Tindouf, 1975: Medical Humanitarian Assistance and Elderly Refugees
For over 40 years, Sahrawi refugees have lived in settlements–camps that have now effectively developed into cities–near Tindouf in south west Algeria. In 1975, following Morocco's partial annexation of the Western Sahara, a mass displacement of people took place from the territory and over the border into Algeria. The refugee population was composed mainly of women, children, and elderly people. The male population, of working and fighting ages followed into the camps during the course of the war and subsequent peace. The League of Red Cross Societies made a "qualified guess'", following a mission in June 1976, that 50,000 refugees were living across twenty camps. Host state Algeria and the Polisario Front (recognised in 1979 by the United Nations as a representative body of the Western Sahrawi people) put forward the figure of 165,000, and this was also adopted by the United Nations High Commissioner for Refugees in its policy and evaluation communications. The Societies' representative also reported that 80 per cent of the population were women and children, and ten per cent were elderly people. This presented a large body of vulnerable refugees, with distinct humanitarian, and medical humanitarian, needs.
The historiography of the Western Sahara illuminates the realities of the mass displacement and the humanitarian challenges it presented to the refugee population; for example, Pablo San Martín's Western Sahara, the Refugee Nation. Research by Alice Wilson published in Sovereignty in Exile investigates the unmaking of tribal structures and the making of an egalitarian state. Elena Fiddian-Qasmiyeh's fascinating work puts forward how, to the present day, the Sahrawi state-in-exile presents itself as 'ideal refugees.' However, the life and experiences of elderly refugees - who often constitute the largest groups within a refugee population - are often hidden from view. In the case of the Sahrawi refugees, the majority of the older men and women displaced in 1975 and 1976, for example, will have passed away in exile, yet little discussion of their lives and deaths appears in the historiography, for this refugee camp context or for others.
Two contemporary reports by humanitarian organisations stand out for their detail and western perspective of the collective needs of the Sahrawi people. The report by Mr Sven Lampell, representative of The League of Red Cross Societies and a report by Dr Tim Lusty on behalf of Oxfam were both circulated following needs assessment missions in 1976 and 1977. Up to two years after the start of the mass displacement, these reports could relate to a post-emergency situation, but they do reflect on the action taken to-date by NGOs working with Red Cross societies including that of Algeria and the Sahrawi. Neither report includes information about the specific health needs of older refugees within the population. Despite forming a relatively small group within the population, older people were a conspicuous group, especially the older men who had not stayed to fight in the Western Saharan conflict.
However, their absence from the humanitarian reports in question is perhaps unsurprising. The scarcity of medical humanitarian services and programmes for older populations in the 1970s could reflect the broader context of medical history and the nascent state of geriatric medicine in the western states from which the foreign medical teams originate. That said, around this time, Cicely Saunders' work was influencing the medical profession, through her writings from the late 1960s in which total pain was contrasted with acute pain, and in the founding and subsequent work carried out at St Christopher's Hospice. Advocates of palliative care in the UK were increasingly considering personhood and concern for the whole person as a patient. When the Sahrawi refugee camps were established in 1976, holistic concepts of total pain and pain management were making ground in the western world, and considerations of older people's health needs were evolving to encompass a broader understanding of diseases such as Alzheimer's alongside conditions such as heart disease and cancer. How, then, did medical humanitarian actors translate these norms and emerging medical practices into refugee camp contexts? And how did these life experiences impact individuals, families, and communities?
Far from being passive recipients of aid, older refugees were active participants in the medical humanitarian response in Sahrawi refugee camps, including the establishment of medical facilities and services. In field reports conducted for Oxfam shortly after the establishment of the camps and published in 1981, Barbara Harrell-Bond reported the involvement of older men in the development of infrastructure. Older men were "seen everywhere, working in mudbrick fields and constructing new offices, medical facilities, and schools" (Barbara Harrell-Bond). The men saw this contribution as having implicit value beyond the immediate need of building facilities in the camps. Barbara Harrell-Bond reported, "I asked how they kept working when every day each man was thinking that tomorrow he might return to his homeland, [he replied] 'when we return we will know how to build.'" These men were not necessarily infirm, or passive recipients of aid, but they were playing a key role in developing both the camp and skills believed to have value for creating infrastructure in their home territories post-return. The education system also provided opportunities for older women to develop skills to contribute to the camp, for example, the 27 February School established in the mid 1970s offered education for women aged 16 to 70.
Alice Wilson's research presents other evidence of how older refugees created ways to alleviate suffering and create joyful experiences. These responses can be considered in themselves humanitarian, even though they are not necessarily accredited to an external, foreign humanitarian organisation. In 1991, twenty years after the mass displacement, the ceasefire between the Western Saharan Polisario and the Moroccan government included a relaxation of mobility restrictions placed on refugees living near Tindouf. As a result, some older refugees were able to take sojourns in Western Saharan pasturelands east of the Berm wall that divides Moroccan territory to the west and Polisario-controlled territory to the east. In her research between 2006 and 2012, Wilson met with refugee camp inhabitants who, in their older age and with access to certain resources–transportation, supplies, support from relatives–were able to take trips to the pasturelands in Western Saharan territory beyond the camp. Wilson suggests that these visits were initiated by relatives of older family members, wishing to offer them respite from the confinement of the refugee camps. The sojourns enabled rest, recuperation, and relief from the harsh environment in the desert camps. They show how members of the population develop tactics to care for the health and wellbeing of older people, and effectively create their own humanitarian responses, in this case to the challenges of older age.
In the camps of the Western Sahara, refugees—including elderly members of the community—have taken various action over the course of their lives to respond to crisis and to contribute to their society. Working together, refugees make attempts that are often undocumented to live well and care for each other, at all the different stages of their lives and deaths.
- Wilson, Alice. 'Ambiguities of space and control: when refugee camp and nomadic encampment meet'. Nomadic Peoples 18, no.1 (2014), pp. 38-60.
- Clark, David. To Comfort Always: A history of palliative medicine since the nineteenth century (UK: Oxford University Press, 2016).
- From Camp to City: Refugee Camps in the Western Sahara, edited by Manuel Herz (Zürich: ETH Studio Basel & Lars Müller Publishers, 2013).
- Fiddian-Qasmiyeh, E. The Ideal Refugees: Islam, Gender, and the Sahrawi Politics of Survival (Syracuse: Syracuse University Press, 2013).
- Harrell-Bond, B.E. 'The Struggle for the Western Sahara: Part III: The Sahrawi People', American Universities Field Staff Inc. (AUFS), Hanover, USA, 1981, http://www.icwa.org/wp-content/uploads/2015/09/BHB-24.pdf [15 August 2018].
Short Biographical Note on Contributor
Jennifer Carr, MSc, BA (Hons) is a Wellcome Trust doctoral candidate at the University of Glasgow. She is writing a medical history of refugee camps focused on Palestinian camps in Jordan and Sahrawi camps in Tindouf, Algeria. An associate of Manchester-based UK-Med, Jennifer has direct experience of the professionalization of medical humanitarian emergency assistance and UK-Med's involvement in the national Ebola response programme. These experiences inspired research questions around the medical experience in refugee camps and how human life is valued at times of emergency and development. Jennifer was a participant of the Global Humanitarianism Research Academy 2018.