13. Advocacy and Empowerment in the Context of Refugee Health

as a process of supporting and enabling people to express their views and concerns, access information and services, defend and promote their rights and responsibilities, and explore their choices and options in life. Advocacy, in that sense, can be understood as an organised effort to influence social or policy change, whereby action can be directed towards both political decision-makers or society as a whole.

In refugee health, advocacy typically includes efforts to lobby for persons with refugee experience to have access to quality health services and to ensure that healthcare services are culturally and linguistically appropriate, taking into account the specific living situation of persons with refugee experience.

Advocacy in refugee health cannot be pursued without the strong involvement of persons with refugee experience themselves to avoid the risk that their real interests will be ignored. Legitimacy and accountability are crucial concepts that need to be considered before taking up advocacy work (Danish Refugee Council 2023). Networks and organizations by and for persons with refugee experience have published guidelines and other works offering valuable information on how to prevent the exclusion or tokenization of persons with refugee experience in (health) advocacy (Global Refugee-Led Network 2019).

In this context, it should be noted that although research in the area of refugee health has significantly increased over the last two decades, substantial gaps in the current knowledge base have been criticized. These gaps are considered to stem from a lack of meaningful participation of individuals with refugee experience in this research (James et al. 2021; Kronick et al. 2021; MacFarlane et al. 2024). As MacFarlane et al. (2024) emphasize, explicit, critical attention must be given to the voices that are heard, the voices that are left out, and the voices of those who are ignored because they do not even have a seat at the table.

empowerment describes encouraging processes of self-empowerment in which people in situations of helplessness and powerlessness begin to become aware of their abilities and strengths, actively shape the reality of their lives and learn to use their resources to lead a self-determined life. Empowerment—in a nutshell—aims at (re)establishing self-determination over the circumstances of one’s own life.

empowerment benefits not only one group or community, but all citizens. A real perspective for persons with refugee experience also means a new perspective for the respective host country. For us, empowerment means that decisions are made with us, not for us. We want to have a say in all matters that affect us and we want to have a say in the future of the country in which we live. But the basis for this is a level playing field and equal civil rights (Amoah et al. 2023: 15).

Empowerment refers to a process of collective self-empowerment in which individuals and groups acquire the knowledge, skills, and resources they need to take control of their own lives and advocate for their own needs. As a professional support service, empowerment is inevitably based on a tension between self-determination and heteronomy, autonomy, and dependency (Lindmeier & Meyer 2020). It is therefore important to be clear about what health and social care professionals can and cannot do in relation to their patients’ or clients’ empowerment processes. Empowerment approaches in the tradition of social movements understand empowerment “as a healing, empowering experience between people with equal rights” (Flory et al. 2020). Health and social care professionals without refugee experience can use their privileged position in society and act in solidarity. This, however, cannot replace empowerment by or with other people who have had similar experiences. Health and social care professionals with refugee experience can both engage in empowerment processes themselves and support others to do so. Their experiences and knowledge are a valuable source for developing the field of refugee health in the future.

When empowerment is applied in professional help contexts in the health and social sector, there is a risk of individualizing unequal power relations by focusing on individual patients or clients and their resources. This is why health and social care professionals need to be able to recognize and critique unequal structural and social power relations, and to advocate for structural change that may also challenge their own privileges. Health and social care professionals, who have structural power and institutional access, are called upon to engage in power sharing (in the sense of power distribution and power access, Rosenstreich 2006) when working with people with refugee experience. A fundamental prerequisite for power sharing is to get to know and take seriously the perspectives, problem definitions, positions, and interests of people with refugee experience. This may require a willingness to change one’s own actions and attitudes. It is also important to avoid a paternalistic attitude and not to speak for people with refugee experience, but to support them in pursuing their own interests (Rosenstreich 2006).

Currently, the association is run from three offices: the main office in Hanover, and a small one in Walsrode and Osnabrück, respectively; and has five full-time employees. Most importantly, the network is supported by a large number of volunteers, the majority of whom are women, representing the diverse African communities in Lower Saxony.

These volunteers are of such a great importance because they are part of their communities, hence they are heard—and they hear what issues are being discussed; they know what the main problems are, because these are their problems as well. These volunteers are trusted, so they can put forth and discuss solutions. In other words, the problems discussed in baobab—zusammensein are problems of daily life, not problems drawn from theoretical discussions.

The following languages are spoken in the network: Kabwe, Ewe, Kotokoli, Twi, Medumbe (Bamileke), Lingala, Lari, Kikongo, Kizombo, Swahili, Tshiluba, Tetela, Peul, Yoruba, Ibo, Wolof, Djoula, Bete, Kreol, Mandingue, Arabic, Tigrini, Somali, Kinyarwanda, Kirundi, Shona, Ndebele, Twi, Bambara, Abron, Haoussa, Baoulé, German, French, English, Portuguese, and Spanish.

With the project ‘Elikia’, which was launched in the spring of 2024, baobab—zusammensein aims to take up the fight against FGM/C in Lower Saxony in order to offer those affected a contact point so that they can come to terms with the suffering inflicted on them. Elikia also aims to carry out low-threshold prevention and awareness-raising work in the communities. In this context, ‘contact point’ must also be understood as a place that can change. Not only is a fixed counselling centre offered where people can go, but the staff of baobab—zusammensein go to the people, i.e., they move around in the communities. This outreach work is time-consuming and labour-intensive, but it also serves to build trust, which is the basis for any collaboration. It is only from this position of trust that effective cooperation can take place with those affected, those at risk, and husbands or fathers.

The project ‘Elikia’ has three target groups: African women; African men; and finally a group made up of educators, primary school teachers, professionals in projects and institutions, and medical doctors.

However, women and mothers are often responsible for forcing their daughters to undergo this cruel practice. Girls are often circumcised at a very young age so that they cannot defend themselves or refuse the practice, and so that the circumcisions are protected from state persecution—as female genital mutilation is now banned in many countries.

In modern Africa, however, there are already many awareness campaigns by various groups, organisations, and governments. But people who have emigrated find it harder to give up their customs. They are more likely to cling to the traditions and associated values of their home country.

The second target group is African men. A lot of educational work and persuasion is needed here. Many men from countries with a tradition of FGM/C who live here bring their traditional way of thinking with them to Europe. They do not want an uncircumcised woman because they have been brought up with the idea that if a woman is not circumcised, she is not pure. If she is not circumcised, she is considered a whore. Most immigrants from Africa are convinced that an uncircumcised woman cannot lead a good life. No one wants to marry her; her community shuns her. This is ingrained in them. These attitudes need to be addressed and clarified.

Both African men and African women need to be made aware of the social and legal values that also determine their lives in Germany.

The third target group (educators, primary school teachers, professionals in projects and institutions and medical doctors) are to be reached through events and workshops. The initial aim here is to raise awareness of the problem of FGM/C: how can I tell if a girl is about to be circumcised, what happens during the procedure, why do mothers (especially), but also fathers, do this to their daughters?

The project is implemented through two main strands: counselling/support and awareness-raising/prevention, with the latter targeting communities and professionals in authorities and institutions. The primary aim is to prevent FGM/C among African women living in Germany—in particular, among young girls between the ages of 3 and 12, as this is the age group in which most of the victims of this practice are found.

Another key objective is to raise awareness of the issue. This includes the third group of educators, primary school teachers, professionals in projects and institutions, and medical doctors. Further training programmes and campaigns are implemented to educate this target group on this sensitive topic and to ensure their commitment to fight against this ritual.

The project started with a needs assessment of the target group, from which specific educational activities were then derived. The process accompanying the needs assessment phase included the following steps:

Indicators of goal achievement:

1. Ability to act independently.
2. Contact and cooperation with the further help systems of state institutions and welfare organisations (KSD/Johanniter/AWO/Caritas/Diakonie, Red Cross, etc.).
3. Involvement as multipliers within the communities—people who have sought counselling become counsellors themselves.
4. Those affected take responsibility for themselves and others; they become health mediators.

In principle, there are two strands to the implementation phase: the first is the organisation and implementation of both the further training programmes for African communities, and the further training programmes as well as the continuous provision of information for the schools, kindergartens, advice centres etc., and the medical sector. Contacts with the medical sector are also intended to serve the subsequent medical care of the women concerned. The second strand aims to strengthen the existing African networks. Future participants and multipliers will be recruited from these contacts to the African communities.

Contact:

baobab—zusammensein e.V.

Georgswall 3

30159 Hannover, Germany

+49-511 – 47 26 26 77

info@baobab-zs.de