This case study is designed to answer the question whether refugees can make a positive contribution to host countries, not simply as individual participants in economic activity, but by contributing to welfare. The thesis provides a detailed study of an NGO originally established to provide medical relief for refugees but which now provides basic health care for local people. Since 1995 this NGO has adopted a policy of providing the same basic care to refugees and to people in local Pakistani villages, thus making no distinction between refugees and the residents of a specific geographical area. The case study also shows that an NGO can be an appropriate and effective provider of primary health care (PHC) as promoted by the 1978 Declaration of Alma Ata. The thesis uses several approaches to demonstrate why this happened and how it was achieved. Firstly, it narrates the history over the twenty-year period 1980-2000 of an international health project originally started for a group of Afghan refugees, and its transformation in 1995 into an indigenous Pakistani NGO called “Frontier Primary Health Care (FPHC)”. Secondly, the study explores the theoretical utility and limitations of the PHC strategy generally. Thirdly, the thesis provides an analysis of the extent to which the underlying principles or “pillars” of PHC, that is, participation, inter-sectoral collaboration and equity have affected the process and outcomes of the project. Locating the case study in the Pakistani context provides evidence of the persistent difficulties and shortcomings of official government basic health care in Pakistan, particularly for rural poor people, showing that the field is open for other providers of health care, such as NGOs. The thesis goes on to discuss strengths and weaknesses of NGOs in general, and particularly as health care providers. In investigating characteristics of the NGO sector in Pakistan, the study pays special attention to the discrete health care system for Afghan refugees created in the early 1980s, including its introduction of Community Health Workers. In order to assess the impact of the NGO on people’s health, the study uses data from mother/child health and family planning programmes (as far as available) demonstrating that this NGO is a more effective provider than the other two agencies i.e. the Government of Pakistan and the Afghan Refugee Health Programme. Placing the NGO in this context also shows that it has a better understanding of the underlying “pillars” and has made more determined and effective efforts to implement them, especially in regard to community involvement. It is unusual for a project initially refugee-oriented to have matured sufficiently to be making a contribution, as a matter of formal policy, to basic welfare in the host country, itself a developing country. The study concludes that the significant factors in its success are continuity of leadership; boundaries of population, geography and administration; dependable income and material resources; rigorous supervision; support, but not takeover, by experienced consultants; capacity to use learning to adapt and move on; and sensitivity to local cultural norms. All these have enabled the project to survive and develop as an indigenous autonomous organisation beyond the twenty years covered by the case study. FPHC is still operational in 2004.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Health literacy is the degree to which individuals have the capacity to understand basic health information and services needed to make appropriate health decisions. Women seen at Maricopa Integrated Health System (MIHS) Refugee Women’s Health Clinic (RWHC) are routinely offered education on developing a Reproductive Life Plan (RLP). In order to influence women’s reproductive health and medical decision‐making, there is a need to tailor RLP counseling to engage their male partners in the refugee community. We aimed to assess increased knowledge on preconception care related to the importance of developing a RLP, perspectives on birth spacing, and the influence of men as well as religion in medical decision‐making. We aimed to identify the refugee community’s receptivity to culturally and linguistically appropriate audiovisual modalities. Study participants comprised 120 refugees (39 men and 81 women) including couples, across the respective target languages with pre‐ and post‐Likert scale surveys assessing perspectives on RLP, birth spacing, the role of religion, and readiness for behavior change. Summary statistics examined changes in pre‐ and post‐Likert scale survey responses with responses dichotomized as Strongly agree/Agree compared against all other responses. A higher frequency of male respondents agreed about knowing what RLP means in the posttest relative to pretest (71.8% to 89.7%, P = 0.016) as well as 'Not having children…' (41% to 64.1%, P=0.035). Female respondents were more likely to agree to 'Know what RLP means' (76.5% to 86.4%, P =0.039) and 'Having a baby soon after…' (65.4% to 76.5%, P =0.035) after the training. They also were less likely to agree that 'RLP is about birth control' (71.6% to 59.3%, P =0.021). Amongst Muslim participants, we found improvement in knowing what RLP means (65.5% to 87.9%) and that it is important for men to have a RLP (67.2% to 84.5%). Cronbach’s alpha was used to measure internal inconsistency, with most values less than 0.5 and deemed unacceptable. Only one value, birth spacing, was > 0.6 and deemed questionable. There was the same degree of concordance, yet there also was discordance in the direction of opinions between women and men pre vs post‐test answers. When comparing couples pre and posttest, there was no significant differences observed across genders. This is the first reported U.S. initiative to provide a culturally and linguistically appropriate preconception health education. Project had demonstrated ability to mobilize several ethnic communities around the RLP. Respondents among both genders were more likely to agree about knowing what RLP means. The most challenging aspect of our community mobilization efforts was recruiting a larger sample size. Another limitation was the use of the Likert scale in a population with low literacy as there were some discrepancies in responses to negatively‐worded questions. Future studies could use a visual analog scale of smiley faces to assist those with limited literacy and incorporate a more global feel.

After being expelled from Bhutan in the 1980s and 1990s, more than 100,000 Bhutanese refugees were forced to reside in refugee camps in Nepal. Twenty years later, in 2006, a global resettlement programme was initiated to relocate them in eight different nations: the USA, Canada, Australia, New Zealand, Norway, Denmark, The Netherlands, and the UK. Since 2010, about 350 Bhutanese refugees have been resettled in Greater Manchester through the Gateway Protection Programme. This thesis is based on 14 months of ethnographic research with members of this community. This thesis analyses the complex relationship between forced migrants, social networks, and ruling, organisational entities, which facilitate refugee resettlement. This qualitative study looks at the structure, role and everyday utility of social networks amongst a small refugee community, and emphasizes that the creation of similarity and difference is an inherent part of community development. The research calls into question the assumptions of UK policy makers, service providers and academics alike, which hold that refugees are removed from their ‘original’ cultures through forced displacement, and thereafter strive to return to a state of ‘normalcy’ or ‘originality’, re-creating and re-inventing singular ‘traditions’, identities and communities. In response to these assumptions, policy makers and service providers in refugee camps and in the UK adopt a Community Development Approach (CDA). However, I argue that there is no fixed and bounded community amongst Bhutanese refugees, but that they actively reshape and adapt their interpretations, meanings and actions through their experiences of forced migration, and thus create novel communities out of old and new social networks. In the process, I juxtapose my informants’ emic understandings of community as samaj, with bureaucratized refugee community organisations (RCOs). This research shows that rather than a creating singular, formalized RCO to serve the ‘good of all’, the Bhutanese refugee community in Manchester is rife with divisions based on personal animosities and events stretching back to the refugee camps in Nepal. I conclude that RCOs may not be equipped to effectively deal with the divisive issues that arise due to refugee resettlement. The thesis is situated at the centre of anthropological investigations of forced migration, community, and policy, and uses interdisciplinary sources (such as policy documents, historical accounts) to highlight the complexities of forced migration and refugee resettlement. This critical research is also a response to the call to make qualitative, ethnographic research more relevant for policy makers and service provision, which is all the more important in this ‘century of the refugee’.

This treatise represents an investigation into the coping strategies of female Zimbabwean refugees at the Central Methodist Church (CMC) in Johannesburg. The CMC in Johannesburg includes a non-profit organisation called Ray of Hope that has functioned as a provider of accommodation and emergency refuge at the church since 1997. A vast number of Zimbabweans are moving to adjacent countries as a consequence of the conflict in Zimbabwe and approximately 85 percent of the people that have sought refuge in the CMC in Johannesburg are Zimbabweans that have fled the economic and political conflict in Zimbabwe. Using an interviewing strategy of a sample of 20 female Zimbabwean refugees, conducted at the CMC, the researcher gathered data, indicating that they face various conflicts on a daily basis inside as well as outside the refugee community in the CMC in Johannesburg. An extensive literature review and researcher‟s own observations during hours spent in the refugee community have also contributed to the collection of data. The findings suggest that coping mechanisms have been adopted by the female refugees to deal with the conflicts. Analysis of data was guided by grounded theory approach which allowed key findings about coping mechanisms to surface which encouraged recommendations presented in the conclusion of the treatise.

The growth of forced migration populations - i.e. the movement of people within and across national boarders as a result of conflicts, disasters, and development policies and projects - has been a defining feature of the twentieth century and will no doubt remain with us well into the twenty-first century (Rutinwa, 2001: 13). Literature searches suggest that the ‘refugee’ constitutes the most powerful label within the forced migration discourse. Published calculations regarding the number of refugees in the world at the end of 2008, range between 15.2 million (UNHCR, 2009: 2) and 13.6 million (World Refugee Survey, 2009: 33). The refugee experience of a small representative population of these figures namely, the Zimbabwean refugees living within the Central Methodist Church (CMC) or Central Methodist Mission (CMM) refugee community, in Johannesburg city centre is the concern of this treatise. From the perspective of the conflict management scholar, the informal and formal conflict management strategies adopted among and between the CMM refugees, have been studied. Analysis of existing literature, interviews conducted with the refugees, as well as hours of experience within the refugee community, substantiate the descriptive study that follows. Guided by the grounded theory approach, research findings have emerged out of the descriptions. The research findings in turn have founded the development of the recommendations that appear in the conclusion to the treatise.