Five Questions About Adolescent Girls in Emergencies

The Five Questions Series is a forum for scholars, government officials, civil society leaders, and foreign policy practitioners to provide timely analysis of new developments related to the advancement of women and girls worldwide. This interview is with Dr. Holly G. Atkinson, Distinguished Medical Lecturer at the CUNY School of Medicine and Assistant Clinical Professor of Medical Education at the Icahn School of Medicine at Mount Sinai, and Judith Bruce, senior associate and policy analyst at the Population Council. Atkinson and Bruce are members of the Girls in Emergencies Collaborative, a multi-organization effort anchored by Omar Robles and Dale Buscher at the Women’s Refugee Commission to address the elevated risks adolescent girls face during humanitarian emergencies.

What are the aims of the Girls in Emergencies Collaborative (GIEC)?

HOLLY: The central concern of the Girls in Emergencies Collaborative is that many girls—the poorest of the poor—are already living in a “state of emergency.”  They suffer a number of abuses in their normative experiences: forced and child marriage, adolescent pregnancy, sexual violence, and disproportionately high HIV/AIDS infection rates, for example. That is the baseline. And then if a disruptive force of a humanitarian emergency is added, it compounds these issues several-fold. When the humanitarian aid community addresses girls’ needs, if at all, they address them way too late in the emergency cycle, usually after the worst abuses occur to the least visible young adolescents.

JUDITH: A fundamental thesis is that investment in adolescent girls is core to addressing intergenerational poverty and all of its elements, including fertility, maternal and child health, disease burden, disease management, justice, education, sustainable livelihoods—keeping in mind that a high and likely rising proportion of adolescent girls will be sole or substantial support to themselves as well as younger and older dependents. Current strategies fail to reach adolescent girls, especially the poorest girls in the poorest communities, despite the fact that girls mediate the scarcities exacerbated by conflict, which may be driven or accelerated by a drought or scarcity.

Take a slow-moving health emergency, like HIV: in high HIV-burden countries more than 60 percent of adolescent girls will be single mothers at some point in their reproductive lives. Or fast-moving health emergencies like a natural geologic disaster, or a cholera or Ebola epidemic: in Ebola zones, 75 to 90 percent of girls will be single mothers. Girls’ poverty is driven by exclusion from economic resources while they are at the same time heavily responsible for providing for their families. This happens with increased velocity in emergencies.

How are adolescent girls particularly vulnerable in the different types of crises that arise from conflict and disaster, from Haiti’s 2010 earthquake or the aftermath of Hurricane Matthew, to the global refugee crisis we currently face?

HOLLY: We focused our recent work on adolescent girls particularly in the realm of climate emergencies because now—and this is a stunning figure—climate-related events account for nearly 80 percent of the increase in humanitarian emergencies. But whether we are talking about displacement due to conflict or natural disaster, when we talk to families in camps, a father will say that he wants a daughter to marry early because of the threat of sexual violence; he would rather marry her off at young age for her “protection.” Of course, if refugee camps were safer and the humanitarian aid community changed their modus operandi to acknowledge the economic and scarcity drivers of girls exploitation—inside or outside of marriage—and assure their safe access to food, water, and services early in any response, we might help families make better decisions.

JUDITH: In terms of the typology of natural disasters, there are some that are reoccurring climate-based events, such as coastal flooding. One of the things we recommend in our paper is that places with reoccurring disasters can be mapped. Take Bangladesh: we included in our paper reference to an interesting study that our colleague Sajeda Amin did, which disaggregated the effects of seasonal flooding and found that in the places where the families are displaced, girls may be married at younger ages as a compensation to the economic losses of displacement. Young girls are in effect a vital credit card for their families. Thus the first 45 days after a disaster hits are crucial, because many decisions about infrastructure and services are made during that early period that are meant to be temporary but frame the often “permanentized” emergency. These decisions can seriously undermine girls’ safe access to vital services.

Why aren’t adolescent girls typically a targeted, high-risk group in humanitarian relief efforts during the immediate aftermath of an emergency? 

JUDITH: It is absolutely in part due to the invisibility of their crucial role in family management and a disconnect between humanitarian relief and development. The vulnerability profile applied at registration in a refugee camp, for example, may overlook girls, and data is either not disaggregated or is analyzed too late to shape consequential early interventions. Boutique programs do not meet the need: for example, in a camp in Jordan that houses 120,000 people, respondents to our survey said that programs were reaching 300 girls. Simple demographics suggest that 15 percent of almost any population are adolescent girls. So 300 girls out of 18,000 reached in three different sites is hardly coverage.  Programming for girls in relief efforts reaches too few girls with too little content too late.

HOLLY: Even in the short term, when the humanitarian aid infrastructure group moves in, their attention to adolescent girls either doesn’t exist or their actions are too late. One of the reasons why we created the GIEC is because, even despite rhetoric about gender-sensitive development, in fact it’s not happening. Or, again, it’s happening so late that the terrible things we’ve already enumerated have already happened to the girls. They’ve been married. They’ve been taken out school. They’ve suffered several forms of sexual violation. They may have already contracted HIV/AIDS. It’s way too late by day 90 or day 120 of an emergency. And this issue—paying attention to adolescent girls—is important not only because they are one of the most highly vulnerable populations but also because, paradoxically, they are one of the most promising populations to pay attention to because of their resiliency and potential to contribute to the recovery process.

How can governments and donors more strategically invest in adolescent girls when emergency hits?

HOLLY: Better data, asset investment, and funds and authority in the hands of on-the-ground program staff to field pilot programs. We need data because you can’t protect and offer girls safety if you don’t know who they are and where they are. If we don’t measure things, we’re not going to be able to move the ball forward. We need not only sex-disaggregated data, but we also need it in more finely-drawn age categories: a 10-to-12-year old is dramatically different from a 15-year old, who is different than a 19-year old. Donors and governments should start to use disaggregated data and fund and empower emergency staff to set up programs rapidly, including thinking about what roles can girls take in recovery processes. Donors and governments should give girls safe access to infrastructure, livelihood training, schooling, and health services. We need funding for pilot projects that give latitude to succeed, or not succeed, and give frontline workers learning tools and resources to share experiences.

Can you describe how findings from pilot programs can be used to better meet the needs of adolescent girls in future emergencies?

JUDITH: Pilot programs need running room, particularly in the chaotic early days of an emergency. Could we give girls 10 to 19 all orange bracelets and call a girls-only meeting as soon as they enter a camp? In Zaatari camp in Jordan, for instance, imagine that all the girls with orange bracelets are called to such a meeting, rather to a homogenized “child friendly space.” If there can’t be a girls’ tent with an orange flag, the child space could have girls’ sessions separate from boys’ sessions, given that boys have much more access to space and meet-ups with their peers. Girls could be given their own food ration cards. And imagine if solar lanterns are distributed through the girls’ groups.

At a meeting of the Girls in Emergencies Collaborative in Jordan co-hosted by the Women’s Refugee Committee and the Population Council, our colleague Omar Robles presented a case example of working with program staff of the Danish Refugee Council in Tripoli, Lebanon, walking the terrain using a tool called Girl Roster to define the community in which the Syrian girls were concentrated. The team inventoried each household in ten-minute interviews and generated quick estimates of the total number of girls by age, those in school or out of school, at grade level for age or not, living with two, one, or no parents. All girls were placed into one or more categories. The finding was that the majority of girls are “off track.” They are either not in school, they are off grade level, or something else, like early marriage, has happened. They’re short of basic entitlements.

The same tool can also be used to learn who is covered by core programs. The finding is typically that there is a skewing of benefits to the better-off. This kind of inquiry has been conducted by the Haitian Adolescent Girls Network with support of UNFPA in the post-earthquake areas of Haiti and soon in the hurricane-affected zones.

In one program in South Sudan, to give another example, Omar worked in a resettlement area after the first wave of the renewed civil war. He asked the camp leadership about the population before the Girl Roster inventory was used. Camp leadership projected that 10 percent of girls were out of school. But at the end of two-day field work, the team discovered that the actual number was 45 percent. Now that’s important for two reasons: first, it is a very high proportion. But second is that it affected programmatic decisions: services, food supplements, and vital information about vaccines were being delivered through school. The Girl Roster tool enables staff to start to “see” the girls. The information gathered is fairly contemporaneous and the tool can be implemented by the staff actually on the ground, with the day-to-day responsibility to act.

Learn more about the GIEC:

Atkinson H.G. and Bruce J. Adolescent Girls, Human Rights and the Expanding Climate Emergency. Annals of Global Health 2015; 81(3):323-330. http://www.annalsofglobalhealth.org/article/S2214-9996(15)01219-9/fulltext

The Girls in Emergencies Collaborative, Statement and Action Agenda from the Girls in Emergencies Collaborative. Annals of Global Health 2015; 81(3). http://www.annalsofglobalhealth.org/article/S2214-9996(15)01220-5/pdf.