Searching for Care
It’s hard to imagine all 115,000 refugees in Cairo securing medical aid from one organization.  Caritas, which is one of the main health organizations for refugees in Egypt, has its main office in Cairo, but it has five local, Cairo branches to minimize the transportation burden for patients.  Bone fractures, blood clots, irregular heartbeats—Caritas responds to the health needs of refugees and asylum seekers alike. The compact clinic blends in with neighboring buildings and is bustling with translators and social workers, but still Caritas can’t reach everyone. Two hours away in 6th of October, Malak, an Iraqi single mother of three, locks eyes with me and tells me that her son’s health is worsening, and there is nothing she can do about it. Since his arrival to Egypt in 2006, he has gained nearly 150 pounds. She is grateful for Egypt’s protection, but is frustrated by its negative effects on her son’s health. 

Three hours away in Nasr City, Husam tells us how he will “never forget” the horrific events that happened to him in Baghdad, which often surface in frequent flashbacks and depression. Yet, there is no time for him to address this. He tells us that he must take care of his son’s illness, caused by complications of high uric acid, before acknowledging his own health. Faruq lives down the street from Husam in Nasr City. A single mother of three, she moved to Egypt with the hopes of giving her children the education and lives they were accustomed to in Iraq. However, as her bills piled up, so did her health problems. She gained over 70 pounds, developed high blood pressure, and increased her cigarette intake to two boxes a day. Why? Her voice muffled, she explained to us how her transition to Egypt left her with too much free time and stress, leading her to unhealthy habits and practices. “Iraqis, like myself, neglect their health when they come to Egypt,” Faruq said. “I just have more important things to worry about, like my children’s safety.”

Like Faruq, Husam, and Malak, many Iraqis expressed similar sentiments about being unable to prioritize their health in Egypt, despite the significant changes they noted. Throughout my conversations with the refugees, I wanted to explore exactly this—the relationship between displacement and prioritizing well-being. For many, the lack of emphasis was attributed to themes of financial insecurity and lack of resources. For others, they reported aspects of the social environment that impacted the way they prioritize health. I realized that each family has its own story, its own battle, with addressing care.

“We struggle as well, you know”
Iraqis are not the only refugees in Egypt. Over 20 nationalities are represented, but the primary concern has been diverted to the recent influx of Syrian refugees. Unlike other refugees and asylum seekers, the Syrian refugees are given the same services afforded to the Egyptians in addition to services provided by the United Nations High Commissioner for Refugees (UNHCR). Because of the Syrian crisis, many Iraqi refugees told us that they are not getting adequate care. Although they sympathize with their conflict, many Iraqis question why Syrians have access to free services while they do not, despite sharing similar stories.

Ibtisam, a 39-year old Iraqi living with her mother, sister, and nieces, and nephews in Nasr City, threw her hands up in the air and listed out all the health complications she acquired after coming to Egypt. “Back pain, dry eyes, weak body, kidney problems, osteoporosis, anemia, vitamin deficiency . . . I have it all,” she said. But Ibtisam refuses to go to Caritas. “Every time I call Caritas, they tell me they are busy with the Syrian cases. There should not be any difference between Syrians and us. We suffered as well, you know.” Ibtisam adds that Caritas is usually very busy when she goes. She has visited Caritas only four times since her arrival in 2006, and she attributes this to the large crowd and long wait. “I am there at 7:30 and I leave at 4:00. The wait is not worth it. I’ll just deal with the pain.” With the new Syrian cases being treated at Caritas, she expects the service to be worse and staff even busier.

Abu Bakr, a 52-year old former fighter pilot, immediately listed out health problems that affected his family. From hypertension to diabetes, Abu Bakr admits to visiting Caritas on a regular basis. “I was very pleased with their services. They even gave me money for my son’s funeral, my MRIs, the physical examinations, my wife’s pregnancy examinations and her caesarean section.” Abu Bakr would go in every month to receive his medications, which usually took only 10 minutes. “And then, the Syrian situation happened,” he said. “I never go to Caritas for illnesses anymore. Nothing is free for us now.”  Abu Bakr said that Iraqis must go to private clinics now for health services, which is a huge financial burden as Iraqis cannot legally work in Iraq. In order to avoid the costs of private clinics, Abu Bakr notes that many Iraqis seek alternate methods of treatments, such as pharmacies and resting. The Syrian situation, he described, caused Caritas to divert their attention away from the Iraqis, who depend heavily on the free services Caritas provided. 

“All I care about is my children’s futures”
Husam is a father of two young boys—both whom are patients at Caritas. Throughout the interview Abdul Hamid, the youngest son, interjected, smiled, and contributed to his father’s story. He was very eager to participate throughout the interview—until we started to speak about health. Abdul Hamid has high uric acid, which is found mainly in adults who are at least 50 years old. Abdul Hamid is 8. Because of the high concentration of uric acid in his bloodstream, he unexpectedly urinates on himself in public places. Husam’s wife tells me, “I went just yesterday with Abdul Hamid to Caritas. Abdul Hamid had an accident and a nurse said ‘This is because you don’t take care of your son!’ I was so mortified.” In response to this, Husam’s wife took their son to a different doctor in Caritas, but he only did a test to confirm his diagnosis. “They don’t help, and now I don’t know what to do.” Despite the frustration she received from Caritas, Abdul Hamid’s mother refused to settle. She explained to me how she is finding a new doctor at another branch, and her search will not halt until she gets answers. A similar situation happened to their other son, Abdul Kareem. His lower jawbone is bigger than his upper jawbone, so Husam took him to get a retainer from Caritas. Because of a lack in adequate resources, Caritas provided a retainer than does not fit his face. Abdul Kareem quietly entered the room and demonstrated how he wears the retainer. He must physically hold the retainer in place, which he says gets very tiring, especially at night before sleeping. Abdul Kareem admits that he rarely wears it.  Despite the lack of sufficient resources provided by Caritas, Husam never misses an appointment. He explains that he has accompanied Abdul Kareem to each visit to get him the proper health service he needs.

After explaining his children’s struggles with Caritas, I asked Husam about his personal encounters with Caritas, and asked when was his last checkup.Husam looked at me, smiled, and said “never.” He admitted to having many health problems, but he dodged any encounter with Caritas by treating himself with natural remedies, like teas and lemon. Husam’s battle with self-care does not stop at physical health. When asked about his mental health, he told me, “You will never forget.” He explained that the images of bullets, threats, and kidnappers surface frequently, especially since he stays at home and does not work in Egypt. “I get very depressed at times, but I try not to show it,” he added. Husam has never been to a psychologist, and does not plan on ever seeing one. “All I care about is my children’s future, so I ignore any thoughts or problems that arise.” Although Husam tries to ignore any thoughts of the past that surface, he admits that he often has nightmares that wake him up and moments when he cannot control his anger. The only thing he said that grounds him is reading the Quran.

Raed, a 46-year old Iraqi, lives in Nasr City with a progressive condition of skin discoloration. Much of his forehead and cheeks are a faint pink, while other parts of his face are tan. Raed said that there is no cure, but admitted that there is possibly something he could use which he would not be able to afford. He tells us that his discoloration is getting worse. Yet, he does not complain. Raed proudly tells us that he does not go to Caritas or any other medical clinic. “I do what I can to provide the best for my wife and children and their futures,” Raed stated. “Their life is more important than my life.” His wife has unstable heartbeats that required her to visit Caritas often to get echocardiogram scans, all of which proved unhelpful. Raed adds that he has bought several drugs that the doctors prescribed, but nothing seems to be working. His daughter recently had an operation to remove her tonsils. Raed stated that Caritas only pays half of the cost of operation, but he will never refuse treatment for his family. Raed accompanies his family to Caritas every visit, but he had not yet scheduled an appointment for himself.

“I live in constant fear”: A Woman’s Battle
Ibtisam, the 39 year old Iraqi woman who also reported the negative effects of the Syrian influx, described that her position as a single Iraqi woman in Egypt deters her from accessing health treatment. Although Caritas is only a 30-minute drive from her home, the traffic could prolong the arrival by up to two hours. Since she does not have a car, she must take public transportation. “I live in constant fear of being kidnapped, harassed, or mistreated in Cairo. That is why I rarely leave the house.” Ibtisam feels that she can never walk the streets of Egypt alone because she is living without a male. She says even with a better financial situation, she would be afraid. “Yeah, we all need money, but I don’t need a man just because of that. I can get that without him; I need him for protection. It’s not just in Egypt. It’s an Arab thing.” Ibtisam describes a Caritas visit as an all-day affair. If you go in the morning, you will come back at night. Because her nephew was recently robbed on the street near her house, Ibtisam told us that she never leaves the house alone.

The wish to have a man’s protection to seek health services was prevalent in many women’s stories. Abir’s daughters live two hours from Caritas. In order to make it to their appointment, they must take three forms of transportation, all among Egyptian natives.  The girls all tell us how they are immediately spotted in a crowd of Egyptians. “Our dialect, our looks…it’s just so obvious we are Iraqi.”  They admit to not using public transportation in Iraq, so they still do not feel comfortable using it in a new country. Abir’s daughter stresses that she feels the men in the street will “devour her” because she does not wear the hijab, so she limits the number of times she leaves the house. Abir adds that, in the Iraqi community in Cairo, most women don’t drive.   She adds that only a select number of families have cars, whereas in Iraq it was the norm. She describes an event when she was very sick, but could not find anyone to take her to the hospital. All of the Iraqi men with cars were out together, and none of the women in the community had a car. Because of similar emergencies, Abir thinks that every house needs a man to head the household.  

“I’m depressed, too”
Mental health is not a widely discussed topic. Throughout the interviews, many Iraqis described how they dealt with memories of the past, troubles of the present, and worries of the future. Throughout our entire stay in Egypt, it was rare to meet an Iraqi refugee who received mental health services. This does not mean that they do not exist.  During our stay, we visited the Psycho-Social Training Institute in Cairo (PSTIC), an organization created to provide psychosocial and mental health support to refugees.  While some refugees use organizations like PSTIC, many Iraqi refugees told us that they engage in other activities to self-diagnose, which at times can lead to detrimental effects.

Raed, the 46-year old refugee in Nasr City with skin discoloration, said that his mental health was the worst at the beginning of his transition to Egypt. He repeatedly saw people dying in his dreams and had frequent flashbacks to his life in Iraq. We asked Raed how he coped with this, and he smiled as he pointed to the table: a half-empty pack of cigarettes. He said that cigarettes get him through “the rough moments.” Raed admitted that he set up an appointment with a psychologist, but never showed up because it was in the middle of Ramadan, the Islamic holy month of fasting.  He explained that traveling and waiting during Ramadan requires a lot of energy, especially since he is not allowed to drink any water. He decided that the appointment was not appropriate during Ramadan and, after Ramadan was over, Raed stated that he “forgot about the whole thing.”

Faruq, a single mother of three in Nasr City, had a similar coping strategy for her depression and stress. During her transition, she smoked up to two packs a day. This increased her appetite and caused her to gain 70 pounds. Faruq stated that every Iraqi should be required to see a psychologist. “We’ve simply been through too much to not see one.” Her daughter, Manal, is a recent graduate from the accounting school in Cairo and is engaged. She can only see her fiancé once a week, because he lives 2 hours away. At one point, Manal leaned towards us and said “You know, I’m depressed, too.” Taken by surprise, we turned our attention to her as she described her situation. “I always have nightmares and flashbacks about Iraq. I can’t tell mama because I don’t want to stress her.” She added that her mother is dealing with several financial problems in Cairo and in Baghdad. “Whenever I feel overwhelmed, I go to my room and cry until I fall asleep,” she said.  Manal does not want to go to a doctor because she does not want to worry her. She prefers to keep her problems to herself in hopes that they subside.

A 50-year old father of three daughters, Imad was a former commander in the Iraqi military. Living among the crossfire, Imad described several traumatic events that left the room in a silence for several seconds. The event that provoked the most feeling was the death of his young son. In a car ride back to his neighborhood, he was surrounded by people who thought Imad was working with the Iraqi government. They opened fire and shot Imad six times. His son was shot once, but died immediately. With such a life-changing event, I wondered how he was coping with his mental health. “Caritas does not help with mental health, and…I don’t ask them to,” Imad stated. He prefers to ignore events of the past to focus on the future. “I try to forget it all. I try to take care of my daughters, my family. I try to hope that the future is better than the past. I try to dream that I will go to the US and begin a new life for my daughters.” Imad is very hopeful in resettling to America, but in order to be ready, he said, he must leave all thoughts and memories behind.

“I just want to get our voices heard”
Once healthy, financially stable citizens, Iraqi refugees say that they are cast in the chaos of Egypt and must juggle problems and issues that were not present in Iraq. From endless conversations with UNHCR to managing school tuitions, Iraqi refugees are fighting to get their voices heard. But are they fighting for their well-being in addition to their other concerns? Ibtisam’s mother does not believe so.

One week after meeting Ibtisam and her family, we visited a UNHCR office. We were guided to the point where UNHCR employees and refugees intersect—an open courtyard with three different windows designating three different services: protection, community services, and voluntary repatriation. As I stood on the quieter, much calmer side of the windows, an older Iraqi woman waved me down and greeted me with a warm smile that I remembered well. She was Ibtisam’s mother, a 70-year old woman living with her two daughters and three grandchildren. She was standing at a window surrounded by refugees from various countries. It appeared that Ibtisam’s mother was waiting in the community services line—a section of UNHCR that provided special attention directed towards refugees needing extra services and aid.

Ibtisam’s mother exemplifies many of the sentiments Iraqi refugees shared towards prioritizing healthcare. One week before our encounter, she explained that her family had only been to Caritas four times since their arrival in 2006, because they were all female and because Caritas is usually swarming with other refugees. She yearns to see a doctor about her depression and flashbacks, but does not feel safe venturing out alone. Yet, this is not the case with UNHCR visits. Ibtisam’s mother travels three hours to wait in an over-packed line with frenzied refugee men from various countries. Why? Ibtisam’s mother explained how she is living for her daughters and her grandchildren. “We have seen so much suffering and so much happened to my family,” she told me to the side. “I just want to get their voices heard, for our human rights.” Ibtisam believes that UNHCR is the only place that can help her achieve this.

Ibtisam’s mother illustrated how well-being is not currently a top priority. However, when it comes to her children and grandchildren, Ibtisam’s mother showed me how she will do whatever it takes—including traveling 3 hours alone at 7:00 am— to give them the services they need. The lines at UNHCR remain long, crowded, and brimming with refugees. With services like apartment leasing support and language classes, the lines represent possibilities for a more comfortable and safer life. Many of the physical and mental health concerns expressed are not priorities but merely aspects of their lives that are put on hold until they secure the futures that they have been striving for since their arrival.