Southern Iraq--Early one morning last fall, Salma, a young Iraqi working for International Medical Corps, arrived at the office, nervous about the day ahead. She and two colleagues, Nour and Jeanette, were starting work on a program aimed at helping recently returned refugee women in the country’s southern marshlands access health care, advocate for their rights, and earn an income. The first step: to interview other women about their struggles and their needs to determine the root causes of gender inequity. The data that Salma and her colleagues collected would then be used to fine-tune International Medical Corps' activities, to ensure that they targeted the women’s most critical needs. Salma had reason to be apprehensive. Soliciting women’s opinions in a conservative, highly patriarchal region of the country was highly sensitive business.

In southern Iraq, a flood of returnees who fled their homes for the security of neighboring Iran and Saudi Arabia during the first Gulf War in 1991, is straining the limited resources of communities already eroded by decades of conflict and sanctions. Women’s lives have been most acutely affected by the region’s ongoing violence and economic hardship. Many women’s spouses died in the conflict. Others returned injured and unable to work. As female heads of the household, these women now have the dual responsibility of caring for their children and home, and serving as breadwinners—at a time when the roles available to them in the public domain are shrinking due to the resurgence of traditional, patriarchal attitudes.

As Salma and her colleagues moved from village to village interviewing hundreds of women, it became clear that the double burden borne by the women in Southern Iraq had taken a tremendous toll on their health. Returning refugee women suffer disproportionately high rates of communicable disease, joint and muscle pain, skin infections, and miscarriage.

Their female interview subjects also expressed dismay over the region’s oppressive cultural restrictions—restrictions that both Salma and Nour understood in a very personal way. The only girl in her family, Salma graduated from secondary school and hopes to attend college one day. But her activities outside the home are strictly regulated by a physically and verbally abusive family. Her brothers, concerned with “family honor”, monitor her work and her rare social outings closely, and beat her if she disobeys their rules. She credits the chance to work with International Medical Corps as “lifesaving”; few opportunities for young working women exist where she lives.

Nour, well-educated and fluent in English, says that her home life is joyless, her relationships with her father and stepmother strained. “My dream is to keep working so that my sister and I will have a bright future and not need help from anyone.” She would like to marry, but only if her husband would allow her to continue working and respect and love her. As a project leader with International Medical Corps, Nour feels fortunate to have the opportunity to help women who have little support and few resources available to them.

Happily, Salma and Nour, along with their team supervisor, Jeannette, have helped. The survey they carried out enabled International Medical Corps to identify the most pressing concerns of returning refugee women: high unemployment, lack of education, domestic violence, little or no access to health care, and a lack of decision-making power within the household. With those needs as a centerpiece, International Medical Corps began to build a comprehensive program to address physical and mental health.

When women have the income to provide for their family’s basic needs, it enables them to think about other issues, such as health care, education, and rights, rather than fretting about putting food on the table. So International Medical Corps structured its programming around an income-generation initiative that provides women with sheep, teaches them how to breed livestock, and prepares them to market and sell their products via a cooperative model. This work helps International Medical Corps staff establish a rapport with the women, who are then more likely to take part in the other components of the program—among them prenatal care, gender awareness training, vaccination programs for children, and health education.

International Medical Corps’ program also provides women returnees with a safe place to express their frustrations in the form of support groups. Once a week, International Medical Corps staff members gather women together and encourage them to speak, openly and confidentially, about whatever is troubling them. By reaching out to women and creating opportunities to empower them, International Medical Corps is giving them the resources and the confidence they need to be able to care for their families and themselves.