PROTECTING Refugee Youth in ECUADOR: AN Evaluation of Health and Wellbeing Acknowledgments Authored by Elizabeth Donger, Arlan Fuller, Jacqueline Bhabha, and Jennifer Leaning We would like to extend our deep gratitude to Jen Leigh, Miriam Chernoff, Abby Rudolph, Matthew Mimiaga, Lina Zhou, Janine Hightower and Harry Han for their analytic support. We would also like to thank Ben Leaman and Susan Lloyd McGarry for their expertise and dedication in copyediting and layout. Copyright © 2017 FXB Center for Health and Human Rights. All rights reserved. Table of Contents I. Executive Summary............................................................................................................................5 II. Introduction...................................................................................................................................... 8 III. Background .................................................................................................................................. 10 Urban Refugee Youth....................................................................................................... 10 Refugees in Ecuador ......................................................................................................... 11 IV. Methodology ...................................................................................................................................13 Study Implementation and Ethics Procedures ................................................................14 Respondent Driven Sampling Diagnostics ....................................................................16 Analysis Methods ..............................................................................................................17 V. Study Findings .............................................................................................................. ................18 A. Demographics ...............................................................................................................................18 B. Protection System in Ecuador ..........................................................................................19 Registration, Documentation and Durable solutions ....................................................20 Programs, Services and Rights ........................................................................................22 Challenges in Protection System Implementation ..........................................................24 Quito vs Lago Agrio ..........................................................................................................27 C. Education .........................................................................................................................27 School Attendance ...........................................................................................................28 Access to and Retention in Secondary School .................................................................29 Access to Tertiary Education ............................................................................................30 Non-formal Education and Skill Training .........................................................................30 D. Livelihoods ........................................................................................................................31 Rates of Work ....................................................................................................................32 Barriers to Work ................................................................................................................32 Exploitative Work ..............................................................................................................33 E. Health ...............................................................................................................................34 Access to Health Systems ................................................................................................34 Psychosocial Health ..........................................................................................................35 Other Health Issues .........................................................................................................35 F. Sexual Violence .................................................................................................................36 G. Housing and home life .....................................................................................................36 Access to Housing ...........................................................................................................37 Home Life and Abuse in the Home .................................................................................37 Alternative Housing .........................................................................................................37 H. Experiences of Public Space ............................................................................................38 Safety in Public ................................................................................................................38 Community Relations .....................................................................................................39 Peer Support Networks ...................................................................................................39 Criminality and Criminal Justice System ..........................................................................39 VI. Discussion and Recommendations ..............................................................................................39 The Protection System for Youth Refugees in Quito and Lago Agrio ............................39 Outcomes for the Youth Refugee Population .................................................................41 Notes on Study Methods ................................................................................................44 Recommendations and Conclusions ...............................................................................45 VII. Appendix A ....................................................................................................................................47 VIII. Appendix B.....................................................................................................................................65 IX. Appendix C.....................................................................................................................................66 X. Bibliography....................................................................................................................................69 Acronyms ASA Asociación Solidaridad y Acción CEISH-UIDE Ethics Committee for Research in Human Beings – International University of Ecuador DINAPEN Dirección Nacional de Policía Especializada para Niños, Niñas y Adolescentes ELN National Liberation Army / Ejército de Liberación Nacional FARC Revolutionary Armed Forces of Colombia FEPP Fondo Ecuatoriano Populorum Progressio FIC Feinstein International Center FLASCO Latin American Social Sciences Institute FMS Federation of Sucumbios FUDELA Fundación de las Américas GEE Generalized Estimating Equations HIAS Hebrew Immigrant Aid Society JIPS Joint IDP Profiling Services MIES Ministry of Social and Economic Inclusion MSPSS Multidimensional Scale of Perceived Social Support POC Persons of Concern RDS Respondent Driven Sampling RET Refugee Education Trust RSD Refugee Status Determination SJR Servicio Jesuita a Refugiados UASC Unaccompanied and Separated Children UNHCR United Nations High Commissioner for Refugees UNICEF United Nations International Children’s Emergency Fund URP Urban Residency Permit 4 Executive Summary Adolescent refugees around the world, facing years of protracted displacement, are increasingly moving to cities in search of safety and opportunity. This study was undertaken as UNHCR’s first systematic effort to understand the impact of its protection work with urban adolescent refugees. This report focuses on youth living in the cities of Quito and Lago Agrio, Ecuador, and has two research goals. First, it defines and describes the protection system for urban adolescent refugees and the role of UNHCR within that system. Second, it assesses the effects of the existing protection system on the health and wellbeing of refugee youth by examining a range of indicators in the areas of education, livelihoods, psychosocial and physical health, home life, safety and violence, and knowledge and use of available programs. Four data collection methods were used to address these two goals: a literature review; focus groups with refugee adolescents; key informant interviews with stakeholders in the protection system; and a quantitative survey with 299 adolescent refugees between the ages of 15 and 19. This target was reached using Respondent Driven Sampling (RDS), an adapted chain-referral method intended to draw a statistically representative sample from hidden, socially connected populations of unknown size. RDS analysis was conducted with the data from Quito, where the sample can be considered a close approximation of the broader population of refugee youth in that city. Peer referrals in Lago Agrio happened particularly slowly, due to factors including low social connections among youth and high rates of internal migration, with the result that sufficient waves of peer referrals were not reached during the study timeframe. As a result,