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P r o c e d i a - S o c i a l a n d B e h a v i o r a l S c i e n c e s 1 3 2 ( 2 0 1 4 ) 6 9 7 – 7 0 0

6th International Conference on Intercultural Education “Education and Health: From a transcultural perspective” Training for health care professionals in the Sahara refugees camps

Maria José Calero-Garcíaa*; María Luisa Grande Gascóna; Ana Diaz-Meco Niñob:

aUniversidad de Jaén. Campus Las Lagunillas. Edf.C1-111.230071.Jaén. España b Hospital Nurotraumatologico. Carretera de Madrid, s/n. 23071.Jaén. España

Abstract

The start of the Saharawi administration has it origin in the proclamation of the Sahrawi Arab Democratic Republic (SADR) in 1976. The priority sectors of the Sahrawi administration are: health and education. But despite the efforts, the SADR has serious deficiencies in health resources and trained health professionals, depending on the solidarity of international cooperation. The Saharawi government is seeking support from academic institutions like the University of Jaén, to allow the training of health professionals in their own area and to ensure the continuity of these graduates in the Saharawi refugee camps. ©© 20142014 TheThe Authors.Authors. Published Published by by Elsevier Elsevier Ltd. Ltd. Open access under CC BY-NC-ND license. SelectionSelection andand peer-reviewpeer-review under under responsibility responsibility of of HUM-665 Encarnación Research Soriano, Group Christine “Research Sleeter and and Evaluation María Antonia in Intercultural Casanova. Education”.

Keywords:Development cooperation; health; Sahrawi population; health training.

1. Introduction

In 1884 Spain started the process of colonization of the Sahrawi territory, settling in the Río de Oro Peninsula until 1976. Tri-partite Madrid Agreements in 1975 were signed in a historical context of political disconcert in Spain (Franco, the head of state, was close to his death). The accords implied the distribution of the between Mauritania and Morocco. At that moment the powers-to-be were more concerned with the Spanish internal situation, and less so with Spanish responsibility as a colonizing country (Vilar, 2005). From that moment, Western Sahara stopped being Spanish to turn into an unresolved colonial issue. (Source, 2006; Martínez,

* Corresponding author. Tel. 0034-953212633 .Fax. 0034-953212632 E-mail address. [email protected]

1877-0428 © 2014 The Authors. Published by Elsevier Ltd. Open access under CC BY-NC-ND license. Selection and peer-review under responsibility of HUM-665 Research Group “Research and Evaluation in Intercultural Education”. doi: 10.1016/j.sbspro.2014.04.375 698 Maria José Calero-García et al. / Procedia - Social and Behavioral Sciences 132 ( 2014 ) 697 – 700

2003; Martínez, 2007) Sahrawian people were opposed to those Agreements and to the Popular Front for the Liberation of Saguia al Hamra. Hence Río de Oro () recognised, as a representative of Sahrawian people, the Sahrawi Arab Democratic Republic (SADR). A war began, which has as a result the abandonment by Mauritania of the ceded area. According to Fernández (2013), from 1999 this conflict goes through four stages: until 2003 a decreasing in repression is produced in the occupied territories and progress is being made on the idea of an autonomy regulated by the Moroccan government. This is followed until 2006 when there is a crisis in the Moroccan strategy in which they reject the Baker Plan II (both Baker Plan I and Baker Plan II supported autonomy in a temporary way under the Moroccan government to hold a referendum after that) and Morocco terminated the idea of celebrating a referendum. To 2008 there is a rapprochement movement towards Sahrawi population so Own Autonomy Plan is suggested. Finally, from 2009 there is a broad increase in the repress towards Sahrawi population which has been widely alleged by International Organizations. Part of the population stayed in the occupied territories of Morocco, some 125.000 people left it to settle in refugee camps in Argelia. In 2002 UNHCR estimated that there were 157.821 people living in those camps were eligible for aid. However, United Nations has limited this number to 90.000 people. This fact has an important consequence for human aid which population receives because their survival depends on the international aid which is given by international organizations such as the United Nations Commissioners for Refugees, the Humanitarian Aid Office of the European Union, the International Committee of the Red Cross and the Official development Aid of different countries. One of the most important sources of aid is Spain, in which the decentralized cooperation plays an essential role. (Grande y Ruiz, 2013) One of the main problems that population has is the safety food which depends on the external aid. Geographic and climatic context makes basically impossible the production of food; less than 1% of consumed food is produced in the camps. The World Food Program distribute monthly food between the whole population but that is limited and little varied, basically flour, lentils, oil and sugar with little consume of fresh food. As a result of this food deficiency, according to UNHCR, malnutrition rate is about 10%. Another important problem is the access to drinking water. In this regard, an administrative authority exists in the SADR, the Hydraulic Department, which manages and coordinates the projects of cooperation to make sure the water supply for the refugee camps, by developing infrastructures of water purification and aquifers prospections. (Fernández- Villa, 2010). However, as noted, the main problem is the lack of health professionals (doctors and nurses) stable in the camps of the SADR.

2. Aim of the study

The aim of this study is the health care situation of Sahrawi population living in refugee camps and the importance of the training for health care professionals to deal with staff shortage in health establishments. The main problem is the lack of health staff and their continuing training. These lacks are being supplied with medical commissions which come from other countries, especially from Spain and which are giving punctual answers to certain medical and surgical problems. These commissions depend on subsidies that financiers hold periodically but which are becoming increasingly scarce due to the current crisis. These actions involved are those which alleviate the problems but do not give long -term solutions by causing external aids dependence. The training of health professionals in others countries, based on agreements between governments and the SADR, has been an effective method for training a large number of professionals. But in some cases, trained staff found better opportunities in these countries and this fact has caused a considerable brain drain. The current debate is focused on changing the educational model and getting these health professionals in the area to SADR. With this purpose, they have created the University of and the School of Nursing Smara. The signing of agreements with others Spanish universities allow the involvement of teachers in this school and facilitate the achievement of this objective. We will focus on exposing the strategy followed by the administration of SADR to achieve this priority.

Maria José Calero-García et al. / Procedia - Social and Behavioral Sciences 132 ( 2014 ) 697 – 700 699

3. Main argument

The Constitution of the Sahrawi Arab Democratic Republic (SADR) adopted in 1999 states in Section 36 that “all citizens have the right to health care and protection”. The SADR health system is regulated by the State which determines the service portfolio, the budgetary allocation, and sets priorities in order to act depending on them. However, the Sahrawi health system has a number of characteristics that make it different. Perhaps, the most important feature is that it is not financed with its own income since it has no tax system. This implies a certain dependence on international aid so that refugees can have access to universal, fair and free health care. On the other hand, this system has a fully defined health structure: the most important institution is the Ministry of Health which includes four Central Agencies (Health Care, Prevention, Medicines and Equipment, and Veterinary), a General Secretariat coordinating logistics, the Cooperation Department, and the National Hospital Management (including all services of medical and surgical specialities) (Fernández-Villa, 2010). This system is defined in the SADR Strategic Health Plan for 2011-2015 in which the priority actions of the Ministry are also established. During the field work we perform, it has been observed that real resources are limited and they have a difficult distribution despite the efforts made to get the highest equity and health cover. In many cases, these resources depend more on the international cooperation offered than on the real shortages and needs of the population. For this reason, it is easy to find sometimes certain materials and products that are not necessary compared with other fungible materials or medicines that are most widely demanded. The same happens with health structure, which is modified depending on cooperating teams that will provide services in each season. The local care structure consists in the Basic Health Unit, which is the dispensary of the daira. Nowadays, refugee camps have 26 dispensaries. There are also small local hospitals in one each of the five wilayas, two specialized centers (Mental Hospital and Anti-Tuberculosis Hospital), and two national hospitals (Rabuni Hospital and Bol-La Hospital). Due to the small number of general practitioners and specialists, the cornerstone of this structure is the nursing care. In fact, the management and direct care of the dispensaries as well as the management of some local hospitals are in charge of nursing professionals. Yet paradoxically, the training of these professionals remains one of the outstanding points of this system. The internal training taught in the Nursing School of Smara needs to be regulated and strengthened academically. On the one hand we find that a large dropout nursing occurs in the second year. It has been observed that the number of second and third-year students is much lower compared with first-year students. In this sense, only 50 % of the students complete these studies. This escape occurs mainly in women since they are the mainstay of the home and family life. They are also required for the care of younger siblings and elderly relatives and sometimes because they have reached the age to get married. Second, as we have said, is that foreign-trained professionals tend not to return to the refugee camps and emigrate to other countries like Spain. Nowadays, a total of 26 qualified nurses are working in the dispensaries to give direct care to the Sahrawi population in the camps. This implies that most of the nursing duties and activities are developed by 338 nursing assistants with minimal training (many of them cannot read or write). These assistants learn thanks to their own experience and training in situ. Meanwhile, nurses have to manage the centers, distribute the resources, supervise health records, and provide direct care in diagnosis consultations. Dispensaries and even hospitals are closed during the evening and night due to personnel shortage. There are many delays in emergency cases as it is necessary to find the health care professional in charge or even go to one of the two national hospitals with an Accident and Emergency Department and 24-hour medical care. Moreover, communication between the different camps is not very good, there are only a few roads, and patients have to go across the desert without the necessary medical transport in many occasions. Another characteristic of health care in the area is the impossibility to schedule medical care due to the dependence of the resources provided by international cooperation and also because this is a nomadic and changing population who go from one wilaya to a different one all the time. Nowadays, most specialized care is performed by medical and nursing committees, whose main task is to solve 700 Maria José Calero-García et al. / Procedia - Social and Behavioral Sciences 132 ( 2014 ) 697 – 700

health problems in situ. But what is really necessary is to lay down the bases of a permanent, scheduled and preventive attention, which has to be provided by professionals with formal training from the SADR and living in the area. Thus, there are three pillars which have to be promoted: improve the level of qualification of nursing assistants with a homogeneous and constant training, strengthen the nursing personnel training at the University of Tifariti, and motivate qualified health care professionals so that they live in the area. There is an agreement between the University of Jaén and the University of Tifariti, which allows a cooperation strategy that acts in three ways: first, movement of professors at the University of Jaén to support teaching in the School of nursing, second, postgraduate training of teachers in this school at the University of Jaén and third, the encouragement of nurses trained by a postgraduate training opportunities, to remain working in the SADR.

4. Conclusions

The situation in the refugee camps, bearing in mind the health of the population, suffers from serious deficiencies. In particular, this is due to the shortage of qualified medical personnel who have to deal with the major health problems that suffer. The brain drain is one of the main difficulties that the Saharawi Administration has to face. The displacement of health care personnel during a short period of time to perform medical and surgical interventions is not a long term solution and it is expected a decrease due to reductions in Official Development Assistance of most donor countries. Cooperation projects for development in the health sector are also being affected by reductions. For this reason, alternative solutions have to be found, one such is focused on the training of professionals in the newly created University of Tifariti. This university is signing some agreements with Spanish universities, reflecting its institutional strengthening and promoting the international exchange of lecturers and students in those degrees that are more necessary to meet the needs of the population, including health care degrees.

5. References

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