It's about fighting for healthcare for all. It's about fighting for healthcare for all.

I am Mado from Women in Exile. Women in Exile is an organisation just for women, for refugee women. An organisation against racism, against discrimination and against violence. For 20 years we have been fighting for our rights and against racism and we also do a lot with health, because many refugee women have a lot of problems in this direction, with health and discrimination and racism. Last August we celebrated our 20th anniversary and we published a book in June with stories of refugee women. We organised a big conference in August, we invited women from other countries: from Central and North America, Africa and Asia.

The theme of the conference was the anniversary of 20 years of Women in Exile. The conference was about connecting and making feminist struggles around the world visible, sharing, empowering each other, but also having fun together. We had different topics, one topic was for example the causes of flight, gender-specific violence and also health.

Solidarity, feminism...

One guest was a woman from Guatemala who offers spaces for healing, for decolonising the body. The idea behind this is that the European perspective on the psyche and the body is quite different from the South and Central American perspective. And that they have taken over the European perspective, by force, through colonisation, and that they are trying to free not only the head but also the body from this colonisation through various workshops and other means. Almost as a means of inner mental healing. It‘s a lot about feeling yourself physically, but also feeling the connection to the group. To connect with the feminine side and soul. And yes, to reveal the fact that one is so cut off from one‘s emotions. The European point of view is that emotions are not really allowed or that they are something bad.

What works well in your initiative?

In the last few years, Women in Exile has done a lot of work on health issues and would like to continue doing so. It‘s a bit difficult to find funding for this. In one project, it was about educating each other and fighting to have healthcare at all. Especially in the asylum system, it is of course difficult. When you arrive, you are only entitled to minimal care if it is very, very acute. But there are many women there who have experienced a lot of trauma in their home countries, on their flight routes and also in the refugee shelters, and they cannot be addressed adequately at all. There is no access to psychosomatic treatment. This is a topic that is now at the top of our agenda: Without this access, how can we actually still try to free ourselves from trauma in some way, to help and empower each other? Another important topic in the health sector is disabled refugees, who of course have a particularly hard time in this system.

What works well: We go to camps and talk to women there. When we go to the camp, it‘s not easy. You have to organise it. The organisation is important, the communication. You can‘t just go to a camp like that. You first have to have a contact person there and with this contact you can arrange visits. You have to organise that and then you can go there, talk to that contact and visit that woman and talk to women about their problems and then many women come with problems and health problems. Many have health problems and the women don‘t receive good treatment because of discrimination. I have lived in a camp and I have seen a lot. I wanted to share the experience I had with other women. This organising is going very well.

The women who are part of WiE were all somehow in the asylum system themselves, in the camps. There are exceptions, there are other women who are also here, outside the system, and are activists. But most of them have had their unpleasant experiences and have got to know a network through Women in Exile how they can deal with things. They have found friends, they have found help and I think that is definitely the big plus. That‘s what‘s special about Women in Exile, that people with the same experiences, also with the same cultural backgrounds meet each other and are more likely to know how other refugee women feel.

There are also the Friends, but we do other meetings with the Friends. The permanent group meets twice a month on Tuesday afternoons, that‘s the activist women. With the Friends we organise demos, or the conference, we need the support of the Friends.

What does the community of refugee women lack in terms of medical care?

First of all, refugee women have this health insurance card, others have the electronic card, it‘s always different. And with this health insurance card there is a limit to the treatments. If I am a refugee, I don‘t have the same insurance and our treatment is always limited. For example, when we go to the doctor, we always get the same treatment: for example, paracetamol. No matter what you have, you are sick with stomach ache, it is always paracetamol. That is the problem. That‘s why we always need this counselling and that‘s why we sometimes work together with the MediBüro, because there are doctors at the MediBüro who are not racists and don‘t discriminate against us. We have to go to these doctors.

It is a good example and also a sad example, because you say that there is actually only minimal care, you get the minimum. When you spoke, I thought that we are talking about the most vulnerable group that arrives in Germany, that is traumatised, that has had very difficult experiences, that actually needs a lot of support. Psychologically, physically, and they only get the minimum care. It takes very long until you are legalised and have full access to healthcare. And then there‘s still a long way to find out what helps me, how do I get better? What have I experienced and how can I continue to improve? Actually, one should turn it around and say that the most vulnerable group actually needs the most support. In Germany it‘s the other way round. If I only prescribe paracetamol, I don‘t look at the person standing in front of me and see: What do they need, in what language do we communicate with each other? How can I take the time to support someone? Instead, I try to get rid of someone quickly.

There are also problems with the language. Sometimes you go to the doctor, you speak English, the doctor doesn‘t speak English and you need a translation and sometimes it‘s not easy to find someone and you are sick. But if you go to the doctor alone, you don‘t get the right treatment. They don‘t understand you and you don‘t understand the doctor. Sometimes we need company, a German person or another person, and then you have to go to the doctor with them.

And also a translation is of course not the direct thing the doctor says. So you can‘t translate everything 100 % correctly either. And then sometimes you don‘t know what to do.

What is missing for this community in terms of healthcare and what spaces are needed?

A list. For example, I think we need a list for doctors. We have a list for lawyers who do good work, where we know that this work is good. I think we also need maybe a list of doctors we trust. For example with information where you can report which doctors are good you can only do that from your own position. Because I don‘t know if the doctor I trust is racist or not.

In Berlin it‘s probably even feasible. I imagine if you are in a camp in Brandenburg or Mecklenburg-Vorpommern, where medical care is already difficult anyway.... What WiE is trying to achieve with the project is also a bit of basic medical knowledge. Of course, it would be nice if we could change the health system and the way doctors communicate from one moment to the next. But that is not realistic. That‘s why the group is trying to create a bit of basic knowledge within the community so that they can have their say.

Exchanging experiences is also important.

Yes, and also a bundling of organisation and spaces. So that it is accessible to new women, so that they know what is available. I can turn to other people. And in these spaces, people also have to think about how accessible they actually are, how open their structures are for refugee women. How can they perhaps also approach such vulnerable groups?

What do people who currently work in the health system need to know?

These people need to know that refugee people don‘t get good treatment. We have said: Health for all, without discrimination. We don‘t only need Germans, we also need personnel from abroad in the german health system, but they always do care for the elderly, they don‘t go to university, they don‘t have the opportunity, they don‘t have the chance to do it.

There are also many people with medical professions that are not recognised in Germany. And they will mostly work in geriatric care or nursing.

Yes, I‘ve also had that experience. There‘s a really great Vietnamese doctor in Berlin and she‘s so overworked now because everyone‘s coming to her. She has taken a break for a while because it was just too much. The supply is too small and the demand is so great. Of course, people want a doctor who understands them, who understands the language. Especially when it comes to the psyche, it is difficult to just say what exactly is going on.

Yes, there are too few. Because when people go to the doctor, they want the doctor to understand them. For example, I speak French and I heard that there is a doctor in Neukölln who speaks French. I have to go there because they will understand me. And the people who speak English should go to a doctor who speaks English. You want to go to a doctor who understands you.

I think one thing is the language and the other...

is also the culture.

What changes would be needed at the legal level?

We fought a lot and now we have the electronic health card. But this electronic card is not the same as the one for Germans, there is no name on it, it‘s just XXXX and I think that when you go to hospital people know that your treatment should be limited.

The card looks like the health card, but in the places where it usually has data like name, address and stuff, it says XXXX. It‘s just an anonymous card, yeah. It‘s like you can pass it on.

The situation is like this: you arrive, you are in the asylum procedure and you are only allowed to do certain treatments, but the treatment is very limited. You can‘t do many things. If you have back pain, you can‘t get a massage. Because there is a law for refugees that puts limitations on you.

So let‘s say you have psychological problems and you can‘t have therapy.

No, you can‘t.

... as long as your asylum procedure has not been completed and you are part of the German health system. And then you are entitled to: I need a massage. I need insoles for my shoes because I have joint problems. I need therapy.

Yes, but before that you get....

Emergency care.

Yes, but this emergency care is paracetamol. Not more. There used to be these sick notes and if you were sick at the weekend, you didn‘t get the sick note because the home management wasn‘t there. But if you got a flat ... Every district has its own rules. There are districts where you have to come to the refugee home to get the sickness certificate, but when you get your flat and you are no longer in the home, you get the sickness certificate by post. If you are sick for a longer period of time, you get it once a month by post. In other districts, you have to go to the refugee home to get the sickness certificate. But if you are sick at the weekend, you can‘t go to a hospital, then you can only go there on Monday.

What specific rooms does the community need?

I would have spontaneously said that we need holistic support for refugee women. Many women don‘t necessarily know what their problem actually is. When someone reports that women in the camp have headaches or other psychosomatic problems, they often don‘t even realise: I am actually very traumatised and these are the effects and I am under stress all day and that makes me sick. The asylum system makes people sick, as does the situation of healthcare. The perception of doctors is also different in other cultures. And maybe having someone to accompany you to medical appointments, or to help you understand what it‘s like here or what problems there are here when you go to the doctor, what can happen? Why shouldn‘t you always trust the doctor one hundred percent? That could definitely help. Is it expensive? I don‘t know. A stronger one-to-one support could definitely be a first step and help. And then a holistic approach, not just fighting symptoms, but looking at the whole picture: How are you? How is the family? What are the problems? That would be very important for many refugee women, and I know that some of them are very passive, especially when it comes to health issues, or they suppress things. Oh, I‘ll do that later, I have other, more pressing problems now. But if people approach you and there is a reminder, also from people with language skills and experience, that could be an important support.

Maybe it would also be possible to set up a kind of centre for health care for refugees in Berlin. With doctors who are sensitised to this, with staff who are sensitised. That is very utopian. There are also many other parts of Germany where there are many refugees, simply because there are camps in the most remote places in Germany. It is difficult to have sensitised staff there. It is unattractive for people to work there and it is unattractive for refugees to be there.

What would other social groups have to do?

That sounds a bit like: What would be our ideal society? Of course, anti-discriminatory work should actually start very early. Of course, every institution has to deal with these questions, even in the kindergarten. In Berlin there are kindergartens or initiatives that deal with these issues, but I doubt whether this is also the case in other federal states in Germany. Of course, the Basic Constitutional Law states that no one may be discriminated against. But there is still no obligation for anyone to think about how racist our systems and our institutions actually are. We receive invitations to talk about such things, but actively we don‘t do the work of explaining this to others, but we actually do really empowering work with the women themselves. So it‘s not like we say we‘re going to do a workshop for the doctors‘ association and tell them something. That might be a possibility. I don‘t know if we want to do that. Of course, there are also trainers who do that. But actually, the interest has to come from the other side, that they really say: I want to learn something. Because if you are obliged to do it, there will be huge resistance. I can imagine that it would be quite good to simply put the topic on the agenda everywhere. Maybe there needs to be an anti-discrimination officer in the health sector.