needs of survivors of violence.

Nduna, S. and Rude, D. A Safe Space Created By and For Women: Sexual and Gender-based Violence Program, Phase II Report. New York: International Rescue Committee (1998). Available at: http://intranet.theirc.org/docs/sgbv_2.pdf.
This report describes the second phase of a program to help the victims of sexual violence and reduce levels of violence in four camps for Burundian refugees in Tanzania. Drop-in centers were established to provide services for survivors of violence, and male community leaders were engaged to help raise awareness of the problem. Further efforts are being made to mobilize state and community-based structures to apprehend and prosecute assailants and to develop sensitive methods to help children who have experienced violence. Staff stress has emerged as a major problem.

Neugebauer, R. Research on violence in developing countries: benefits and perils. American Journal of Public Health 89(10):1473-1474 (1999).
This editorial weighs the positive and negative impacts of mental health research on the victims of international conflicts. Benefits include bringing attention and humanitarian aid to the victims of violence. However, such research may harm the study participants, who are vulnerable to breaches of confidentiality, may be further traumatized by retelling their stories, and may be unable to give truly free and informed consent.

Palmer, C. Refugee Women and Domestic Violence: Country Studies, Kosovo. Edition 3. London: Refugee Women’s Resource Project, Asylum Aid (September 2002). Available at: www.asylumaid.org.uk/Publications/DV reports/DV individual reports/RWDV Kosovo Sep 02.doc.

Reis, C. et al. War-Related Sexual Violence in Sierra Leone: A Population Based Assessment. Boston: Physicians for Human Rights (2002). Available at: www.phrusa.org/research/sierra_leone/report.html.

Shanks, L. et al. Responding to rape. Lancet 357(9252):304 (2001). Available with free registration at: http://pdf.thelancet.com/pdfdownload?uid=llan.357.9252.news.14982.1&x=x.pdf. Rape is a highly effective and frequently used means of terrorizing communities in wartime, and international legal efforts have yet to offer women protection from it. Rape is also poorly addressed by humanitarian agencies, in part because women are reluctant to report it. A complete response includes a full history of the event, a physical examination, antibiotic prophylaxis, HIV prophylaxis, emergency contraception and abortion if needed, reconstructive surgery, forensic examination, and mental-health support.

Steinitz, M. The role of international law in the struggle against sex-based and gender-based violence against refugee women. The International Rescue Committee and Refugee Reproductive Health Consortium (March 2001). Available at: www.rhrc.org/pdf/steinitz.pdf.
Planners and staff members of programs fighting gender-based violence in refugee settings will find this overview of concepts, precedents, and legal organizations useful.

Swiss, S. and Giller, J. Rape as a crime of war: a medical perspective. JAMA 270(5):612-615 (1993).
After reviewing data on the occurrence of rape in wartime, this article discusses the role of the medical community in investigating and documenting rape and treating survivors. Health care workers have four different, sometimes conflicting, responsibilities: documenting individual incidents of rape, using medical data to assess the magnitude of rape during war, collecting evidence (such as sperm samples) that may establish the identities of the perpetrators, and treating individual trauma. The authors argue that restoring social and community bonds is central to the process of healing.

Swiss, S. et al. Violence against women during the Liberian civil conflict. JAMA 279(8):625-629 (1998).
To document the extent of violence against women during the civil conflict in Liberia, Liberian health care workers interviewed 205 women aged 15 to 70 in high schools, markets, displaced persons camps, and urban communities. Almost half (49%) reported experiencing at least one act of physical or sexual violence by a soldier or fighter. Women were more likely to have suffered violence if they had been accused of belonging to a particular ethnic group or if they were under age 25. The research legitimized discussions of violence against women by putting it under the domain of health, encouraged Liberian team members to work for social change, and led to the development of a program that uses role-playing and storytelling to organize women to stop violence.

United Nations High Commissioner for Refugees (UNHCR). Prevention and Response to Sexual and Gender-based Violence in Refugee Situations. Proceedings of the Inter-Agency Lessons Learned Conference, Geneva (March 27-29, 2001). Available at: www.unhcr.ch/cgi-bin/texis/vtx/home/+swwBmeOYnR_wwwwGwwwwwwwhFqA72ZR0gRfZNtFqr72ZR0gRzFqmRbZAFqA72ZR0gRfZND zmxwwwwwww5Fqw1FqmRbZ/opendoc.pdf.
These proceedings outline a multi-sectoral and functional approach to (1) prevent sexual and gender-based violence and (2) respond appropriately and compassionately to survivor needs. The approach involves a variety of participants, including refugees themselves along with international agencies, NGOs, and the host government. Working groups at the conference clarified lessons learned from field experiences in five key sectors: the refugee community, community services, health care, protection, and security. For each sector, the report discusses roles and responsibilities, issues faced, and recommendations. Other issues that cut across sectors are also addressed, including children, coordination, monitoring and evaluation, and male involvement. Appendices include sample guidelines, indicators, and report forms needed to implement the recommendations.

Ward, J. If Not Now, When? Addressing Gender-based Violence in Refugee, Internally Displaced, and Post-conflict Settings. A Global Overview. New York: The Reproductive Health for Refugees Consortium (April 2002). Available at: www.rhrc.org/resources/gbv/ifnotnow.html.
This series of 12 case studies from around the world looks at major issues and programming efforts related to gender-based violence in populations affected by conflict. Actual programs are compared to an ideal multi-sectoral response that includes social, legal, and security services. Common program weaknesses include lack of data collection; an exclusive focus on sexual crimes; weak protection for survivors; lack of enforcement of relevant laws and codes; short-term funding and shifting priorities of donors; unrealistic demands for self-sustainability; lack of national-level strategies and policies; unwillingness to challenge social, cultural, and political determinants of violence; and the absence of men as targets for services and agents of change. The report concludes with recommendations for the donor community; national and local governments; ministries of internal affairs, the judiciary, social welfare, and health; international and NGO service delivery organizations; and mens organizations.

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Guidelines and tools

Callamard A. A Methodology for Gender-Sensitive Research. Quebec: Amnesty International Publications and the International Centre for Human Rights and Democratic Development; 1999. Available at: http://www.fafia-afai.org/resources/doc2_e.htm.
This manual describes a standardized gender-sensitive methodology for documenting human rights violations. It is designed to assist local activists, non-governmental organizations, and other agencies to collect, analyze, and disseminate information on violence against women. It was published with a companion booklet: Documenting Human Rights Violations by State Agents: Sexual Violence. Quebec: Amnesty International Publications and the International Centre for Human Rights and Democratic Development; 1999. The companion booklet provides a step-by-step description of a gender-sensitive approach to research and suggests ways of addressing the specific challenges faced by women's rights workers. It focuses on the monitoring and documenting of specific categories of women's rights violations, helps the reader prepare for fact-finding missions, and provides guidelines for the collection and analysis of evidence. These documents were produced in conjunction with the International Centre for Human Rights and Democratic Development.

ARE. Moving from Emergency Response to Comprehensive Reproductive Health Programs: A Modular Training Series Draft For Field Testing. Washington, DC: CARE; 2002. Available at: www.rhrc.org/pdf/FinManual.pdf. A CD-ROM of this manual can be ordered from: CARE, 1625 K Street, Suite 500, Washington, DC 20006, USA; [email protected].
CARE developed this training series on behalf of the Reproductive Health Response in Conflict Consortium. The purpose of this set of training materials is to prepare the health management team in a conflict situation by providing them information, resources, and problem-solving techniques to analyze the current situation and plan to provide quality reproductive health care.

Dixon, G. Contraceptive Logistics Guidelines for Refugee Settings. Arlington, Virginia: Family Planning Logistics Management Project (1999). Available at: www.deliver.jsi.com/PDF/G&H/CL_refugees.pdf.
T hese guidelines adapt the principles and procedures of contraceptive logistics management to refugee settings. The publication covers selecting contraceptive methods, estimating the quantities needed, developing a management information system (MIS) for logistics, managing inventories, and storing contraceptives. It also includes sample logistics forms used by FPLM in developing countries. The project recommends using a simple management information system to track quantities of methods dispensed from emergency supplies so that, after conditions have stabilized, managers can order an appropriate supply of contraceptives for the refugee population.

Holmens,W. Protecting the Future: HIV Prevention, Care and Support Among Displaced and War-Affected Populations. New York: International Rescue Committee (2003).
This manual outlines a practical step-by-step process for humanitarian aid workers to use in the design and implementation of HIV programs. It starts by building the health workers’ awareness on the issue, then describes how to engage the community in HIV prevention efforts. The manual outlines a comprehensive approach to the management of HIV, with an emphasis on linking prevention with care and support.

McGinn, T. et al. Setting Priorities in International Reproductive Health Programmes: A Practical Framework. New York: Center for Population and Family Health Columbia School of Public Health (1996). Available at: http://cpmcnet.columbia.edu/.
This document was prepared in response to the International Conference on Population and Development's Programme of Action. The international health community has embraced this mandate of comprehensive, women-centered reproductive health, but they recognize the challenges inherent in carrying it out. The document is intended as a tool to help policy makers and program planners set program priorities. Using the Programme of Action as a starting point, this framework identifies key factors that should influence the decision to implement an intervention (importance of the reproductive health problem, efficacy of potential interventions, program requirements, costs, capacity of the health system and, finally, cultural, policy, and legal factors).

RHR Consortium. Refugee Reproductive Health Needs Assessment Field Tools. New York: RHR Consortium; 1997. Available at: www.rhrc.org/resources/general%5Ffieldtools/needs_menu.htm.
This publication gives field workers a complete set of tools to assess the reproductive health needs of a refugee population so that appropriate services can be offered once a crisis stabilizes. The tools, which have been extensively field tested by the RHR Consortium, include a basic information form about the site, a questionnaire for refugee leaders, a guide for group discussions, two survey questionnaires, and a health facility questionnaire and checklist. Accompanying the tools is a practical discussion of how each may be used, given the specific situation. The publication encourages field workers to involve the refugee community throughout the needs assessment process.

Joint United Nations Programme on HIV/AIDS (UNAIDS). Guidelines for HIV Interventions in Emergency Settings. Geneva: UNAIDS (1996).
These guidelines describe the threat posed by HIV/AIDS during emergencies and recommend what actions should be taken throughout each of the four stages of an emergency to prevent the transmission of the disease. The guidelines also provide detailed instructions on how to prevent transmission through blood transfusion, universal precautions, provision of condoms, provision of information, and STI care. Available in English and French.

United Nations Population Fund (UNFPA). The Reproductive Health Kit: Reproductive Health for People in Crisis Situations; an Essential Part of Primary Health Care. Geneva: UNFPA/ERO (1999). Available at: www.the-ecentre.net/.
This document lists the 12 sub-kits that are included in the contents of the official Reproductive Health Kit CD-ROM. The product is intended to aid in the appropriate delivery of reproductive health services in an emergency and in initiating activities in refugee situations. Readers get information on the basic components of the kit along with the standard process of obtaining it. The CD-ROM is available in English, French, Spanish, and Portuguese.

United Nations High Commissioner for Refugees (UNHCR). Sexual and Gender-Based Violence against Refugees, Returnees and Internatlly Displaced Persons: Guidelines for Prevention and Response. Geneva: UNHCR (May 2003). (Full report available online at www.reliefweb.int/ and synopsis available at www.rhrc.org).
These guidelines offer practical advice on how to design multi-sectoral strategies and activities aimed at preventing and responding to sexual and gender-based violence. Intended for use by UNHCR staff and members of operational partners involved in protection and assistance activities for refugees and the internally displaced, they also contain information on basic health, legal, security and human rights issues relevant to those strategies and activities. The guidelines were developed in consultation with UNHCR's partners in refugee protection: governments, inter-governmental agencies and nongovernmental organizations.

UNHCR. Reproductive Health in Refugee Situations: An Inter-agency Field Manual. Geneva: UNHCR (1999). Available at: www.rhrc.org, at: www.ippf.org, and at: www.unfpa.org/emergencies/manual/. Contact information for ordering a print copy in English, French, Portuguese, or Russian available at: www.rhrc.org.
Over two dozen organizations contributed to this field manual, which was the first publication to specify which reproductive health services should be offered to refugees and how these services should be organized. After discussing minimum services for the initial phase of an emergency, succeeding chapters describe comprehensive services for stable situations, including sample forms and protocols. Topics include safe motherhood, sexual and gender-based violence, STIs and HIV/AIDS, family planning, adolescent health needs, and surveillance and monitoring.

UNHCR. Guidelines on the Protection of Refugee Women. Geneva: UNHCR (1991). Available at: www.unhcr.ch/.
These guidelines urge planners to thoroughly assess the characteristics of the refugee population and the circumstances they find themselves in, as they relate to potential protection issues for women. Next, the physical and legal security problems faced by refugee women are described, including physical and sexual attacks, spouse and child abuse and abandonment, military violence, and sexual exploitation. Then improvements that can increase women's level of protection are suggested. These concern the design of camps and settlements, how assistance is delivered, and implemntation of education, skills-training, and income generation activities to foster greater protection of refugee women.

UNHCR and the Womens Commission for Refugee Women and Children (WCRWC). Work with Young Refugees to Ensure Their Reproductive Health and Well-being: Its Their Right and Our Duty. A Field Resource for Programming with and for Adolescents and Youth. New York: UNHCR and WCRWC (2002). Available at: www.rhrc.org/pdf/unhcr_paper_new.pdf.
This field resource is designed to help humanitarian programs of all kinds (including water and sanitation, shelter, education, health, and income-generation projects) address the reproductive health needs of young refugees. It lists key reproductive health problems facing adolescents, guiding principles for working with young refugees, and useful resources. A lengthy checklist of program strategies offers detailed guidance on how to ensure young peoples reproductive health and well-being. Various checklists address how to take a comprehensive approach, determine young peoples needs and strengths, identify and involve young people, ensure a safe and secure environment, ensure young peoples right to education, promote their livelihood, and ensure access to health care.

Vann, B. Gender-Based Violence: Emerging Issues in Programs Serving Displaced Populations. Arlington, Virgina: JSI Research and Training Institute (September 2002). Available at: www.rhrc.org/pdf/gbv_vann.pdf.
This report describes key lessons learned during the author’s five years of work with gender-based violence (GBV) programs in 12 countries. The report is divided into three sections. The first section, Emerging Standards, describes the evolution of GBV programs serving populations affected by armed conflict. The second section, Common Issues, Practical Solutions, analyzes the seven most common difficulties for GBV programs. The third section, Varied Programs, Shared Challenges, profiles seven GBV programs and their technical assistance needs. Appendices provide a resource list and a sample procedural manual for interagency GBV prevention and response. The author is technical advisor for the Global GBV Technical Support Project, a collaboration between JSI Research and Training Institute and the Reproductive Health for Refugees Consortium.

Ward J. Gender-based Violence Tools Manual: For Assessment, Program Design, Monitoring and Evaluation in Conflict-Affected Settings. New York: Reproductive Health Response in Conflict Consortium; 2004. Available at: www.rhrc.org/pdf/GBVsingles.pdf. Due to the size of this document, it may be difficult to download. Please contact [email protected] if you would like a printed copy shipped to you.
This manual promotes a multi-sectoral model of GBV programming that encourages action within and coordination between the conflict affected community, health and social services, and the legal and security sectors. The tools allow program staff to understand the scope of the problem in a specific context, design effective programs, hire appropriate staff, and use monitoring and evaluation to measure the program effectiveness. The intended audience for the guide is humanitarian professionals addressing GBV prevention and response.

World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR). Clinical Management of Rape Survivors: A Guide to the Development of Protocols for Use in Refugee and Internally Displaced Situations. WHO/RHP/02-08. Geneva: UNHCR; 2002. Available at: www.rhrc.org/pdf/cmrs.pdf.
This publication provides guidance to health care providers for medical management after rape of women, men, and children. It is designed to assist qualified health care providers (medical coordinators, medical doctors, clinical officers, midwives, and nurses) to develop protocols for the management of rape survivors, based on available resources, materials, drugs, and national policies and procedures. Managers and trainers of health care services can also benefit, as they may use the guide to plan for survivor care and train health care providers accordingly.

WHO. Clinical Management of Rape Survivors: Guide to Assist in the Development of Situation-specific Protocols [Draft for field testing]. Geneva: WHO (June 2001). Available at: www.rhrc.org under "Resources.")
This guide offers step-by-step instructions to help providers prepare rape survivors for examination, take a history, collect forensic evidence, perform a thorough physical exam, record the findings, and offer medical care. It does not cover psychological counseling or referrals to community, police, or legal services, although those may also be necessary. To help managers adopt best practices, the guide also includes sample forms and protocols.

WHO. Reproductive Health During Conflict and Displacement: A Guide for Programme Managers. Geneva: WHO (2000). Available at: www.who.int/reproductive-health/publications/RHR_00_13_RH_conflict_and_displacement/index.htm.
This guide focuses on the managerial and service delivery challenges in meeting reproductive health needs during and displacement, and it is designed to complement the UNHCRs Inter-Agency Field Manual. Managers can used it to help plan, implement, monitor, and evaluate health care programs, to improve existing services, as a reference document, or as a training tool. The guide outlines reproductive health needs and interventions specific to each phase of conflict and displacement, and matches them with appropriate management tools. There is also a special section on how to respond to gender-based and sexual violence. The appendices describe a number of relevant management tools.

WHO. Mental Health of Refugees. Geneva: WHO (1996).
This instruction manual helps health care workers understand the unique stresses experienced by refugees and other displaced persons. A series of training modules give clear and detailed instructions to providers about how to identify and manage a wide range of mental disorders, how to help refugee children cope with stress and trauma, how to manage alcohol and other drug problems, and how to help the victims of torture and rape. The publication is available in English, Dutch, French, Russian, Serbian, and Spanish.

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