(PDF) Urban refugees in Cairo

Photo: René de Cock

Urban Refugees in Cairo

Elżbieta M. Goździak and Alissa Walter

Georgetown University

Center for Contemporary Arab Studies

Institute for the Study of International Migration

Acknowledgements

This research was conducted with the generous nancial

support of the Bureau of Population, Refugees and Migration

(BPRM) in the U.S. Department of State. We are grateful to Ms.

Sarah Cross, our project ocer at BPRM, for her dedication to this

project. Our heartfelt appreciation goes to our team members

on the ground in Cairo, particularly Dr. Ray Jureidini and Ms.

Emilie Minnick, as well as our refugee research assistants who

wish to remain anonymous. We would not have been able to

complete this project without you. Many thanks to the sta

members of UNHCR, BPRM and UNHCR implementing partners,

and other service providers who gave generously of their time

and knowledge. We wish to express our admiration to for all

the refugees in Cairo whose experiences of displacement and

coping with formidable challenges are inspiring. Thank you for

sharing your stories! And last but not least, we want to thank

each other and our copy-editor extraordinaire Nina Laufbahn.

Table of Contents

Executive Summary 4

Chapter 1: Setting the Scene 5

1.1 Refugees in Egypt 5

1.2 The Study 6

1.3 Methodology 6

1.4 Organization of the Report 9

Chapter 2: Legal and Policy Frameworks 10

2.1 The Evolution of UNHCR-Egypt’s Policy on Urban Refugees 10

2.2 Legal and Policy Frameworks for Refugees 10

2.3 Legal Frameworks for Human Rights Protection 12

2.4 Trends in Durable Solutions 13

2.5 Protection Threats: Before the Revolution 14

2.5 Protection Threats: After the Revolution 14

2.6 Recommendations 16

Chapter 3: Refugee Livelihoods 17

3.1 Access to Employment 17

3.2 Vulnerability of Domestic Workers 18

3.3 Financial Assets: Savings and Remittances 19

3.4 Cash Assistance 19

3.4 Housing Costs and Living 20

3.6 Recommendations 22

Chapter 4: Education 25

4.1 Access to Primary Education 25

4.2 Access to Secondary Education 27

4.3 Access to Higher Education 27

4.4 Recommendations 28

Chapter 5: Access to Quality Aordable Healthcare 30

5.1 Health Insurance 30

5.2 Healthcare Services 30

5.3 Health Issues 32

5.4 The Eects of the Revolution

on Refugees’ Health and Well Being 35

5.5 Access to Healthcare 35

5.6 Eorts to Mainstream Refugee Healthcare 36

5.7 Recommendations 37

Chapter 6: Conclusions 39

References 40

Executive Summary

4

Executive Summary

Cairo, Egypt is home to one of the largest populations

of urban refugees in the world. In recent decades, waves

of refugees from Sudan, Iraq, Ethiopia, Eritrea, Palestine

and elsewhere have ed to Cairo hoping to nd third-

country resettlement, eventually return to their countries

of origin, or start a new life by integrating into Egyptian

society. For all of these refugees, the United Nations

High Commissioner for Refugees (UNHCR) is the primary

institution responsible for determining refugees’ status,

oering protection, and facilitating durable solutions.

Despite the many eorts of UNHCR, the Government of

Egypt, and numerous non-governmental organizations

(NGOs) to provide protection and assistance for these

various refugee populations in Cairo, numerous challenges

remain for these refugees in the areas of legal protection

and security, livelihoods, education, and healthcare.

UNHCR has adopted various strategies over the years to better

respond to refugees’ needs. One major initiative was UNHCR’s

1997 Policy Statement on Refugees in Urban Areas, which

stressed self-reliance for urban refugees. In 2009, UNHCR

issued a new policy on urban refugees aimed at increasing

protection for refugees in cities and at mainstreaming

refugees into national institutions when possible. This report

seeks to provide a preliminary evaluation of the impact of

the new 2009 policy while undertaking a comparative

analysis of the diering needs, experiences, and protection

gaps of Cairo’s many dierent refugee populations.

Our study is based on household interviews with both

refugee and local Egyptian populations, conducted in Cairo

between December 2010 and March 2011. Our research

team conducted 63 household interviews, distributed across

target populations: 49 per cent Iraqi refugee households,

22 per cent African refugee households, 32 per cent local

Egyptian households. Refugee or local Egyptian research

assistants trained and supervised by an on-the-ground team

member conducted all household interviews. Households

were asked open-ended questions about their past and

present experiences with safety, livelihoods, education,

and health; respondents interviewed after the Egyptian

Revolution in January 2011 were asked additional questions

about the impact of the revolution on their security and

ability to access basic services. Interviews were translated

and analyzed by our research team in Washington, DC.

In addition, our team conducted extensive interviews

with 16 stakeholders in Cairo, including with UNHCR,

international NGOs, Egyptian NGOs, and local community-

based organizations. These stakeholders represent

the main NGO-based refugee service providers.

Based on this data, this report makes the following

recommendations:

Legal

t Re-negotiate the 1954 MOU between UNHCR-Egypt

and the Government of Egypt

t Train law enforcement about refugee rights

t Re-interview Sudanese refugees with closed cases

t Train implementing partners in anti-discrimination and

cultural sensitivity

t Provide additional training for refugee and local

community networks and organizations

Livelihoods

t Advocate with the Government of Egypt to extend the

right to work to all refugees

t Build protective elements into economic refugee

programs

t Create roles for employment advocates and job

developers within refugee NGOs

t Work with the Egyptian government to allow

microcredit enterprises

t Track the employment of refugees

t Address negative economic strategies

t Expand economic development programs

Education

t Streamline school admission requirements

t Build capacity in Egyptian public schools

t Provide training for Egyptian teachers and

administrators, as well as for refugee teachers

t Involve educated refugee adults to enhance capacity of

local schools

t Build additional schools to increase educational

capacity for refugees and Egyptians alike

t Involve UNICEF

t Provide additional educational training for adult

refugees

Health

t Create a subsidized health care insurance plan for

refugees

t Partner with the Government of Iraq to form a special

fund for secondary and tertiary health care for Iraqis

t Mainstream refugees into the Egyptian health care

system

t Decentralize refugee health care

t Reformulate systems of mental health care for refugees

5

Chapter 1: Setting the Scene

More than half the refugees the United Nations High

Commissioner for Refugees (UNHCR) serves now live in urban

areas. Egypt is among the top ve countries with the largest

number of urban refugees in the world and is one of only two

African countries that do not mandate that refugees reside

in camps (Sperl 2001; Zohry 2005). The majority of refugees

in Egypt live in the capital city of Cairo (Grabska 2005).

UNHCR developed its rst Policy Statement on Refugees in

Urban Areas in 1997, mainly to discourage urban settlement

due to the diculties of protecting and supporting

refugee populations in cities. At the time the 1997 Urban

Policy was written, UNHCR was struggling to adequately

respond to situations when refugees abandoned rural

camps and moved to cities, where they often lived in the

poorest neighborhoods, took menial jobs in the informal

economy in order to survive and were frequently arrested

or mistreated by the local authorities or attacked by the

host population (Chatelard 2011: 9). By and large, however,

UNHCR’s 1997 Urban Policy did not deter refugees from

moving to cities. Furthermore, its emphasis on self-reliance

did not adequately address the needs of urban refugees

in countries like Egypt, where refugees do not have the

right to work. As early as 2001, researchers like Sperl noted

the detrimental eect the 1997 policy had on refugees in

Cairo, who were simultaneously urged by UNHCR-Egypt to

become self-sucient and barred from legal employment

by the Government of Egypt. The result, in Sperl’s words, was

often “destitution.” In response to the various shortcomings

of the 1997 policy in Egypt and elsewhere, UNHCR issued

a new policy on urban refugees in 2009. In this new policy,

UNHCR argued that cities are a legitimate place of refuge

for those seeking asylum and committed itself to providing

protection to refugees in urban areas. This new policy

shifted its emphasis from self-reliance to mainstreaming

refugees into local institutions, noting the cost and ultimate

inability to sustain parallel, refugee-specic services.

Our research team began eldwork in Cairo in December

2010, which was a key moment of transition for both UNHCR-

Egypt and, on the eve of revolution, for the country as a

whole. Our eld data, collected between December 2010 and

March 2011, captures both the lingering ill eects of the old

1997 policy and the promise of new beginnings under a new

2009 UNHCR policy as well as a new Egyptian government.

Cairo is currently hosting large numbers of refugees

from Iraq, Sudan, Somalia, Ethiopia, Eritrea, Palestine and

elsewhere. Each refugee group in Egypt has a unique prole

based on its legal rights, wealth, education level, languages

spoken, length of time in Egypt and prospects for durable

solutions. We will explore these complexities and their

implications in greater depth below. In this report we focus

primarily on the Iraqi refugees residing in Cairo, Egypt,

whose situation is often quite distinct from that of African

refugees in Cairo. Iraq is a middle-income, oil-producing

country whose citizens at one time enjoyed quality social,

educational and healthcare services. When Iraqi refugees

began arriving in Cairo after 2003, many came from middle-

class communities, were well-educated and had adequate

nancial resources to cover their costs of living. While these

resources in many cases are running out after years of living

in Cairo, Iraqi refugees’ social and educational backgrounds

continue to set them apart from other refugees in Egypt.

In this report we focus on Iraqi refugees’ access to legal

protection, livelihoods, education and healthcare. We

contrast their situation with the circumstances of other

refugees settled in Cairo as well as with the situation of

the local population residing in the same neighborhoods.

Many of these refugee groups share the same unsustainability

of their current lives in Cairo, as durable solutions have been

elusive for many refugees. Many refugee populations have

lived in Egypt for more than ve years without “immediate

prospects for implementation of durable solutions,” thus

constituting a “protracted” refugee crisis based on UNHCR

criteria (UNHCR 2009a). The prolonged stay in Cairo

endured by many refugees further indicates that neither

resettlement nor repatriation are viable durable solutions

for many of Cairo’s refugees. At the same time, refugees’

long-term residence in Cairo does not necessarily indicate

successful integration. Local integration is understood

to have three basic components: legal, economic and

socio-cultural. Legally, integration may be achieved when

refugees acquire a sucient amount of rights in their host

state to access the jobs, healthcare and education they need

to be self-sucient. Economically, integration is achieved

when refugees live at approximately the same standard of

living as members of their host community. Socially and

culturally, refugees have integrated when they participate in

the community life of their host country on an equal basis

as host country nationals (Fielden 2008). By these measures,

few refugees in Egypt have successfully integrated:

they lack access to the formal labor market, nearly all

seek health and educational services outside of local

Egyptian institutions and many suer from discrimination.

UNHCR-Egypt’s refugee services attempt to ameliorate

the integration challenges refugees face, but may also

inadvertently contribute to refugees’ separation from

mainstream Egyptian society by creating parallel refugee-

specic systems of care. UNHCR-Egypt and its implementing

partners have developed a wide range of programs to

meet the diverse needs of their refugee clients. While these

services have undoubtedly been essential for many refugees

in procuring livelihood support and accessing healthcare

and educational services, the support system as it stands

shows signs of strain in the face of a large and heterogeneous

refugee population dispersed throughout Cairo and vicinity.

Moreover, UNHCR’s 2009 Policy on Urban Refugees also

points to the cost and ultimate inability to sustain parallel,

refugee-specic health and educational programs outside

of mainstream local institutions. The strain of maintaining

parallel refugee systems is particularly evident in Egypt. At

the same time, any long-term solution put forth by UNHCR-

Egypt and its partners needs to take into account the fact that

Egyptian health and educational services are overstretched,

poorly funded and often of low quality, and that many

Egyptians also suer from the same conditions of poverty and

high rates of unemployment as do refugees. UNHCR-Egypt

has taken some promising steps towards mainstreaming

aspects of refugee health services, particularly during

and immediately after the 2011 Egyptian revolution. Our

CH1: Setting the Scene

research revealed new short- and long-term strategies for

continuing this mainstreaming trend in order to improve

refugees’ access to essential services, increase protection,

enhance prospects for local integration and reduce the

burden on current refugee-specic service providers.

The results of this study conrm conclusions other researchers

have made over the past decade (Sperl 2001; Grabska 2006,

2008; Kagan 2011); namely the best way forward is to

shift away from short-term programs and parallel service

delivery systems towards the practice of mainstreaming

refugees into Egyptian institutions and according them

rights enjoyed by Egyptian citizens, including the right

to work. As recommendations to mainstream refugees in

Egypt have been made for over 10 years with little progress

made, we are cognizant of the practical barriers and political

realities in Egypt that have made implementation of these

recommendations dicult. As our research indicates,

however, the current system of refugee-specic services is

inadequate in many respects and expensive to maintain,

and as such, drastic changes must be made. We argue

that the shift to mainstreaming must be accompanied by

the investment of development aid into improving and

expanding Egyptian healthcare and educational institutions

for the benets of both refugees and the local population.

The necessity of this shift is all the more clear in a city

like Cairo, where a relatively weak civil society and

resulting paucity of viable community-based partners

has hindered UNHCR-Egypt’s eorts to create a robust

and sustainable system of refugee-specic services. In

the ten years since Sperl’s study, the overall number of

refugees in Cairo has increased considerably and the

economic situation has worsened, further taxing refugee

services oered by non-governmental organizations. The

Egyptian revolution has negatively impacted the Egyptian

economy and security situation, worsening the living

conditions of Egyptians and refugees alike. Faced with

these daunting conditions, UNHCR-Egypt will benet from

increased burden sharing with Egyptian institutions and

better strategies to integrate refugees into local society.

1.1 Refugees in Egypt

The modern state of Egypt received multiple waves of

refugee populations throughout the twentieth and the

beginning of the twenty-rst century. We will provide a

brief overview of each refugee population in chronological

order as a way to provide a brief overview of the uctuations

in Egypt’s refugee policies over the years and the impact

of these policies on refugees residing in Egypt today.

Palestinian Refugees

Egypt has hosted Palestinian refugees since as early as

1948; UNHCR estimates that as many as 70,000 Palestinians

live in Egypt currently (2010). Initially, the Government

of Egypt extended numerous rights and privileges to

Palestinians, permitting them to attend public schools and

access state institutions on the same basis as nationals. This

policy changed in the mid-1970s, following a breakdown

in relations between the Egyptian government and the

Palestinian Liberation Organization (PLO) (Shiblak 1996;

El-Abed 2005). Since this time, Palestinians have been

prohibited from attending public schools or utilizing other

state services. Palestinians must pay foreigner tuition fees for

private schools and universities. Furthermore, Palestinians

are typically not eligible for refugee-specic services. The

United Nations Relief and Works Administration (UNRWA)

does not operate in Egypt. UNHCR-Egypt has identied

70,000 Palestinians in Egypt as Persons of Concern, but

assists only 30 of them (UNHCR 2010a). Thus Palestinians

have no ocial protection space within Egypt. In response,

Palestinians have developed a number of community-

based institutions, including schools and clinics, to

provide for the needs of their refugee community. Most

Palestinians in Egypt live far below the poverty line,

though there are some wealthy members and benefactors

within the refugee community in Cairo (El-Abed 2009: 80)

Sudanese Refugees

The largest refugee population in Cairo is the Sudanese, with

approximately 10,300 registered refugees and an additional

14,500 asylum seekers currently in Egypt (UNHCR 2012)—

the latter number indicating those who are persons of

concern to UNHCR but who are not eligible for resettlement.

There are unknown numbers of Sudanese with closed les.

Egypt and Sudan have deep historical ties and a certain

amount of cross-border migration and trade has always

existed. Migration ows increased dramatically during

the years of the Sudanese Civil War and crisis in Darfur,

which sent thousands of Sudanese to Egypt as refugees.

These refugees underwent individual Refugee Status

Determination (RSD) with UNHCR-Egypt in Cairo, and not

all were ocially recognized. Many of those with closed

les remained in Egypt, however. Those who have closed

cases do not have the protection of UNHCR as refugees

and are not eligible to access a number of refugee-specic

services oered through NGOs. In 2004, the Governments

of Egypt and Sudan signed the Four Freedoms bilateral

agreement, which granted Sudanese the rights of work

and residency. Since 2004, Sudanese asylum-seekers have

been granted temporary protection status by UNHCR-

Egypt, but UNHCR-Egypt no longer undergoes RSD with

Sudanese refugees. This “temporary protection” was

supposed to last for 6 months, but the Government of

Egypt has extended it until today, though without clarifying

what status Sudanese refugees may eventually hold long-

term. This temporary protection status qualies them for

certain NGO services; however, temporary protection status

disqualies Sudanese from international resettlement. In

recent years, UNHCR-Egypt has begun to practice RSD with

Darfurians and Northern Sudanese, and these recognized

refugees would potentially be eligible for resettlement

(Kagan 2011). The complexities of the RSD process for the

Sudanese population in Egypt, combined with low rates of

resettlement, has resulted in tension and misunderstandings

between the Sudanese and UNHCR-Egypt over the past

decade, which has periodically ared up into protests and

violence. As recently as April 2011, UNHCR-Egypt has re-

committed itself to increasing the use of third-country

resettlement for refugees in Egypt, including the Sudanese.

East African Refugees

A number of refugees from other countries also live in

66

CH1: Setting the Scene

6

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7

Cairo. Approximately 8,000 Somali refugees and asylum

seekers have established themselves in Egypt, along with

1,300 Eritreans and a few hundred registered Ethiopians

(UNHCR 2012). Somalis are granted refugee status on a

prima facie basis. In contrast, Ethiopians and Eritreans

must go through the RSD process, and the acceptance

rate for these communities has been as low as 20 per cent

in some years, which explain the disparities in numbers of

registered refugees between these communities. Scholars

estimate that there may be thousands of unregistered

refugees—Ethiopians, in particular—living in Cairo. These

migrants are usually living without a recognized legal

status in Egypt, which can contribute to a profound sense

of instability, vulnerability and fear. According to scholar

Fabienne Le Houerou, many unregistered Ethiopians are

young men who deserted the Ethiopian and Eritrean armies

and potentially face the death penalty if they return. Prior

to 2004, few Ethiopians received refugee status, in part due

to a lack of understanding among the Ethiopian community

about the RSD process. Since 2004, a legal aid organization

has assisted with RSD applications and interviews, resulting

in much higher acceptance rates (Le Houerou 2006).

Though Cairo was once the primary destination for East

African migrants, in recent years increasing numbers

have attempted to pass through the Sinai Peninsula

into Israel. The authors recognize the grave protection

risks that migrants and refugees along the Israeli

border face. However as this report focuses on the

experiences of urban refugees in Cairo, the experiences

of refugees in the Sinai will not be considered here.

Iraqi Refugees

Egypt also hosts a large number of Iraqis: currently 7,400 have

refugee status in Egypt (UNHCR 2012). Most Iraqis arrived in

Egypt between 2006-2007. The Iraqis are distinguished from

other refugee populations in Cairo by their previous wealth

and education. Upon arrival, 31 per cent of Iraqis reported

they had a “very good” nancial situation, while 51.4 per

cent reported a “sucient” amount of nancial resources

to cover basic needs (WHO and MOH 2009). A number of

Iraqis receive remittances from relatives in Iraq. At the same

time, the wealth and well-being of the Iraqi population has

deteriorated over time—now only 4.7 per cent reported a

“very good” nancial situation, and 56 per cent reported a

decline in their health and nutrition ( WHO and MOH 2009).

Although Iraqis speak Arabic and do not tend to suer from

racial discrimination in Cairo, Iraqis reported to our research

team that they did not have close relations with the local

host community. Iraqis also reported that they lacked a

sense of cohesion and community with other Iraqi refugees

in Egypt. Unlike the Sudanese, they have few community-

based organizations (CBOs) or institutions because President

Mubarak’s administration repeatedly refused to accept

any applications to form Iraqi CBOs. All Iraqis interviewed

expressed a strong preference for resettlement in a third

country; none accepted staying in Egypt indenitely.

1.2 The Study

This report is part of a larger, comparative study on Iraqi urban

refugees in Cairo, Egypt and Amman, Jordan (see Martin and

Taylor 2012; Davis 2012). This study focused on the most

politically complex set of challenges, namely incorporating

refugees into existing urban structures that deliver healthcare,

education, child welfare and other forms of assistance to

the poor while also facilitating access to employment.

While Cairo’s urban refugees, including Iraqis, have received

research attention in the past, most studies focused on a

single refugee group. This study provides a comparative

perspective on Iraqi urban refugees in Cairo that investigates

their situation not only in relationship to protection

principles as enunciated in the Refugee Convention, but also

in comparison with similarly situated local populations and

other refugees living in the same urban neighborhoods. In

Cairo, there are signicant populations of Sudanese, Somali,

Ethiopian, Eritrean and Palestinian refugees with whom

we have compared the Iraqi refugees. These comparisons

have been illuminating not only in understanding the

situation of the Iraqi refugees, but also in identifying

more precisely the public reaction to the refugees and

the context in which decisions are made on their future.

1.3 Methodology

Seeking both depth and breadth of understanding of the

studied issues and aected populations, we designed

our study to have both a “top-down” and “bottom-up”

approach, interviewing both stakeholders and refugees in

order to gain a comprehensive picture of the lives of urban

refugees in Cairo and their ability to access educational

and health services and provide for their families. We

assembled a research team that was well-suited to gain

access and insights from our various research subjects. For

stakeholder interviews, we formed a collaborative team

between Georgetown University’s Institute for the Study of

International Migration, Georgetown University’s Center for

Contemporary Studies and the American University in Cairo.

Principal researchers and research assistants from all three of

these institutions took part in identifying and interviewing

government ocials, international and local NGOs, and

CBOs in Cairo. For interviews with refugees, we relied on a

Community-Based Participatory Research methodology,

whereby our team trained refugees to conduct interviews

within their own communities.1 Our refugee assistants were

recommended to us by our colleagues at the American

University in Cairo and by NGO service providers. These

assistants used snowball sampling to identify their research

subjects, targeting neighborhoods where large numbers

of refugees lived.2 We instructed our assistants to be sure

to interview a wide range of households, with varying

1 Community-Based Participatory Research is a methodology that has been highly praised by researchers in a number of elds. This

methodology not only engages with members of the studied community as “equal partners,” but also often allows for more rigorous

research by gaining the investment and cooperation of research subjects in the study. Researchers scrutinizing this methodology have

found that Community-Based Participatory Research often increases both the quantity and the quality of the data collected (see: Viswa-

nathan et al. 2004).

2 These neighborhoods included: 6th of October, Heliopolis, Maadi, Arba’ wa Nuss and Ard al-Liwa.

CH1: Setting the Scene

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8

income levels, refugee registration statuses, educational

backgrounds, livelihood opportunities and ages. We also

hired an Egyptian research assistant to conduct similar

interviews with Egyptian families living in neighborhoods

with signicant refugee populations living nearby.

Data Collection:

Household and Individual Interviews

The project included a total of 63 household interviews

with refugees and local populations. Following our

original research plan, these included 31 interviews with

Iraqi households and 14 interviews with households

among other refugee populations, including Sudanese,

Ethiopians, Somalis and Palestinians. Additionally, we

conducted 20 interviews with Egyptian households. Our

team also conducted focus groups and informal group

discussions with refugees in settings in which they naturally

congregate. Although the total sample size is small, we

are condent that we were able to be suciently strategic

in identifying key neighborhoods and populations so

that our summary ndings relate to patterns and trends

among the urban refugee populations in Cairo. However,

our sample size does not allow for quantitative analysis.

The interviews followed a discussion guide but were

not restricted by a close-ended questionnaire. Open-

ended questions were asked and intensive participant

observation was also carried out. In the course of this

study we have explored a wide array of issues, including:

t Socio-demographic characteristics

t The Iraqi community of origin

t Migration history

t Livelihoods and living conditions

t Self-reported health status and experiences

with the healthcare system

t Experiences with the education system

t Experiences with other services in the area

t Goals for the future

t Relations with other Iraqi refugees, local

populations and other refugees

t Perceptions of security in their neighborhood

and in the city

t Interactions with UNHCR-Egypt

The Egyptian revolution began midway through our data

collection. As such, we were well positioned to gage changing

perceptions of security among both refugee and Egyptian

populations. During our eldwork in December 2010, prior

to the revolution, our teams asked general questions about

safety and perceptions of security of refugees and local

populations. Beginning in January 2011, we added additional

questions to our household interview guides to determine

how refugees and Egyptians perceived their safety and

security prior to the revolution, during the 18 days of protests

in January 2011 and after the fall of Mubarak. Because we

were able to ask these questions in the immediate aftermath

of the revolution, the experiences and memories of our

respondents were very “fresh.” We consider their testimonies

reliable indications of changing perceptions of security.

Individual interviews lasted anywhere from one to two

hours and with few exceptions were conducted in the

refugees’ native languages. Notes from interviews with

Arabic speaking refugees were provided to the research

team in Arabic and translated by two graduate research

assistants from the Center for Contemporary Arab Studies

at Georgetown University. Notes from interviews in

languages other than Arabic were rendered in English.

Data Collection:

Stakeholder Interviews

The second half of our study consisted of a top-down

approach wherein our team met with key service providers

working with refugees. We conducted in-depth interviews

with a total of 16 dierent service providers covering the

elds of health (6), psychosocial programs (7), legal aid

(5), vocational training (6), schools and other educational

programs (4), human and refugee rights (3).3 Of these 16

organizations, our team met with a variety of dierent

types of stakeholders: international organizations (3);

International NGOS (2), Egyptian NGOs (7), Egyptian

health institutions (2), Egyptian private school (1), and a

Community Based Organization (1). These 16 organizations

represent the main NGO-based refugee service providers.

Issues explored with stakeholders included the following

questions:

t Eligibility requirements for services

t Barriers faced by refugees to access services

t Dierences between refugee groups in

accessing services

t Dierences between locals and refugees in

accessing services

t Barriers faced by refugees in seeking

employment

t Impact of Iraqis on health services, educational

services, the labor market and cost of living

t Dierences between refugees groups in

registering with UNHCR-Egypt

t The benets and burdens to the local

community in hosting Iraqi refugees

t The benets and burdens to the local

community in hosting other refugees

Data Analysis

The qualitative research approach used in this project oered

many advantages. Ethnographic interviews enabled us to

see the phenomenon under study from an emic perspective

or the “insider’s point of view.” The emic understanding is

developed through close exploration of dierent sources

of data, including participant observation and in-depth,

open-ended interviews. The ethnographic process oered

the refugees dignity by encouraging them to take the lead

in the interviews if they so chose. They were able to narrate

their own experiences in their own words, highlighting

issues that “experts” may not consider important.

Interviews with stakeholders also provider the insiders’

perspectives on the challenges and opportunities involved

in meeting the needs of urban refugees residing in Cairo.

In keeping with the methodological principles of

3 Several organizations provide more than one service, so the numbers add up to 31, rather than 16.

CH1: Setting the Scene

9

ethnography, analysis commenced within a short period

after the rst set of interviews was conducted. Having

local researchers and refugee research assistants on the

ground allowed us to go back to the interviewed refugees

when we needed more information or were unsure of our

interpretation. Collected data as well as peer-reviewed

papers and gray literature identied during the literature

review process were managed and analyzed using NVivo, a

computer software used to manage and analyze text-based

data (Bazeley 2007). NVivo was instrumental in conducting

both “interpretive” (making sense of research participants’

accounts) and “reexive” (the research team’s contribution

to the data creation and analysis process) analysis.

1.4 Organization of the Report

Our report is organized around four main topics: legal policies

and protection space, livelihoods, education, and health. In

each of these four sections, we compare the relative ease

or obstacles encountered by dierent refugee populations

in accessing essential services. Each section includes policy

and programmatic recommendations. The executive

summary that opens the report provides an overview

of the study and summarizes our recommendations.

CH1: Setting the Scene

10

Chapter 2: Legal and

Policy Frameworks

IRefugees who spend any length of time in Cairo face

numerous obstacles to meeting their basic needs due to the

highly restrictive legal environment in which they live and

receive services. Protection space varies between dierent

refugee populations, as Egyptian laws distinguish between

refugees of dierent national origins. Furthermore, protection

space appears to have shrunk in recent years: stakeholders’

budgets have constricted, numbers of urban refugees

remain high and the Egyptian Revolution and its aftermath

continue to contribute to an unstable environment. As a

result, security and access to services for refugees are often

jeopardizeds. UNHCR’s 2009 urban policy responds to the

limited legal protection of urban refugees everywhere by

expanding UNHCR’s protection mandate to refugees in cities

(2009b). Over the past ten years, the Government of Egypt

and UNHCR-Egypt have taken dierent steps to expand

their protection of urban refugees, which will be explored

below. Even with this laudable expansion of selected

rights for select groups of refugees, these rights remain

largely limited in practice and are rarely fully implemented.

2.1 The Evolution of UNHCR-Egypt’s Policy on Urban Refugees

UNHCR rst promulgated policies regarding protection and

assistance for urban refugees in 1997. This policy reected

a growing trend among refugees seeking livelihoods and

services outside of UNHCR-supervised camps. The primary

objectives of the 1997 policy were to foster local integration

and to promote self-reliance among urban refugees.

In 1999, UNHCR’s Evaluation and Policy Analysis Unit

undertook an assessment of the urban refugee policy

framework and commissioned several case studies,

including an assessment of the situation in Cairo. The

evaluation noted that the demographic assumptions of the

policy—namely, that the majority of urban refugees were

young men—was not evidenced by data (Obi and Crisp

2001). The evaluation also found signicant problems with

the implementation of the policy’s focus on self-reliance.

In Cairo, UNHCR-Egypt took steps in 1997 to explore the

possibility of oering vocational training and providing

microcredit opportunities to female refugees to start small

businesses, but the Egyptian government refused to permit

the microcredit programs (Sperl 2001). Since this time,

UNHCR-Egypt has struggled to develop economic self-

suciency programs that the Government of Egypt will

approve and which will ensure adequate livelihoods for

refugees residing in Egypt. From the time of these reports

in 2001 until the present, it has been clear that integrating

refugees locally in Cairo would be dicult and unlikely,

mainly due to restrictive host country labor laws. In this

context, UNHCR policies designed to reduce refugees’

dependence on aid actually led to destitution (Sperl 2001).

In 2009, UNHCR changed its policy towards urban refugees,

partly as a result of its experiences in helping some 400,000

of an estimated 2 million Iraqis who ed Iraq after 2003,

most of whom went to big cities in Jordan, Syria and Egypt.

The new policy focused more specically on protection.

In order to expand protection space in urban areas, the

2009 policy calls for establishing reception centers in

urban areas, writing new procedures for registration and

data collection, ensuring documentation, creating more

ecient refugee status determination processes, engaging

in community outreach, fostering more constructive

relationships with urban refugees, ensuring greater security,

promoting livelihoods and greater self-reliance, expanding

access to healthcare, education and social services,

meeting material needs, and promoting durable solutions.

When refugees take up residence in an urban area,

whether or not this is approved by the authorities,

UNHCR’s primary objective will be to preserve and

expand the amount of protection space available to

them and to the humanitarian organizations that are

providing such refugees with access to protection,

solutions, and assistance (UNHCR 2009b: 4)

Without preempting our conclusions, let us indicate at the

outset that despite the improvements made by UNHCR-

Egypt in its revised 2009 policy, our ndings indicate that

“protection space” for urban refugees in Egypt has shrunk

over the past 10 years due to the arrival of thousands of new

refugees in Cairo without a corresponding and proportional

increase in funding and durable solutions for most refugees.

At the same time, chronic problems—Egypt’s restrictive

legal framework and lack of widespread implementation of

existing rights, UNHCR-Egypt’s budget and sta constraints,4

limited capacity and coordination among stakeholders,

donor fatigue—continue to contribute to a low quality of

life for many refugees in Cairo. In addition, the negative

impact of the 1997 UNHCR-Egypt policy is still being felt

within refugee communities in Egypt, and it is perhaps too

soon to see the widespread impact from the revised 2009

policy. Lastly, the recent revolution in Egypt negatively

aected refugees in Cairo in the short-term; it remains to be

seen if in the long run the eects of the revolution will be

positive or negative for the local population and for refugees.

2.2 Legal and Policy Frameworks for Refugees

CH3: Refugee Livelihoods

4 The nancial requirements for Egypt’s operation in 2012 are slightly higher than at the beginning of 2011 and amount to $19.7 million.

During the course of 2011, Egypt’s budget increased signicantly due to the supplementary needs for the situation in Libya. In 2012,

the additional needs resulting from the Libya crisis have been included in the comprehensive budget. These budget increases will have

minimal, if any, eects on Iraqi and African refugees in Cairo.

CH3: Refugee Livelihoods CH2: Legal and Policy Frameworks

CH3: Refugee Livelihoods

Refugees in Egypt have only a few rights under Egyptian

law due to a number of prohibitions and restrictions

put in place by the government. Even when rights do

exist on paper, refugees are often unable to utilize

these rights for reasons that will be explored below.

The pillars of international protection for refugees in Egypt

are the 1951 Convention, the 1967 Protocol Relating to the

Status of Refugees and the 1969 Organization of African

Unity (OAU) Refugee Convention. Egypt is a signatory of

the 1951 Convention and the 1967 Protocol, but with heavy

restrictions and limited eective protection (Olwan 2009). It

is also a signatory to the 1969 OAU Convention, which has

broader criteria for those eligible for refugee status than

UNHCR policies. After 2004, many Sudanese and Somalis in

Egypt were accepted as refugees under the OAU Convention.

Those refugees accepted under OAU criteria are eligible for

refugee services in Cairo, but they are usually not eligible for

resettlement because most countries in Europe and North

America are not signatories of the OAU convention and do

not recognize their criteria. Adopting OAU convention thus

limits the durable solutions available to a segment of urban

refugees in Egypt. The likely permanence of this refugee

population in Cairo underscores the urgent need to develop

a more robust and sustainable framework of legal rights

and access to public services in order to facilitate successful

local integration for those ineligible for resettlement.

Egypt ratied the 1951 Convention on May 22, 1981, with

reservations to Articles 12(1) (personal status), 20 (rationing),

22(1) (access to primary education), 23 (access to public

relief and assistance) and 24 (labor legislation and social

security). According to Egyptian government ocials from

the Ministries of Foreign Aairs (MOFA), Health, Labor and

Manpower as well as the National Council of Childhood

and Motherhood (NCCM), as interviewed by Grabska (2008:

77), “refugees should not have access to the same rights as

those guaranteed to citizens.” The reasons provided by the

government ocials included: struggling economy, high

unemployment rates, lack of educational opportunities for

Egyptian children and lack of basic social services for poor

Egyptians. Ocials felt strongly that the Egyptian Government

cannot aord to divert its resources towards foreigners.

Egypt has not adopted any domestic legislation to

implement the 1951 Convention. There is no national

procedure for the determination of refugee status in Egypt.

The determination of individual requests for refugee

status in Egypt is done by UNHCR-Egypt, as has been the

case since 1954, when the Government of Egypt signed a

Memorandum of Understanding (MOU) with UNHCR. The

Government of Egypt expects that refugees recognized by

UNHCR-Egypt in Egypt will be resettled to third countries or

return to their country of origin: the MOU explicitly states

that the Government of Egypt does not consider local

integration a viable solution for refugees within its borders.

The two reservations that have had the greatest impact on

refugee populations living in Egypt are those placed on Article

22 on free primary education and Article 24 on employment.

Education Laws

In 1981, the Government of Egypt signed the 1951 Refugee

Convention and the 1967 Refugee Protocol, placing

restrictions on refugees’ right to education when it did

so. Over the years, however, there have been ministerial

decrees and decisions that have provided exceptions for

certain refugee groups. In 1992, the Minister of Education

issued Decree No. 24 allowing Sudanese children, inter

alia, to attend Egyptian public primary schools. In 2000,

the Minister of Education agreed to expand this right

to all refugee children. However, bureaucratic hurdles

remain in place and prevent most refugees from exercising

this right. In 2004, the Egyptian Ministry of Education

instructed schools to accept only those refugee students

with UNHCR-Egypt documentation and government-

issued residence permits, among other documents. The

extensive documentation requirements—birth certicate,

a valid passport or valid national identity document (such

as refugee card), the original school certicate from the

country of origin and a letter from UNHCR-Egypt—have

limited this right in practice, and the vast majority of

refugees have to resort instead to private schooling, the fees

for which most refugees cannot pay without considerable

assistance (Azzam 2006, Hilal and Samy 2009, Al-Sharmani

2008). In fact, Catholic Relief Services—the primary NGO

responsible for facilitating refugee education—told our

research team that they were not aware of any registered

refugees attending Egyptian public schools, though some

non-refugee Sudanese nationals may attend in very small

numbers. The situation in Cairo regarding refugee children

education contrasts the situation in Jordan, where the

government explicitly opened schools to Iraqis (Davis 2012).

Labor Laws

Reservation on Article 24 (labor legislation) prevents

refugees from acquiring work visas and applies to Iraqi,

Somali, Ethiopian and Eritrean refugees recognized by

UNHCR-Egypt. Sudanese—whether refugees or migrants—

have been technically granted the right to work under the

Four Freedoms Agreement (2004), but in actuality, few

have been able to successfully complete the cumbersome,

lengthy process required to obtain one. Palestinians

have been restricted from obtaining work visas since

Egyptian laws excluded them from the labor market in

1978. Additionally, obtaining work visas is dicult for all

foreigners, as Egypt has enacted policies over the years to

protect its domestic labor market from foreign competition,

due in large part to the country’s high unemployment rates.

However, there might be a loophole in the laws regulating

refugee employment in Egypt. As Jureidini points out,

open to exploration is Article 17 of the 1951 Convention,

to which Egypt did not enter any reservations. The rst

paragraph of Article 17 states: “The Contracting States shall

accord to refugees lawfully staying in their territory the

most favorable treatment accorded to nationals of a foreign

country in the same circumstances, as regards the right to

engage in wage-earning employment” (Jureidini 2009:

81). In practice, these rules have not always been adhered

to, either because Egyptian ministries were slow to adopt

new rules or because the rules were easily circumvented.

Nevertheless, this loophole ought to be explored further.

Foreign nationals’ access to employment is often based on

reciprocity, but the general rule is that 10 per cent of workers

in any company can be foreign-born. Only civil service is

reserved to nationals of Egypt (Di Bartolomeo, Fakhoury and

Perrin 2010). Foreign nationals must obtain work permits

through their employers. It might be prudent for UNHCR-

1111

CH3: Refugee Livelihoods

CH2: Legal and Policy Frameworks

12

Egypt and/or BPRM to assess the local labor market with a

view towards which labor sectors or companies are looking

for workers but have not exhausted their 10 per cent of

foreign-born workers rule. In general, it could be benecial to

open a dialogue with employers on their labor force needs.

Without expanded rights, including the right to education

and the right to work, refugees in Egypt have no real

chance for local “integration,” one of UNHCR-Egypt’s three

“durable solutions” (Crisp 2004). While local integration is

often conceptualized as a “durable solution” and meant to

be a permanent solution to protracted refugee situation

(see: Jacobsen 2001; Meyer, 2008), it can also be an

“interim” solution. The social scientic conceptualization of

integration considers it a process of interaction between

refugees and hosts and does not need to preclude eventual

repatriation or cross-border livelihoods and identities (see:

Polzer 2008). Policy-makers often shy away from discussing

the local integration of refugees, worrying that it would

not be politically palatable to host governments. However,

not discussing integration issues can be dangerous as well,

both for refugees and hosts. Lack of integration means a

lack of rights and for refugees, spells discrimination and an

inability to provide for their families. It also means a lack of

understanding of local laws and can, inadvertently, lead to

undesirable behaviors. It also can result in hosts, particularly

the poorer segments, perceiving refugees as “privileged”

since refugees are provided assistance while not working.

Emphasis on local integration—whether permanent or

interim—can lead to refugees being perceived by host

governments as an opportunity rather than a burden.

2.3 Legal Frameworks for Human Rights Protection

The Government of Egypt is signatory to a number of

international conventions, some of which potentially

impact the rights and services aorded to refugees in Egypt.

Egypt became a signatory to the United Nations’ Convention

on the Rights of the Child in 1990 and notably did not

enter any reservations upon ratication. Article 22 of

this Convention explicitly states that refugee children

are protected under the statutes of this agreement. One

key aspect of this Convention is that Article 28 stipulates

the rights of every child to free and compulsory primary

education and that all children should be able to access

vocational education if so desired. In practice, however, most

refugee children are unable to attend public schools due to

perceived legal barriers (whether real or misunderstood),

cost, and cultural and linguistic barriers. All refugees are

prohibited from vocational training in Egypt. The protection

of these rights on paper thus does not guarantee that refugee

children receive their full rights in practice (OHCHR 1989).

Egypt is a signatory to the United Nations’ International

Convention on the Protection of the Rights of All Migrant

Workers and Members of their Families, which went

into eect in 2003. Though refugees do not have the

legal right to work in Egypt, this agreement would likely

constitute the framework by which future labor rights

for refugees would be granted. This agreement provides

limited rights and freedoms to migrant laborers. However,

it explicitly states that domestic workers do not qualify as

“laborers” under this agreement. Furthermore, human

rights organizations have noted frequent violations of

this agreement by the Government of Egypt, including

allegations of torture and the racist treatment of migrant

workers by law enforcement in Egypt (EIPR and FIDH 2007).

The government also agreed to the United Nations’

Convention Against Torture and Other Cruel, Inhuman or

Degrading Treatment of Punishment in 1986. However,

there are widespread allegations that the police routinely

engaged in torture. Refugees reported their anxieties that

they would suer physical abuse from Egyptian police if

they were ever arrested. Despite Egypt’s ratication of this

convention, there is no assurance that refugees in Egypt are

safe from abuse, wrongful detention or harsh treatment if

taken into custody for any reason. These concerns have been

realized in recent years: UNHCR-Egypt and human rights

organizations have criticized the Government of Egypt for

detaining, mistreating and forcibly returning illegal migrants

CH3: Refugee Livelihoods

Table 1: Rights According to Dierent Refugees Settled in Cairo

Sudanese Iraqis

East Africans:

Recognized

“Refugees”

with Closed

Files Palestinians

Right to

Work

Yes, on paper; in

practice, no

(Four Freedoms

Agreement 2004)

No

(GoE reservation

to refugee con-

vention)

No

(GoE reservation

to refugee con-

vention)

No

(lack legal resi-

dency)

No

(Egyptian Law

1978)

Right to

Public

Education

Yes, on paper; in

practice, no

(Four Freedoms

Agreement 2004)

Yes, on paper; in

practice, no

(Decree 2000)

Yes, on paper; in

practice, no

(Decree 2000)

No

(lack legal resi-

dency)

No

(Egyptian Law

1978)

Right to

Public

Health Care

Yes, public

healthcare on

the same basis

as uninsured

Egyptians

(Decree 2005)

Yes, public

healthcare on

the same basis

as uninsured

Egyptians

(Decree 2005)

Yes, public

healthcare on

the same basis

as uninsured

Egyptians

(Decree 2005)

May use public

health facilities

but must pay

full fees because

they are not

legal residents.

Yes

(no restrictions)

CH2: Legal and Policy Frameworks

5 The Government of Egypt’s response to Palestinian refugees followed a dierent trajectory, owing to Palestinians’ unique legal status

and claims within the international refugee system. The Government of Egypt’s varying policies towards Palestinians will be discussed in

greater detail below.

6 UNHCR-Egypt did occasionally perform RSD with a small number of Iraqi asylum-seekers in exceptional cases, such as when an Iraqi

was suspected of being a former Ba’athist.

CH3: Refugee Livelihoods

13

and asylum-seekers attempting to cross through the Sinai Peninsula into Israel (UNHCR 2008; Human Rights Watch 2009).

2.4 Trends in Durable Solutions

UNHCR-Egypt has responded in varying ways to the

legal constraints placed upon them by the Government

of Egypt when it comes to providing durable solutions

for refugee populations in Cairo. Both the Government

of Egypt and UNHCR-Egypt have promoted voluntary

repatriation as the preferable durable solution for the

waves of Sudanese, East African and Iraqi refugees

who have arrived over the past few decades.5

Beginning with the waves of Sudanese refugees who ed

to Egypt in the 1980s during the war in Southern Sudan,

UNHCR-Egypt performed RSD for each refugee applicant

in accordance with the MOU between the Government of

Egypt and UNHCR-Egypt. From 1978-1995, the Sudanese

in Egypt additionally beneted from the terms of the Wadi

El Nil agreement between the Governments of Egypt

and Sudan. This agreement granted Sudanese in Egypt

(refugees and ordinary migrants) rights of education,

employment, health services and property ownership.

This agreement ended in 1995 following an assassination

attempt on President Mubarak in Ethiopia, which the

Government of Egypt blamed on Sudanese Islamists.

Between 1995-2004, Sudanese refugees in Cairo were

aorded only the limited protections provided in Egypt

under their MOU with UNHCR-Egypt. However, those

recognized as refugees by UNHCR-Egypt were eligible

for repatriation in third countries during these years. Of

the 20,700 Sudanese who were recognized by UNHCR-

Egypt between 1997-2004, 14,300 were resettled in third

countries. Signicant protection gaps remained however:

the 20,700 recognized Sudanese refugees constituted

only a fraction of the total number of Sudanese who

approached UNHCR-Egypt for asylum. Upwards of 60 per

cent of Sudanese cases during these years were rejected

because the Sudanese could not necessary prove that, as

individuals, they had a “well-founded fear of persecution”;

they were simply eeing the general violence of the war.

To rectify this situation, in 2004 UNHCR-Egypt began to

recognize Sudanese refugees under the criteria of the

Organization for African Unity (OAU), which recognizes

refugees eeing the violence of war even if individuals

did not experience targeted persecution. Problematically,

however, switching to the OAU criteria for RSD disqualied

many Sudanese refugees from international resettlement,

since most host countries in Europe and North America do

not recognize the OAU’s criteria. Thus from 2004 onward,

Sudanese refugees had an extremely dicult time in trying

to get resettled internationally, despite the fact that this was

the preferred durable solution for most Sudanese refugees.

At the same time, prospects for locally integrating the

Sudanese improved somewhat in 2004. In this same year,

the governments of Egypt and Sudan entered into the “Four

Freedoms” agreement, which provided Sudanese in Egypt

with the legal right of work, residency and other freedoms.

Beginning in 2007, Sudanese refugees led protests against

UNHCR-Egypt, advocating for increased resettlement

opportunities. Though negotiations were sometimes often

tense, UNHCR-Egypt began to increase the numbers of

cases recommended for resettlement in a third country.

Following the Egypt’s revolution and a new wave of protests,

High Commissioner for Refugees Gutierrez announced

a “new start” for refugee resettlement for UNHCR-

Egypt, announcing a new annual resettlement target of

2,000 cases. This number was several times higher than

resettlement rates had been in the mid-2000s (Kagan 2011).

UNHCR-Egypt reported to our team that ve additional sta

members were assigned to review UNHCR-Egypt’s database

of resettlement les to identify particularly vulnerable

cases that may be eligible for third country placement.

Other refugee populations in Egypt have had less volatile

experiences in regards to durable solutions. Perhaps

learning from past mistakes with the Sudanese refugee

population, UNHCR-Egypt granted all Iraqi asylum-seekers

refugee status on a prima facie basis without undergoing

RSD.6 This qualies Iraqis for international resettlement;

thousands have been resettled since the rst wave began

arriving in Egypt in 2003. Likewise, refugees from Somalia,

Eritrea and Ethiopia were registered either on a prima facie

basis or through individual RSD. Recognized refugees from

these countries have been eligible for repatriation in third

countries, and many have been resettled over the years.

Palestinians, in contrast, are not registered as refugees by

UNHCR-Egypt, and they are not eligible for resettlement.

Voluntary repatriation is an option to all refugees at all

times. Since 2008, UNHCR-Egypt has actively involved

itself in assisting Iraqis with voluntary repatriation.

According to statistics from UNHCR-Egypt, as many as

1,439 Iraqis left Egypt, either with UNHCR-Egypt assistance

or spontaneously. In 2010, that number dropped to 548. In

2011, the year of the Egyptian Revolution, only 445 Iraqis

left Egypt despite the increased instability and worsening

quality of life. (UNHCR 2011b, 2011c). The declining number

of returns may indicate that, despite worsening conditions in

Egypt, some Iraqis and other refugees may never voluntarily

return. Furthermore, UNHCR-Egypt ocials indicated to our

research team that these returns are not always sustainable:

a number of “returnees” from Egypt to Iraq ended up

leaving Iraq once again to seek asylum in Jordan or Syria.

Likewise, only a small number of Sudanese have returned,

and it is unlikely that many will return to South Sudan

until the relationship between the governments of the

North and South have stabilized. In 2011, 333 Sudanese

and Southern Sudanese were assisted with returns by

UNHCR-Egypt, and similar numbers of Sudanese returned

the year prior (393 Sudanese). To give perspective, a total

of nearly 25,000 Sudanese asylum-seekers still remain in

Egypt (UNHCR 2011c). Few Ethiopians or Eritreans have

returned. According to the research by Fabienne Le Houerou

CH3: Refugee Livelihoods

CH2: Legal and Policy Frameworks

14

(2006), many Ethiopians living in Egypt fear reprisal or

prison upon return due to their roles in Ethiopia’s civil war.

Local integration is arguably the durable solution that

requires the most attention currently from UNHCR-Egypt

and its partners. On the one hand, a few promising steps

have been taken by the Government of Egypt to extend

some rights to refugees who are unlikely to ever resettle to

a third country or repatriate to their country of origin. These

rights include the opening of primary health clinics and

primary schools to refugees. On the other hand, these rights

are insucient even on paper: refugees require education

beyond primary school and have health needs beyond

primary care. More problematically, these rights often exist

only in theory and are not realized in actuality. The result is

that many refugees of all nationalities live precarious lives

in Egypt, where they are unable to support themselves

or become full-edged members of their host society.

2.5 Protection Threats: Before the Revolution

Iraqis: Live Largely Outside of Local Society

Iraqis reported to our research team that they live largely

outside of local Egyptian society: they seek privacy from

their neighbors, they tend to live on the outskirts of

the city, and they report perceptions that Egyptians are

potentially untrustworthy. Few reported direct threats to

their safety; only a few reported being victims of petty theft

or street crime. Most frequently, Iraqis complained of being

defrauded by Egyptian “business partners” who pledged to

open small businesses with Iraqis, only to disappear with

the Iraqis’ investment funds. On the part of the Egyptians,

our team noted that Iraqis were blamed for aecting rent

increases and the cost of food. Iraqis also face a certain level

of discrimination due to Egyptians’ assumptions that all Iraqis

are Shi’i.7 In at least one instance reported to our team, a Shi’

Iraqi boy was harassed in his primary school on account of his

religious aliation. Iraqis are distinctive from the Egyptian

population on account of their dialect and thus can be “singled

out” in conversations. Iraqis are not racially distinct from

most Egyptians and thus do not experience racial prejudice.

Sudanese and East Africans: High Levels of

Discrimination

In contrast, Sudanese and East African refugees report

high levels of racial discrimination from the Egyptian

population. Many authors have documented the frequent

verbal abuse that Sudanese, East Africans and even

Egyptian Nubians experience in Egyptian society. Certain

professions in which Sudanese and East African refugees

work also expose them to a greater risk of physical,

verbal, sexual, and emotional abuse. Their employers, for

example, often abuse domestic workers, and they have

little recourse in Egyptian law and society (Jureidini 2006).

In Arab and African societies, kinship and social linkages

are quite important and serve as informal protection

mechanisms. Some refugees, Iraqis and others, are fortunate

enough to have their families with them, providing some

comfort and security. Most vulnerable are single women,

widows or women separated from their husbands or

other male relatives; Egyptian men often harass them.

I feel insecure every time I leave the house because I

am harassed and abused in the streets and in public

transport systems. I am also afraid of being stopped

by security ocers and asked to show my ID. If I am

not recognized by the UNHCR-Egypt as a refugee

I could be arrested and deported back home. And

now that the political situation in Egypt is not stable,

there is uncertainty as to what is going to happen

to me next or any other refugee for that matter.

A Somaili Woman

Even though I have a blue card [a UNHCR issued

identication card] and can live legally here in

Egypt, I experience a lot of harassment from the

local men everywhere I go and the only time I feel

safe and comfortable is when I am in the house.

A Sudanese Woman

Egyptians: Also Feel Insecure

However, lack of security does not aect solely refugees.

Prior to the revolution, we heard many stories about

Egyptians fearing arrests, beatings by the police and,

in some circumstances, torture. The Nadim Center, for

example, was established in 1993 to provide services to

Egyptian survivors of torture and victims of state violence

and police brutality. Reportedly, police used torture in

Egypt quite frequently to obtain information from people

or recruit them to be informants. They often resorted to

torture to force people to provide witness testimony in

criminal cases. A psychiatrist we interviewed told us a story

about a young boy who had been tortured because he was

either implicated or had witnessed a murder in his village.

He was rounded up and severely beaten to “confess” that

he had seen the murderer the police was investigating.

2.5 Protection Threats: After the Revolution

The revolution created signicant vulnerabilities and

protection threats for all refugee populations in Egypt.

UNHCR closed its oces for several days and evacuated

international sta during a portion of the uprisings in

January 2011. With the oces were closed, refugees were

not able to receive services they required, and those with

appointments scheduled during the revolution had to wait

for weeks to have their appointments rescheduled. Monthly

cash stipends from Caritas to refugees were interrupted

during the protests, leaving a number of refugee families in

critical nancial situations. There was a rise in both protest-

related violence and criminal violence during the revolution,

creating palpable fear among refugee populations and

the local Egyptian population alike. UNHCR reported to us

CH3: Refugee Livelihoods

7 The Egyptian Muslim population is overwhelmingly Sunni. In contrast, only approximately 20 per cent of Iraqis are Sunni, creating a

perception among Egyptians that most Iraqis come from a dierent sectarian background.

CH2: Legal and Policy Frameworks

15

that xenophobic attitudes increased during and after the

revolution; African refugees were particularly vulnerable

to xenophobic harassment due to the long history of

racially-based discrimination and harassment against

African refugees in Cairo even prior to the revolution.

Refugees of all nationalities also reported more complaints

to UNHCR about problems with their landlords: many

more than usual were being evicted or reported that

their landlords were raising the rent on their apartment.

This was attributable to both increasing xenophobic

attitudes and the real economic hardship experienced

by the entire Egyptian population after the revolution.

Iraqis: Fearful

In our interviews, a number of Iraqis who applied to UNHCR-

Egypt for refugee status expressed fears for their lives in light

of the deteriorating security situation in the Egypt, particularly

during the revolution. UNHCR also reported to our team that

signicant numbers of Iraqis applied for refugee status for

the rst time after January 2011, even though they had been

in Egypt for a long time. These applications represented

Iraqis’ growing fears about their safety and futures in Egypt.

Stakeholders also reported that Iraqi refugees’ anxiety and

fear during and after the revolution was signicantly higher

than other refugee populations, perhaps related to trauma

from the very recent wartime ghting they had experienced.

St. Andrews and other organizations held psychosocial

support sessions to help respond to the Iraqis’ anxiety.

However, it appears that fears about safety and security

caused many Iraqi refugees to further isolate themselves

in the aftermath of the revolution, fearing to venture too

far from home to access resources and services from NGOs

located in the center of Cairo. Though the research team was

not aware of any specic violent threats against Iraqis, given

the number of deaths during the revolution, the perception

of fear was very real. Reportedly, the Iraqi embassy in Cairo

oered to return any Iraqi citizens to Baghdad should they

wish to return. However, some of the Iraqis we spoke with

were afraid to return to Iraq for fear of what could happen to

them there, while at the same time fearing to remain in Egypt.

African Refugees: Don’t Feel Safe

Other refugees were also fearful. A male Ethiopian refugee said:

I don’t feel safe here in Egypt now more than ever

because of the current situation. It is unpredictable

as to what may happen next. What if the people do

not want us in Egypt anymore? What will happen

to us? When the demonstrations started in Cairo,

the UNHCR-Egypt closed its oce and left and

refugees were stranded without anyone to protect

us. I am even afraid to go the coee shops because

I am afraid of the way the locals look at us. I don’t

feel safe anymore. I have heard of refugees who

have been robbed and attacked by the locals.

Especially our women are subjected to more and

more attacks and abuse by the locals and that is

very frustrating. We don’t have any rights here and

we are discriminated because of our skin color.

Egyptians: Experiencing Increased Insecurity

Although many Egyptians did not trust and feared the policy

long before the revolution, they did feel safe, particularly in

neighborhoods they knew well. After the revolution, Egyptians

interviewed in the course of this study shared the same fear

and anxiety about safety and security expressed by refugees.

I don’t think Cairo is safe. I used to feel safe before

the revolution, but now I don’t. I wouldn’t go to

the police. They have always treated people badly

and now so much is changing, it is dicult to tell

how the police will react; they are unpredictable

which makes me afraid to approach a policeman.

A young Egyptian man

It’s a “security vacuum.” I am a Christian and I am

constantly subjected to violations from all sides. On

March 5, 2011 in Giza Muslims attacked Christians

gathered in a church, desecrated the church, and set

it on re while the army looked on and did nothing.

A young Christian Egyptian man

Parents, both Egyptians and refugees, expressed increased

concerns about the safety of their children after the

revolution. Before the revolution, an Egyptian woman we

interviewed had moved with her family to 6th of October

because it was a safe neighborhood. However, since the

revolution she is feeling less and less secure there. “There are

some bad people in 6th of October,” she said, “and they have

spread since the revolution. They have no ethics or religion

and there is no police since the revolution so anyone can

take your purse. I do not let my children go outside alone.”

At the same time, there were individual refugees who reported

that the revolution aected their lives in some positive

ways, as well. For example, many Iraqis participated in the

neighborhood watch groups that formed during the 18 days

of the revolution in January 2011. These Iraqis reported that

this was an important step in helping them to get to know

their neighbors and feel like part of their local community.

Refugee stakeholders also reported that their Eritrean,

Ethiopian, Somali and Sudanese clients reported similar

experiences during the initial days of the protests. Since

January 2011, however, feelings of community cohesion that

took place during the initial “emergency” of the revolution

have abated, and further steps are necessary to ensure that

refugees are better integrated into their local communities.

CH3: Refugee Livelihoods

CH2: Legal and Policy Frameworks

16

2.6 Recommendations

All refugees residing in Cairo are in need of expanded rights

and protection. However, black Africans are particularly

vulnerable because of widespread racial discrimination.

Indeed, we have observed much prejudice against the

Other—refugees of color and refugees of dierent social

class—by Egyptians and Iraqis alike. Iraqi refugees petitioned

an international health NGO to designate particular days of

the week for services to the Iraqi community to avoid sitting

in the same waiting room with African refugees. The service

provider in question was very disappointed that UNHCR-

Egypt would not allow them to institute this practice and

appealed to the research team to make a recommendation

that would override UNHCR-Egypt’s decision. Middle-class,

educated Egyptian service providers saw Iraqis as peers and

treated them accordingly. They had much less appreciation

for the challenges African refugees faced and often dismissed

their plight saying: “They [African refugees] did not lose

nearly as much as Iraqis. They didn’t have much to begin

with.” Sudanese, Somali and Ethiopian refugees reported

many incidents of racism in the form of verbal abuse and

physical assaults. They reported that racial discrimination

was often the root cause of unfair rent practices, limited

access to health care and harassment by law enforcement

(see also: FMRS 2006). Sperl (2001) speculates that the

local community treats Muslim refugees better than non-

Muslims. Grabska (2006), however, posits that racial/ethnic

discrimination and hostility override shared religion.

t Re-negotiate the 1954 MOU between UNHCR-Egypt

and the Government of Egypt. This recommendation

comes from an analysis conducted by Michael Kagan

(2011); the research team concurs with his ndings. In

this new agreement, the Government of Egypt would

pledge refugee non-refoulement and would grant

rights to refugees, including the right to work, but

would n=ot be asked to permanently settle refugees.

UNHCR-Egypt would continue to do RSD, and the

Government of Egypt would respect their decisions.

UNHCR-Egypt would continue to provide support,

which would considerably diminish the drain on

Egyptian resources, but would need to provide much

less support if refugees were allowed to work. The

priority of durable solutions would be as follows: rst,

voluntary repatriation, second, resettlement and last,

local integration. UNHCR-Egypt would encourage

repatriation with as much transparency as possible.

After this, UNHCR-Egypt would prioritize international

resettlement for those who have lived in Egypt for

ve years or longer and who have no prospects for

repatriation or local integration. Kagan’s arguments are

commensurate with the notion that local integration

does not necessarily indicate permanent settlement.

t Egypt would grant permanent residency to those

who truly cannot return or resettle, but could

link quota numbers for local integration to the

numbers of those resettled in order to maintain

pressure on UNHCR-Egypt and resettlement

countries to admit signicant number of refugees

who had lingered in Egypt for ve plus years.

t Train Law Enforcement about Refugee Rights. Police

ocers are not well versed in refugee laws and often

times question the validity of UNHCR-issued refugee

documentation and resulting refugee rights. There is a

need to work with the Government of Egypt to implement

mandatory training for police ocers—particularly

those ocers working in refugee neighborhoods—

to better understand refugees’ statuses and rights.

t Re-interview Sudanese Refugees with Closed

Cases. We recommend that UNHCR-Egypt re-

interview Sudanese refugees to nd those eligible for

resettlement. UNHCR-Egypt pledged to dedicate ve

sta members to review closed cases following the 2011

revolution and the subsequent protests at UNHCR. We

recognize that this recommendation poses some risks;

UNHCR could decide that the Sudanese are not eligible

for refugee status, and the refugees could lose all the

rights and services that they currently have as Persons

of Concern to UNHCR under the under the Organization

of African Unity (OAU) convention. Nevertheless,

the alternative is a prolonged, protracted situation

without any prospects for any viable durable solution.

t Anti-Discrimination Training for Implementing

Partners. There is a lot of scope for UNHCR-Egypt

and BPRM to train their implementing partners to

understand race and class dierences among refugee

populations in Cairo as well as to institute and/

or monitor implementation of anti-discriminatory

practices and behaviors while working with the

Egyptian government on extending a broader set

of rights and protections to all refugees. Training of

current and future implementing partners is particularly

important if UNHCR-Egypt will indeed increase funding

for refugee and local civil society organizations.

t Training for Refugee and Local Community Networks

and Organizations. Refugee communities in Cairo

live in isolation from each other and from the local

Egyptian community. They often make assumptions

about each other that can lead to misunderstandings

or prejudice. UNHCR-Egypt should organize training

programs, information exchange sessions and informal

gatherings of refugee community leaders and members

to facilitate better cross-cultural, cross-religious and

cross-sectarian understanding and communication.

BPRM should fund an eort to identify or adopt existing

training materials and curricula to the local context.

CH3: Refugee Livelihoods

CH3: Refugee Livelihoods CH2: Legal and Policy Frameworks

CH3: Refugee Livelihoods

17

Chapter 3: Refugee Livelihoods

Improving the livelihoods of Cairo’s refugees is the single

most important step towards increasing refugees’ protection,

promoting durable solutions, and contributing to their

long-term well-being. In the past, UNHCR-Egypt focused

primarily on assisting and preparing refugees for eventual

return or resettlement, since the Government of Egypt was

averse to permanent integration of refugees. As a result,

there were few policies and programs to address refugees’

needs for long-term livelihoods solutions in Cairo. However,

in the rst years of the new millennium, UNHCR began

globally to frame livelihood as an essential protection issue

in the context of protracted refugee situations, especially in

urban settings. Consequently, livelihoods have acquired a

prominent place in UNHCR’s Convention Plus initiative and

in the Agenda for Protection (UNHCR 2006; UNHCR 2003).

Issues of refugee livelihoods were further highlighted in

UNHCR’s recent publication Promoting Livelihoods and

Self-Reliance: Operational Guide on Refugee Protection in

Urban Areas (UNHCR 2011). In these publications, UNHCR

emphasized that the right to work is a human right (Article

23.1, Universal Declaration of Human Rights and Articles

17-19 of 1951 Geneva Conventions) for all people, and for

urban refugees, in particular, it is closely associated with

issues of protection and durable solutions (UNHCR 2011).

The Urban Policies of both 1997 and 2009 also emphasized

the importance of livelihoods, though the 2009 policy

includes a more somber assessment of the obstacles many

urban refugees face in seeking work than its earlier iteration.

Despite the increased emphasis on refugee livelihoods,

UNHCR-Egypt and its implementing partners in Cairo

operate within a legal framework that, on the one hand,

does not allow refugees to work legally and, on the

other hand, sometimes turns a blind eye to refugees

working in the informal economy. These restrictive labor

laws pose enormous challenges for the international

refugee regime operating in Cairo, but the inconsistent

attitude towards working refugees provide some,

albeit very limited, opportunities for creative strategies

facilitating livelihoods and protecting working refugees.

We discuss these strategies in the recommendations.

No clear denition of the concept of livelihoods has emerged,

illustrating the complexity of the phenomenon. Chambers

and Conway (1991) indicate that “livelihood” refers to the

capabilities, assets and strategies used by people to make a

living. A sustainable livelihood allows individuals and families

to cope with and recover from stress and shocks, to maintain

or enhance its capabilities and assets in order to provide

sustainable livelihood opportunities for the next generation.

It also contributes net benets to other livelihoods at

the local and global levels. In other words, livelihoods

refer to the means used to maintain and sustain life.

Similarly to other urban refugees, Cairo’s refugees are often

confronted with a wide range of legal, nancial, cultural,

and—for non-Arabic speakers—linguistic barriers in their

eorts to establish sustainable livelihoods. In many cases

they have little alternative but to join the informal economy.

In the remainder of this chapter we will discuss refugees’

access to formal and informal employment with a particular

emphasis on: the vulnerabilities and opportunities faced by

domestic workers, nancial assets (savings and remittances)

as well as cash assistance, and housing costs and living

conditions. We will discuss other expenses, including

education and healthcare costs, in subsequent chapters.

3.1 Access to Employment

Despite the pronouncements about the importance of

livelihood initiatives, in Cairo most refugees continue to face

immense challenges in attaining self-reliance and economic

self-suciency. As indicated in the previous chapter, Egypt’s

reservations to the 1951 Convention on article 24 (labor

legislation) mean that refugees cannot work legally in Egypt.

This restriction aects Iraqi and East African refugees who

are registered with UNHCR-Egypt. Refugees with closed

les are barred from working since they lack legal residency

required to apply for a work permit. Palestinians have been

barred from working in Egypt since 1978 (El-Abed 2005). The

Sudanese are in an exceptional situation: the Four Freedoms

Agreement (2004) technically provides the Sudanese with the

right to work. In practice, however, it is almost impossible for

the Sudanese to obtain the necessary work permit required

for legal employment. Securing a work permit is an expensive,

lengthy and complicated process, which requires employer

sponsorship and no competition from a similarly qualied

Egyptian citizen (see also Buscher and Heller 2010). Despite

these restrictions, some refugees—mainly Africans—are

able to nd work, albeit illegally in the informal economy in

unregulated sectors and occupations with few protections.

One loophole exists for all foreigners: under Egyptian law

domestic service does not constitute labor. As a result,

many refugees are able to nd waged employment as

domestic workers, but without any protections under

Egyptian labor laws. Housekeepers, baby-sitters, cooks,

gardeners, and other servants enter into private contracts—

often times verbal agreements—with private citizens who

need their assistance. These informal arrangements put

many refugee domestic workers at risk for exploitation.

Iraqis: Unable to Work Legally, Reluctant to Take

Menial Jobs

Iraqis interviewed in the course of this project were adamant

that they would not take jobs below their level of education.

All wanted jobs commensurate with their education

and work experience in Iraq. Some were willing to take

a dierent job that they were trained for as long as it was

“a desk job.” Without exception, all Iraqis we interviewed

expressed a profound disdain for manual labor and jobs

“below [their] level.” Stakeholders conrmed our data, noting

that Iraqis tended to only be interested in entrepreneurial

opportunities and shunned manual labor. At the same

time, mental health care professionals reported to our team

that Iraqi refugees who have taken up menial jobs below

their professional qualications often display symptoms of

depression and should receive mental health counseling

CH3: Refugee Livelihoods

to mitigate this situation. This stands in sharp contrast to

many mental health approaches that suggest that keeping

refugees busy decreases social isolation and serves as

a protective factor minimizing the risk for depression.

Iraqis with relatives or friends in the United States were

appalled that many were not able to re-establish their

professional careers and some had to take up menial jobs. In

some interviews with stakeholders, we observed that service

providers have supported Iraqi refugees rather classist

attitudes towards menial labor and jobs not commensurate

with their education. Refugee service providers, particularly

middle-class Egyptians, bemoaned the fact that refugees

resettled in the United States were encouraged to enter the

labor force as quickly as possible regardless of the type of

employment that was available to them. They were very

supportive of Iraqi refugees’ decisions to look for opportunities

in Europe rather than in the United States or Canada.

Some Iraqis with resources at their disposal attempted to

start small entrepreneurial ventures: open a bakery or a

barbershop, serve as middlemen on commission in real

estate sales, or operate a small grocery store. However, many

were told that in order to start a business in Cairo they needed

an Egyptian partner. Several Iraqis we spoke with have either

been deceived by Egyptian partners or heard of others who

were swindled out of their money. One Iraqi man told us that

when he and his parents rst came to Egypt in 2007 they

opened a small market in the neighborhood. However, an

Egyptian neighbor, who seemed to be a good man, told them

that they had to share the prots because they were illegal.

At rst they did not believe him, but after several weeks of

nagging they gave in. Reportedly, he stole 10,000EP from

them. In 2009 they took him to court, but at the time of our

interview in December 2011 the case had not been settled yet.

3.2 Vulnerability of Domestic Workers

Domestic work—including house cleaning, cooking, and

childcare—is often one of the few elds in which refugees are

able to nd work. In our analysis of refugees’ participation in

domestic labor, we partnered with Dr. Ray Jureidini (formerly

of the American University in Cairo, now with the American

University of Beirut), who has published extensively on issues

of domestic labor in Egypt and throughout the Arab world.

We have also analyzed other publications on this topic and

interviewed many domestic workers, particularly women.

Service providers and refugee advocates we spoke with have

also indicated that this group requires particular attention.

African Refugees: Eager to Work, At Risk for

Exploitation

Many African refugees—Sudanese, Somalis, Ethiopians and

Eritreans—work in the informal economy. Women typically

work as domestic servants, providing household cleaning

and childcare. Men who are able to nd work often nd

employment in the service sector as chaueurs, deliverymen

or gardeners. Somali and Sudanese women, in particular,

have had consistent success in nding employment as

domestic workers in private homes. Accurate statistics

do not exist regarding the number of domestic workers

in Cairo. But it is believed that for thousands of refugees

in Cairo, domestic work is the only type of employment

available, and it has proven to be a crucial source of income

for their survival. Virtually every African refugee woman

we spoke with worked as a domestic worker or baby-

sitter in an Egyptian household, as there is high demand

among middle- and upper-middle class Egyptian women

for domestic workers. However, pay is typically inadequate

and insecure. Domestic workers are not legally considered

“workers” and thus are not protected by Egyptian labor

laws, nor are their contracts valid legal documents.

In a survey of 633 foreign-born domestic workers in Cairo

conducted by Jureidini (2009), 10 per cent of interviewees

complained of sexual harassment, including rape,

inappropriate touching and demand for sexual favors.

Those who tried to refuse were red or threatened with

ring. One interviewee said: “The husband comes to my

room every night for sex. I can’t say no because he gives

me money and helps me with many things” (Jureidini

2009: 87). Based on his research, Jureidini found that

male employers were often the perpetrators of sexual

harassment. However, because of the shame associated

with the abuse and the lack of legal protections in place

for domestic workers generally, abuse is rarely reported.

Abused refugees have little recourse in terms of getting

protection from the Egyptian legal system. While

interviewing a female family physician working with

African refugee women we heard a story about a Sudanese

domestic worker who was raped by her employer in a dark

courtyard. Distressed by the situation she ran into the street

and a passer-by, a male doctor, summoned the police to

help the victimized woman. When the police arrived they

said that in order to make a credible claim the victim would

have to have an adavit signed by a medical doctor. The

passer-by oered to attest to what he saw—after all he was

a doctor—but the police told him that the adavit had to be

issued by a doctor who works for the police to be credible.

Obviously, there was no such doctor in the street. The police

told the woman to go home. In her case, “home” was the

house of the rapist since she was a live-in housekeeper.

In addition to sexual harassment and sexual exploitation,

domestic workers faced other forms of abuse. When she

rst arrived in Cairo, Salima,8 a young Sudanese woman,

worked as a housekeeper for an Egyptian family. The lady

of the house took her passport and would not return it

when Salima needed the passport to register with UNHCR-

Egypt. Only after Salima waived her salary, the Egyptian

employer returned the passport. Salima eventually quit,

having become ill from working long hours with only

one meal a day. Our research assistants told us other

accounts of employers strip-searching their domestic

employees whenever they were suspected of theft.

Refugee men also work in the informal economy, though

there is less demand for their labor and subsequently many

nd it dicult to get hired. Based on group interviews

conducted by our research assistants at Refuge Egypt,

many Sudanese men reported working as chaueurs,

running small errands for employers or working as

deliverymen. Though some of these men reported good

1818

8 Pseudonyms have been used to protect the anonymity of interviewees.

CH3: Refugee Livelihoods

18

CH3: Refugee Livelihoods

19

working relations with their employers, other complained

of racism, unpaid wages and unjustied dismissals.

For obvious reasons, employment in the informal economy

is not very secure. This insecurity has been exacerbated

after the revolution. African refugees reported being

“laid o” from their domestic work, gardening and other

unskilled positions. In community meetings with UNHCR-

Egypt, African refugees explained the reasons given by

employers for stopping employment: “It was Mubarak

who allowed you in here and now he is gone, so it’s time

for you to go too”; “We don’t need you here now”; “We

have our own issues to deal with.” As the economy is not

likely to recover soon, refugees are likely to continue facing

increased economic vulnerability in the months to come.

3.3 Financial Assets: Savings and Remittances

Iraqis: Running Out of Savings, Relying on

Remittances

Iraqis and refugee service providers interviewed in the course

of this project indicated that many Iraqi refugees continue to

live on their savings. There is a general perception that Iraqi

refugees are fairly well o. However, the Iraqi refugees we

spoke with worried that these resources were diminishing

quickly, and we heard reports that some Iraqi families

had reached such a precarious position that they had to

choose between educating their children and paying for

medication. While it is probably true that savings or funds

from property sales are drying up, visits to Iraqi households

suggest that they are trying to hold onto urban, middle-

class standards of living and are better o than African

refugees living in Cairo. Even though most Iraqi apartments

we visited were sparsely furnished, many were located in

nice residential neighborhoods, primarily in 6th of October.

Furthermore, each household we visited had a television,

most interviewed Iraqi refugees had Internet and cell

phones as well as basic but sucient furniture for household

members. In contrast, most Sudanese and Somali refugees

lived in overcrowded dwellings in poor neighborhoods in

central Cairo with insucient furniture and few amenities.

Many lived with roommates—extended family members or

non-relatives—whereas Iraqis did not. Some African refugee

women opted to work as live-in domestics simply because

they could not aord to rent a room, much less an apartment.

To supplement their dwindling savings, a considerable

number of Iraqi households continue to receive remittances,

either from properties in Iraq or relatives living in Iraq

or elsewhere in the world. In one of the rst Iraqi families

we interviewed, the mother—a middle-age widow with

an engineering degree from an American university—

told us that she would not register with UNHCR-Egypt

because then she would not be able to travel to Baghdad

to collect rent money from tenants living in the house

her late husband built.9 We also heard of a case of an

Iraqi man who was arrested because he received a large

money transfer from Iraq of $7,000 and the police claimed

he was using the money to aid terrorists. The police

conscated the funds and detained the man. UNHCR-

Egypt got involved and presented him with the option of

deportation to Iraq or going to another country. He chose

to go to Syria because he had business connections there.

A survey of Iraqi households conducted by the World Health

Organization (WHO) and the Ministry of Health (MOH)

indicated that an estimated 60 per cent of Iraqi households

do not have sucient nancial support because of lack of

resources to meet their basic or other special needs (WHO and

MOH 2009). However, that means that 40 per cent are doing

relatively well. If they could work legally in Cairo, the majority

of Iraqi households would most likely be self-sucient.

Other Refugees

Some Sudanese, Somali and Ethiopian refugees we

interviewed also received money from friends and

relatives. The Somalis who received remittances from

their families did not work, and some were able to

pay for their education with this money. However, the

sums were small and rarely exceeded a couple hundred

dollars every few months. No African refugees reported

having any savings. As one Ethiopian woman told us:

I work six days a week and more than 16 hours a day and

the pay is very little. I don’t have any savings and my life

is from hand to mouth and I am worried about my future.

Every African refugee interviewed expressed similar

concerns about their vulnerabilities from living “hand to

mouth.” Those refugees with closed les are even more

vulnerable since they lack the ability to receive services

and cash assistance from Caritas and similar organizations.

3.4 Cash Assistance

Discussing the situation of Iraqi refugees, UNHCR-Egypt

pledged assistance, but not direct cash assistance:

The challenge of assisting vulnerable refugees in the region

should not be resolved through direct cash assistance.

Assistance to Iraqis in the region should be delivered to

host community networks, such as national social agencies

and civil society. This methodology will allow UNHCR

to simultaneously reach more beneciaries, provide

UNHCR more leverage with host country authorities to

advocate for more eective protection standards, as

well as support the local infrastructures in coping with

the impact of the presence of large Iraqi populations in

their territories. Signicantly, UNHCR’s support…to this

social network will also have a positive spillover eect

upon host communities and the most vulnerable within.”

(UNHCR Strategy for the Iraq Situation, Revised 2007: 4).

Despite this initial policy position, UNHCR has provided cash

assistance to Iraqi refugees in Jordan and Syria (Davis and

Taylor 2012: 41). In Egypt, cash assistance is distributed by

Caritas; it is distributed to families on the basis of need and

9 UNHCR-Egypt and the Government of Egypt require refugees returning to their country of origin to close their cases with UN-

HCR-Egypt. Refugees may re-open their case once they return. However, refugees hoping to travel frequently between Egypt and Iraq—

as in the case of this woman—have preferred not to register with UNHCR-Egypt in order to maintain their mobility.

CH3: Refugee Livelihoods

20

family size, and refugees of all nationalities expressed the

importance of this cash assistance in meeting their basic

needs. However, because cash assistance is only distributed

to refugees with open les, cash assistance is not available for

the most needy population—those with closed les. Somalis,

Sudanese, Ethiopians and Eritreans are more likely to receive

cash assistance than Iraqis, due to the lower average wealth of

African refugee families as compared to Iraqi refugee families.

Given the Egyptian government’s restrictions on refugees’

right to work and on vocational programs (the government

prefers to reserve vocational training to only those refugees

who signed up for voluntary repatriation programs),

NGOs have had limited impact on refugees’ labor force

participation and livelihoods, apart from providing limited

cash and in-kind assistance. Our interviews indicate that

existing cash support is insucient and unreliable. Virtually

every refugee who has been receiving cash assistance

mentioned being strapped for cash at some point, having

the cash assistance interrupted for no apparent reason

and/or needing to re-apply, and, as a result, having

diculties making ends meet and planning their expenses.

A Sudanese woman reported receiving 380EP every

two months from Caritas in the fall of 2010, after

a couple of months the amount was increased to

960EP, but then the cash assistance stopped. She

was supposed to apply again in January 2011 but

because of the revolution her appointment was

cancelled. Her rent—about 400EP/month—was

two months overdue at the time of our interview.

A Sudanese family of nine was receiving 1800EP

every two months. The father reported that it was

not enough to cover the family’s expenses. His

children are often unable to go to school because

they do not have the money for transportation.

It costs him 10EP every day for breakfast and

transportation for each child or 50EP for ve of

the school age children in the family. When the

electricity bill—about 40EP per month—arrives

he does not send the children to school for a

couple of days to save money to pay the bill.

Most interviews included narratives about interruptions

in cash assistance, the need to re-apply and long waits

for a decision regarding reinstatement of cash assistance.

The research team interviewing refugees in Amman

reported similar stories of interrupted cash assistance

payments (Davis and Taylor 2012). The steady decrease of

subsistence allowances, combined with the progressive

reduction of UNHCR-Egypt support for health and

education, has put many refugee families in a crisis situation.

Sadly, the situation has not improved much in the 10 years

since Sperl’s study of the Iraqis (Sperl 2001) and Grabska’s

research on Sudanese refugees in Cairo (Grabska 2008).

The majority of NGO-operated programs do not focus on

helping refugees improve their livelihoods while in Egypt,

but rather aim at meeting people’s immediate needs

or helping them prepare for resettlement or eventual

repatriation. As our colleagues found in Amman, Jordan:

The situations of Iraqis in Jordan are no

longer as “emergency” warranting relief. Thus,

some funding targeting Iraqis may be better

directed towards development that will benefit

the refugees, the local communities, and

other migrant communities. (Davis 2012: 74)

Those who have had refugee status applications rejected

and are residing in Egypt illegally are excluded from any

form of formal assistance. The Egyptian government does

not support any irregular migrants or refugees whose

claims have been rejected. We visited two dierent social

service agencies working with poor Egyptian families—

one aliated with the Ministry of Social Welfare and one

aliated with the Coptic Church—and both reported

that they could not provide much assistance for refugee

families, especially in the form of cash assistance. One of the

agencies provided skills training (at the time of our site visit

the training focused on rst aid) to a mixed group of Iraqi,

Kurdish, Sudanese and Ethiopian refugees—approximately

20-25 people—and the other used to provide vocational

training with UNHCR support, but the funding ended and

at the time of our research they mainly provided social

support or distributed donated clothing or furniture.

3.5 Housing Costs and Living Conditions

Housing and living conditions varied widely between

refugee communities as well as within each national

group. Most refugee interviews for this study were

conducted in homes, and detailed observations were

recorded about the dwellings and furnishings. Refugees

were also queried about the cost of rent and asked

to describe their living situations in their countries of

origin and compare them with the situation in Cairo.

Iraqis

Egypt’s rent-protection laws ensure that Egyptian citizens do

not have to pay exorbitant rent. However, these protections

do not apply to foreigners, including refugees, who often

pay up to 10 to 15 times more than Egyptian nationals (Briant

and Kennedy 2004). Most Iraqis we spoke with were used to

living in spacious houses with gardens or large apartments in

quiet residential areas in Baghdad or other large cities in Iraq.

They were very dissatised with living conditions in Cairo.

Iraqis were often quite particular about their neighbors.

Iraqis indicated that they prioritized neighborhoods that

were quiet, had few foreigners and were populated primarily

by “respectable” residents. One Iraqi man said the following

about the need to move to another apartment: “We rst lived

in an apartment in Nasr City but had to move to another

apartment, because we do not want any foreigners in the

area.” Another woman specically noted that she did not

want to live near students, Palestinians or others whom she

viewed as potential “trouble makers.” Some Iraqi households

indicated that proximity to their children’s school was

important, both to reduce the cost of daily transportation to

school and to protect the safety of their children by reducing

the distance they traveled to go to class. For the Iraqis that

could aord the higher rents of Cairo’s satellite communities,

such as 6th of October, many preferred to move there for

CH3: Refugee Livelihoods

21

its more spacious residences, proximity to schools and

perception of safety. The downside of this choice, however,

is that 6th of October, Rehab City, Heliopolis and other

middle-class neighborhoods favored by Iraqis are located

far from Cairo’s city center and, consequently, far from many

of the centralized NGO services and the UNHCR-Egypt oce.

Some Iraqi refugees lived in sparsely furnished, modest

apartments, while others resided in more spacious

apartments in the nicer areas of Cairo’s suburbs. All Iraqi

families we interviewed were able to aord a sucient

number of beds for each family member, a TV, a computer

with Internet and an air conditioner. Iraqi families

appeared to prioritize these creature comforts, perhaps

as status-markers of their middle-class backgrounds in

Iraq or in order to improve the quality of their children’s

education with the provision of a computer. Television and

Internet undoubtedly mitigated some of the boredom

and isolation often associated with refugee life in Cairo.

At the same time, the presence of these items did not

necessarily signify nancial auence. In one striking

example, a researcher was invited into a large, airy four-

bedroom apartment of an Iraqi who was living in a nice area

of 6th of October City. Despite its size, the apartment had

almost no furniture. When the refugee hostess oered the

researcher a small snack, it was revealed that the woman

had very little food in her home. This particular instance

was a more extreme example of the general trend among

Iraqis to prioritize neighborhood safety, apartment size and

amenities over furniture and protein. This trend appears to

be changing, however, as Iraqis have depleted their savings

in this protracted refugee situation. In several interviews,

Iraqis indicated that they could no longer aord to pay

for rent, medication and education fees, and were thus

looking to adjust their family budgets by moving, seeking

less medical treatment or pulling children out of school. In

2008, 77.2 per cent of Iraqis needed to borrow money to

pay for food or rent (WHO and MOH 2009). Likewise, 87.1

per cent of African refugee households borrowed money

to pay for the same basic needs (WHO and MOH 2009).

The sample size of Iraqi refugee households is too

small to generalize about housing costs in the greater

metropolitan Cairo. However, a survey of rent costs among

28 Iraqi households indicates that the average household

interviewed spent an average of 1,153EP on rent, though

rents ranged widely from 600EP to 2000EP, with variations

due to location, size and whether or not it was furnished.

Only one Iraqi family interviewed owned their at. Of the

non-Iraqis interviewed, refugees indicated that they paid a

similar range for rent (600EP to 2000EP), but that they were

much more likely to divide their rent between roommates

so that each resident was responsible for only approximately

300EP (approximately $50). All refugees paid a rough

average of 100EP (approximately $16) for utilities in addition

to rent. Many refugees interviewed paid for at least a portion

of their rent with the help of cash assistance from Caritas.

Other Refugees

In general, few refugees have established networks to

facilitate nding housing or to share housing. Those

refugees who did have friends or relatives already in Egypt

often used these contacts to help locate neighborhoods

or apartments in which to live. Iraqis usually did not move

in with non-relatives (only two interviewed reported

sharing their apartment with a non-relative), while most

African refugees interviewed were sharing housing with

friends or relatives. While sharing housing helps refugees

reduce the cost of rent, it can also lead to overcrowding.

The African refugees interviewed often chose to live in

close proximity to co-nationals and near churches or other

common gathering places for their refugee communities.

Few could aord move to the more auent neighborhoods

on the outskirts of Cairo, especially if they worked in more

central Cairo neighborhoods, since commuting costs could

cut deeply into meager earnings. For Ethiopian, Somali and

Sudanese refugee women working as domestic laborers,

proximity to their employers’ households is a key consideration.

All refugees complained that it was dicult for their

children to socialize outside of the house. Many refugee

mothers expressed fears that it was unsafe for children to

play outdoors or that their children would be subject to

harassment or discrimination, especially on account of race.

Worryingly, many refugee children suer from Vitamin D

deciency due to being kept inside the house for prolonged

periods. This problem is worse for children whose mothers

work outside the home. Due to a lack of aordable and

adequate childcare and a lack of a familial network to

provide childcare, many mothers must leave their children

locked at home while they work (Briant and Kennedy 2004).

Egyptians

Similarly to refugees, poor and working class Egyptians

interviewed in the course of this project also struggled with

nding appropriate housing, paying rent and utility bills

and often resorted to a variety of strategies, including living

in multigenerational households with parents, aunts and

uncles, and older married siblings. Virtually all unmarried

men and women live with parents or other relatives. Married

Egyptians also often have to take in their elderly or widowed

parents and support them. However, in contrast to refugees,

some Egyptians interviewed for this study were able to

obtain subsidized housing from the Egyptian government,

some lived in rent controlled ats and others lived rent-free

in family-owned houses or apartment buildings. Several

of our Egyptian respondents lived in the working class

neighborhood of Bulaq Abu Al-Ala in government-built

apartment buildings. The neighborhood also included

a slum section where Egyptians lived in abject poverty.

Yet long-time refugee residents of Egypt and the low- and

mid-income Egyptians interviewed were much more likely

to own their at or to benet from “old rents,” a form of rent-

xing for certain long-time apartment residents. Among

the refugees, Palestinians were the most likely to own their

homes or live in xed-rent apartments. For families who

have lived in the same apartment for decades, these “old

rents” can amount to as little as 7EP (approximately $1) per

month. Newcomers cannot benet from the old rent system.

In the “new rent” system, landlords are legally entitled to

raise rent by 10 per cent at the beginning of each calendar

year. Many refugees reported that their landlords increased

the rent on their apartments every year, which resulted in

families moving every few years to nd cheaper housing.

While refugees and poor Egyptians generally share many

of the same concerns and burdens in daily life, in the area

of rent and housing, Egyptians have signicant advantages.

CH3: Refugee Livelihoods

22

Of the poor and working-class Egyptians interviewed, three

lived in family-owned apartments, one beneted from

the “old” xed-rent system, several lived in government-

subsidized or –built homes, and only a handful indicated

that they paid above 1000EP per month (whereas Iraqis’

average rent cost was 1100EP). Furthermore, adult children

are expected to continue living with their parents until

marriage, and some even continue to live with their families

after their weddings as well. Egyptians thus can benet

from a number of social and institutional safety nets to

acquire aordable housing that are out of reach for refugees.

3.6 Recommendations

Refugees in Cairo are economically, politically and culturally

tied to the larger urban community, therefore their livelihoods

are inextricably interdependent on local relationships and

processes. Refugees, particularly less educated African

refugees, face similar challenges as the urban poor, including

rising unemployment rates, insecure housing access, lack of

social safety net compounded with barriers such as racism,

discrimination and insecure legal status, which make them

more vulnerable to exploitation and marginalization.

The problem of refugee livelihoods is compounded by Egypt’s

high unemployment rates, for citizens and refugees alike. The

Egyptian Government’s Oce of Statistics placed the ocial

unemployment rate at 12.4 per cent at the end of 2011

(CAPMAS 2012). Unocially, most experts suggest that the

real unemployment rate is double or triple the ocial statistic,

and underemployment is a pervasive problem. Even using the

government’s data, however, it is clear that unemployment

has risen still higher in the aftermath of the 2011 revolution.

Ethnographic data from interviews suggests that refugees

as well as poor working class Egyptians struggle to

establish sustainable livelihoods. Refugees who are able to

work depend mainly on unstable and irregular earnings;

many work as domestic workers. Refugees working in

the informal economy are exposed to numerous risks

and abuses. At present, there are no mechanisms to

monitor refugees work conditions. Given the state of

the economy in Egypt and the staggering 40 per cent

unemployment rates, there are insucient opportunities

for safe and dignied employment for refugees.

Without legal access to employment opportunities,

refugees in Cairo will not be able to support themselves and

will have to continue to rely on costly international aid and

charity. There is a need to develop self-reliance programs

for both the local poor and refugees. We are cognizant

that this is a long-term goal. In the meantime, there is

also a need to implement creative strategies aimed at

enhancing urban refugees’ self-reliance more immediately.

BPRM has recently commissioned two studies on achieving

urban refugee self-reliance. One of the studies has been

carried out by the Women’s Refugee Commission (2011)

and resulted in two reports: Dawn in the City: Guidance for

Achieving Urban Refugee Self-Reliance and Bright Lights,

Big City: Urban Refugees Struggle to Make a Living in New

Delhi. Karen Jacobsen has also written extensively on

refugee livelihoods, including in her book The Economic

Life of Refugees (2005). All three of these publications make

many creative recommendations regarding urban refugee

livelihoods. However, the dierence between Cairo, Egypt

and the urban environments examined by the authors

of these reports—i.e. Kampala, Uganda, Johannesburg,

South Africa, New Delhi, India—is considerable, primarily

because of Egypt’s reservations to the 1951 Convention

on article 24 (labor legislation) and resulting lack of

refugees’ right to work legally in the country. However,

we have consulted both reports as we analyzed our

own data and compiled resulting recommendations.

Cognizant that the bar on legal employment coupled with

the extremely high unemployment rates in the country pose

signicant barriers to refugees’ labor force participation,

adversely aect refugees’ livelihoods and impede self-

reliance, we suggest that UNHCR and BPRM and their

implementing partners consider the following strategies:

Access to Employment

t Advocate with the Government of Egypt to extend

the right to work to all refugees. We recognize that

this is a long-term goal and might require changes in

the Egyptian labor legislation. However, as the new

Egyptian government is considering many political

and social changes, it might be an opportune time to

open discussions on strategies to reduce impediments

for securing work permits and expanding employment

opportunities for refugees and asylum seekers.

t As an intermediate step, the Government of Egypt

should consider expanding refugee employment

opportunities in the sectors with insucient labor

supply or in industries where Egyptian citizens do not

want to work for religious or other cultural reasons.

t Build in protective elements into economic

programs. Egyptian refugee policies—lack of right

to work—severely impede refugees’ ability to pursue

livelihoods. However, local authorities “turn a blind

eye” and tolerate refugees involvement in the informal

economy. Eorts to protect refugees working in the

informal economy should be explored. Protective

elements—such as accompaniment, requiring codes

of conduct for employers, sensitization campaigns,

linkages with local women’s leadership and political

groups—should be built into economic development

eorts in order to ensure protection and safety

of refugee workers, particularly refugee women.

t One program in Cairo trains refugee women as

domestic workers, and sta accompany them

on the rst day of their jobs. The NGO sta act

as witness to the agreed employment terms,

including compensation, letting the employer

CH3: Refugee Livelihoods

23

know that the woman has a support network.

This model should be expanded upon in all

of the relevant informal economy sectors.

t The majority of refugees working as domestic

workers are women. Care needs to be taken

to protect refugee women from gender-based

violence on the job. Women should be consulted to

identify their vulnerabilities to GBV, assess the scale

of the problem and devise ways to mitigate these

risks. For example, NGO job placement programs

should focus on nding employment opportunities

for refugee women that will not require them

to be outside late at night, unaccompanied or

work in back rooms and other small spaces with

male colleagues. At the same time, there is room

for UNHCR-Egypt and NGOs to lobby for the

Government of Egypt to better respond to and

prosecute sexual harassment and other GBV.

t Create an employment advocate/job developer.

Once the barrier to legal employment is lifted,

programs should hire employment advocates/

job developers assisting refugees in nding and

maintaining employment, advising on upward mobility

and advocating with employers to hire refugees.

t Work with the Egyptian government to allow

microcredit enterprises. The government previously

denied UNHCR-Egypt permission to implement

a microcredit enterprise they had developed.

However, such a scheme would allow refugees of all

nationalities to support themselves by opening small

stores and other types of businesses, and the topic

should be explored anew with the new government.

t Track employment of refugees. Track refugees’

employment to understand where they have gained

footholds in the economy in order to tailor training and

advocacy. These activities would be consistent with

UNHCR’s 2011 operational guidance on livelihoods and a

desire to improve monitoring and evaluation of refugee

livelihoods. Employment tracking would rely on self-

reporting; this could be relatively easily accomplished

by adding a few questions about employment and labor

force participation to an intake interview when refugees

come to a particular program for assistance. UNHCR

would need to coordinate this data collection eort.

t Address negative economic strategies. Stakeholders

indicated that some refugee families engage

in negative economic strategies such as eating

fewer meals, selling household assets, living and

working in exploitative relationships and pulling

children out of school. The following strategies

could be used to alleviate these problems:

t Counseling on forced and exploitative labor,

including training on workers’ rights.

t Monitoring child labor to ensure that youth

engaged in economic activities can combine them

with educational pursuits.

t Expand economic development programs. Currently,

the Government of Egypt does not allow vocational

training, except for voluntary returnees. However, in

the past some attempts to provide vocational training

to a broader group of refugees had been implemented.

We recommend that vocational training opportunities

be expanded to all refugees. Promising practices

implemented with UNHCR funding in the past should

be assessed and expanded [see below for an example].

With funding from UNHCR, the Coptic

Evangelical Organization for Social Services

(CEOSS) ran an economic development

program for refugees. This program included

vocational training and job placement

components. From 2007 to 2008, the

program trained 300 refugees (43 per cent

female) and placed 94 participants in jobs

upon graduation. Specialized consultants

conducted market assessments in areas

with identied labor demand. The selected

sectors—medical care/nursing, embroidery,

Internet-based enterprise, computer

maintenance and others—either did not

require work permits or the work could

be performed in refugee homes. CEOSS

developed relationships with Egyptian

employers in order to create a “job bank” for

referring graduates of the program (Adapted

from Women’s Refugee Commission 2008).

t Focus on vocational training necessary to work in

informal economy. Since most jobs available to refugees

are in the informal economy, eorts should be undertaken

to assess what kind of vocational training is necessary to

ensure protection and safety of workers in the informal

economy. These training programs should focus both

on skill development as well as occupational safety.

t Conduct labor market analysis to identify niche

employment opportunities for refugees. We

encourage BPRM and UNHCR to fund a labor

market analysis eort in order to identify sectors

and industries where refugees might be able to ll

labor supply gaps. For example, Egypt has a robust

tourist industry with jobs—such as restaurants and

cruises where alcohol is served—that are not always

suitable for observant Muslim Egyptians. Christian

refugees could be trained to ll in these labor gaps.

t Organize training for aspiring entrepreneurs. UNHCR

and BPRM implementing partners should explore

the possibility of training aspiring entrepreneurs

on local laws governing business partnerships

with Egyptian citizens, incubation projects

and scal responsibilities of dierent partners.

t Promote nancial literacy programs. Despite

restrictions on employment, many refugees do work

in Cairo. Refugees work in formal and informal jobs,

but are remunerated mainly in cash without few

records of money paid and owed. We encourage

UNHCR and BPRM implementing partners to organize

nancial literacy training programs, including:

t Basic banking and budgeting. Many families

interviewed in the course of this project, talked

about not having enough money to send children

to school or feed them three meals a day. Some of

these diculties may result from poor budgeting.

CH3: Refugee Livelihoods

24

t Simple accounting involving keeping track

of hours worked and payment owned.

t Financial planning. Many refugee households

manage their cash ow from day-to-

day without planning for future needs,

such as rent, utility bills and school fees.

Housing

t UNHCR should monitor housing options for

refugees to ensure that discrimination by nationality,

ethnicity, religion, gender or other factor is not

limiting services to Iraqi and other refugees.

t UNHCR and BPRM should lobby the Egyptian

government to allow refugees access to rent-controlled

housing options or provide housing subsidies.

t The Egyptian government should negotiate with socially

minded landlords to set aside aordable housing units

for the poorest refugees. Muslim or Christian charitable

organizations, churches and mosques may also be

suitable partners for providing subsidized housing or

donated furniture to refugees. Zakat, or tithe, a practice

of giving a xed portion of one’s wealth to charity,

generally to the poor and the needy, is well known and

practiced both in Islam and Christianity. This practice

should be explored in terms of providing cheap housing,

donation of furniture and other housing equipment.

t BPRM and UNHCR implementing partners

should organize training programs on housing

laws, tenant rights and lease negotiations.

t NGO advocates and/or legal aid workers should

review housing leases on refugees’ behalf and

accompany refugees to sign leases in order to

ensure that they are entering into a fair agreement.

t UNHCR and BPRM implementing partners

should set up committees to monitor housing

conditions. These committees should include

representatives of NGO and refugee communities.

These committees would be particularly important

in neighborhoods with substandard living

conditions where structural problems in apartment

building might create dangerous living conditions

t Improve housing conditions through sweat equity

and mutual self-help programs. What refugees

do not have in nancial resources, some have in

determination and willingness to work hard. Mutual

self-help housing programs could bring together

groups of refugees to help renovate and maintain

each other’s homes under the supervision of a skilled

contractor or landlord. In-kind contribution of labor to

beautify dwellings could serve to oset housing costs.

t Organize training programs on household management.

Some of the refugees residing in Cairo came to the city

from rural areas and might need help in adjusting to living

in apartments and sharing communal space with others.

Financial Stability

t Assessment. Conduct an assessment of the level

of income needed to survive in Cairo and use

this information to devise an updated formula

to calculate cash assistance to refugee families.

t Means and Assets Test. Institute a means and assets

test to determine who qualies for cash assistance. This

test should take into account income from properties

in Iraq and remittances received from family and

friends. This strategy requires a good reporting system.

t Social security. Work with the Governments of Egypt

and Iraq to develop a social security system for refugees

too old or disabled to work. The Government of Iraq

could transfer retirement money to UNHCR-Egypt

or directly to the Government of Egypt. Distribution

of these funds could be done through a debit card. A

social security system administered by the Government

of Egypt has several benets; it would: increase the

reliability of cash assistance for permanently needy

refugee families, facilitate the integration of refugees

into mainstream Egyptian institutions, and lighten

the responsibilities of Caritas in providing monthly

cash assistance to a wide number of refugees.

We encourage UNHCR to set up a demonstration

project that would test some of these strategies.

t Transparency. Whatever strategy gets implemented,

UNHCR must be very transparent about eligibility

for cash assistance and/or social security. At the

moment there is too much confusion about eligibility

criteria for any type of cash assistance, the duration

of eligibility and the schedule of disbursement.

t Financial services. For poor refugees, borrowing

money further increases their vulnerability. Formal

or informal saving schemes can guard refugee

families against income shocks. UNHCR and BPRM

implementing partners should explore establishment

and training for small savings and credit programs

akin to the Grameen Bank or self-help groups set up

by ILO for poor residents of developing countries.

CH3: Refugee Livelihoods

25

Chapter 4: Education

In Egypt free and equal access to education has been

guaranteed to all Egyptian citizens since President Nasser’s

socialist reforms in the 1950s. However, due to high

population growth rates and lack of nancial resources,

the public education system has been struggling to

accommodate rapidly increasing numbers of students.

According to the Egyptian government’s statistics agency

CAPMAS, 43.5 per cent of the population (approximately

35 million) are currently below the age of 20 (CAPMAS

2012). While enrollment rates have risen steadily during

the last decades, the quality of state-provided services

has deteriorated. As a result, the provision of education

has increasingly been taken over by non-state actors. The

privatization of education is taking place on two levels

simultaneously in Egypt: on the ocial or formal level, a

growing number of private schools and universities are being

established, while at the same time a “shadow education

system” of private supplementary tutoring has evolved on

the informal level and out of the reach of state control. Today,

a large part of instruction and learning in Egypt takes place

outside of the ocial classroom, either at home or in private

tutoring centers. These private lessons, which the majority

of Egyptian high school students and even a large number

of elementary and preparatory school students take in the

afternoons and evenings, consume not only much of the

students’ and teachers’ spare time but also a substantial part

of the average Egyptian family’s budget (Hartmann 2008).

The Egyptian educational system is highly centralized and is

divided into basic education, which comprises primary and

preparatory stage, secondary education and post-secondary

education. Education is compulsory until 15 years of age. The

free compulsory education law applies only to the preparatory

phase. The great majority of students in Egypt from the

primary to tertiary levels are enrolled in public institutions.

According to service providers, there are approximately

9,000 school age refugee children in Cairo. There are two

main barriers to education: structural and social. First,

there are numerous bureaucratic obstacles. Refugees can

only enroll in public schools if they are legally recognized

and can provide extensive documentation, including birth

certicates and letters from UNHCR-Egypt. Despite the fact

that the Minister of Education granted all refugees the right

to attend public primary schools in 2000, this right is not

widely known or clearly understood by many local teachers,

school administrators and even stakeholders. As a result,

the decree has rarely been implemented in schools for any

refugee population. Language barriers, cultural dierences,

experiences of discrimination or harassment, and dierences

in curricula from refugees’ schools in their countries of origin

also present formidable obstacles to mainstreaming refugee

children into Egyptian public schools. Furthermore, the

government has still maintained restrictions on the rights of

refugees to attend public secondary schools or universities.

Cost is the second signicant barrier to quality education

both for Egyptians and refugees. Public and private

schools have fees for books, uniforms and extra-curricular

lessons. Private school tuition fees are often far beyond

what refugees can aord. A refugee community advocate

said that some families are forced to enroll only one child

in school while keeping the rest of their children at home,

because they cannot aord the cost of private education.

At the time of our research, the Catholic Relief Service

(CRS) provided educational grants to approximately 6,000

children. A study carried out by CARIM (Consortium for

Applied Research on International Migration) indicated that

in the school year 2007/2008 some 6,900 refugee children,

including 2,621 Iraqi children, received UNHCR-Egypt

education grants (Roman 2009). Catholic Relief Services

has continued to provide approximately 7,000 grants

annually since the time of CARIM’s study. These numbers

seem small in relation to the estimated number of urban

refugees living in Cairo. However, educational stipends

are distributed only to refugees who are registered with

UNHCR-Egypt. As indicated before, many refugees do not

want to register because refugee registration information

is shared with the Egyptian government, who refugees do

not trust. Many African refugees who arrived prior to 2004

were not recognized by UNHCR-Egypt but have remained in

Cairo. Others do not register because they want to migrate

to another country; many Iraqis do not register because they

want to preserve the ability to travel back and forth between

Egypt and Iraq. Palestinian refugees are not eligible to

register with UNHCR-Egypt. Refugees not registered with or

recognized by UNHCR-Egypt face greater barriers to access

to education than those registered with UNHCR-Egypt.

4.1 Access to Primary Education

According to the Egyptian Ministry of Education, in the

academic year 2007/2008 a total of 4,209 Iraqi children

were enrolled in private primary and secondary schools.

Yet, because of the structural limitations detailed

above and Iraqis’ preference for higher quality private

education, 3,903 Iraqi children attended private schools

and only 306 attended public schools (Roman 2009).

Private schools in Egypt have high tuition rates, ranging from

$300 to $700 per year. UNHCR-Egypt oers education grants

to registered refugees, but these grants do not cover all of

tuition costs: refugee education grants range from $130 to

$275 per child per year. The education vouchers can also be

used for uniforms, school fees and books. It is noteworthy

that the situation in Egypt is very dierent from Jordan, where

refugees are mainstreamed into the Jordanian school system.

CRS provides additional voucher money for children

with disabilities allowing them to attend specialized

classes. However, as reported by an Egyptian parent,

special education programs do not exist in Egyptian

public schools. Some private schools are equipped to

provide specialized services to children with learning

disabilities or mental illness, but these schools are very

expensive and “the state does not subsidize or support

the disabled,” said a mother of a child with disabilities.

CH4: Education

Iraqis

Iraqis have a strong preference for private schools at all levels

of education; a preference that is also shaped by the fact that

most Iraqis cannot or believe they cannot enroll their children

in public schools. Most of the Iraqi families we interviewed in

the course of this project did enroll their children in private

schools, despite its signicant cost. They spoke about

Egyptian public schools with disdain—as did many Egyptian

families—and in many instances were disillusioned with

Egyptian private schools as well. Iraqi parents put a premium

on good education. Most are well educated themselves and

want their children to receive an equalivalent education.

Service providers remarked that Iraqis feel their children

are entitled to good education. This feeling of entitlement

seems to be related to the fact that education was free in Iraq.

One Iraqi father said he had three sons in private schools

to the cost of 1,700 EGP, or $280, for each one. Although

he received 2,000 EGP ($328) in educational vouchers per

child, he found it inadequate to cover all the additional

costs such as uniforms and school fees. In a private middle

school we visited, tuition was 2,200 EGP ($360) per year.

The principal estimated the cost of books at about 65-120

EGP ($10-$20), depending on the grade level. Uniforms cost

85 EGP ($14) per outt; most students need two uniforms.

Refugee students who received educational stipends from

UNHCR-Egypt had to pay the tuition upfront and then

go with the receipt to UNHCR-Egypt or CRS to receive

their stipend. Parents indicated that it sometimes posed

a burden on them, as they had to wait to be reimbursed,

often for several days or weeks. This particular school did

not oer scholarships or nancial aid to any students,

Egyptian or Iraqi. However, the principal mentioned that

occasionally a rich benefactor supports some students. A

few months prior to our research, an Iraqi businessman

gave each of the 220 Iraqi students 500 EGP ($80).

Parents also talked about the need to augment the

education that children received in schools with private

tutoring. As already mentioned, private tutoring is

ubiquitous in Egypt and is largely seen as a requirement

for students to satisfactorily pass annual examinations.

The cost of private tutoring is not insignicant—anywhere

from 10-100 EGP (or $2-20) per hour depending on how

many subjects the tutoring sessions cover. Teachers expect

that children will be tutored in several topics at least once

or twice a week. The costs add up. On the other hand,

it seemed that teachers insist on the need for private

tutoring because they want to make additional money.

Since almost no refugee students are able to aord the

exorbitant costs of attending university, families must make

dicult decisions, weighing the relative benets of setting

aside a signicant portion of the household income to pay

extra costs for education. Based on our interviews, many

Iraqis are still expecting to be resettled internationally, and

thus they invest in their children’s education with the hope

that they will continue their studies abroad. The same is not

necessarily true about African students (see discussion below).

Reports about tensions between Egyptian and Iraqi students

were rare. A principal of a private primary and middle school

in 6th of October reported only one incident of a st ght

that erupted between a Sunni Egyptian and a Shi’i Iraqi boy

over a dierence in interpreting a call to prayer. On the other

hand, she also shared a disturbing story with us regarding

Iraqi students. At the time of our interview in the winter of

2010, Iraqi students constituted about 10 per cent (or 200

students) of the school’s population. Four years prior to our

research, in 2006, there were about 700 Iraqi children in this

particular school, but the principal received an order from

the security forces not to accept any more Iraqi children

because there were too many Shi’i students in the school.

The Egyptian pupils come solely from Sunni families. When

asked what happened to the 500 students she said that

some graduated, some returned to Iraq, some were resettled

in the United States and Canada, and some left the school

because they could not aord the tuition any longer. We

wondered if the last cohort left the school because of the

opposition of the Security Services to the Iraqis’ enrollment.

Iraqi students face several challenges in Egyptian schools,

particularly if they arrive in the middle of a school year.

School curricula are not compatible, and the dierence in the

Arabic spoken in Egypt and that spoken in Iraq contribute to

some diculties. Egyptian children start learning English in

Kindergarten or the rst grade, while Iraqi students begin

to learn English in fth grade. Overcrowding of Egyptian

schools severely limits refugee children’s access to education.

In December 2006, dozens of Iraqis protested in front of the

Ministry of Education when their children were expelled from

school because their visas were no longer valid (Roman 2009).

Similar complaints have been heard among Iraqi refugees

in Jordan, who also struggle to adjust to the dierences

between the Iraqi and Jordanian curricula (Davis 2012).

Africans

Sudanese refugee children can, in theory, exercise their

right to public education under the Four Freedoms

agreement as well as under the 1992 and 2000 Ministry

of Education decrees. However, in practice, the extreme

population pressure on Egyptian schools and the extensive

documentation—birth certicate, last school certicate,

identity documents with legal residence permit and a letter

from the Embassy of Sudan—required to enroll a refugee

child in school, severely limit refugee children’s access to

public education. Refugee children and adolescents with

rejected asylum claims constitute the most vulnerable

group without any hope to access free public education.

According to community members, racial prejudice poses

an additional barrier to education for African refugee

children. Given tensions between African refugee and

Egyptian children in schools, UNHCR-Egypt funded a special

program helping students from dierent backgrounds get

to know each other. Classmates participated in artistic and

musical activities and talked about their lives and hopes

for the future. No formal evaluation has been conducted of

the program; therefore, while it is dicult to say with any

certainty how eective this strategy is, it appears promising.

Most Sudanese refugee children attend so-called “Refugee

Schools,” created and run by Sudanese refugee communities

in Cairo. These schools are often aliated with churches, much

cheaper than private schools, and located closer to where

refugees live. Africa and Middle East Refugee Assistance

(AMERA) reported that the situation in these schools has

been improved recently by the introduction of the Sudanese

curriculum allowing students to receive accredited diplomas.

In the last two years, Sudanese students have been allowed

2626

CH4: Education

27

to take the Sudanese university entrance exams by paying

$50 to the Sudanese embassy. Other African refugees from

Eritrea, Somalia and Ethiopia also attend refugee schools,

usually attending those run by the Sudanese since these are

the largest and best organized. There are also Somali refugee

schools, but these have been plagued with organizational

and administrative problems. It is unclear whether the 2011

secession of the Republic of South Sudan from Sudan has

impacted this arrangement. Generally speaking, we did not

hear very favorable assessments of these schools. Parents

and volunteer teachers alike bemoaned the fact that these

schools do not have the capacity to prepare students for

further educational pursuits. According to some reports,

only one of these primary school programs teaches the

Egyptian Curriculum. One father said that the teachers

are often barely literate themselves and do not have any

pedagogical preparation. One mother suggested the

schools “warehouse” students, but quickly added: “It’s better

than having the children roam the streets and get in trouble.”

Many Sudanese families expect to be resettled in the United

States and prefer to send their children to schools where

English is the language of instruction. Southern Sudanese

favor English language schools because of their past

experiences in Sudan and their rejection of the Arabization

of instruction that took place after 1989 (Peterson 2001).

The Sudanese value education and see it as the only

way out of poverty for their children. Unfortunately, few

options exist for Sudanese refugee children living in Cairo.

According to our interviews, very few Somali or Ethiopian

refugees benet from church-based educational programs

oered in Cairo. Self-help schools organized by the

Somali community in Cairo provide an alternative for a

small group of Somali children, though many go without

education altogether and stay at home while their parents

seek work. Ethiopians have fewer options still. According

to researchers, a large number of Ethiopians in Egypt

have rejected refugee claims or have been reluctant to

approach UNHCR-Egypt for refugee status, and thus live

in Egypt illegally. Legal vulnerability, social instability,

language barriers and perceived racism in Egypt have

all acted to inhibit Ethiopians from forming community-

based organizations and schools. In interviews, Ethiopians

and Somalis were the least likely to attend school and the

most likely to report extreme anxiety and social isolation.

For the African refugees who have had their applications

for resettlement rejected or who have decided to remain

in Egypt indenitely, there are fewer perceived benets

to continuing to pay education fees for their children,

especially beyond primary school, which explains in

part the lower percentages of enrollment for Sudanese,

Somali and Ethiopian children (although linguistic

and cultural barriers also play an important role).

4.2 Access to Secondary Education

Refugees are prohibited from attending public high schools;

as a result, any refugee desiring to attend high school

must attend a private or refugee-run school. CRS provides

educational grants to refugees of any nationality to help

oset the tuition and uniform costs. Iraqi adolescents

generally attend mostly private high schools with the

support of CRS grants. Secondary education is virtually

inaccessible to most African refugee youth for logistical

reasons: refugee-run schools often do not follow the

Egyptian curricula, and thus their students do not take the

required annual examinations necessary to enter high school.

I dropped out of high school because of the

problems in Ethiopia. And here I don’t have much

opportunity for education. Even if I got a chance

to study I don’t think I would be able to learn

because I have a lot of stress. I am always worried

and depressed about my life here and about my

future. One needs to have a clear mind to learn.

Plus I do not have money for tuition and transport

so I don’t even think about learning at the moment.”

An Ethiopian youth

Since most African refugees attend these informal schools

rather than private Egyptian primary schools, few are eligible

to enroll in secondary education programs. Economic

factors also pose a barrier: the relative and absolute poverty

of many African refugee individuals and households pushes

many adolescents to seek work rather than education.

Palestinians

Between 1960 and 1978 Palestinians had the same right to

public education as Egyptians. Political events in the late

1970s “marked the end of the golden era for Palestinians

in Egypt” (El-Abed 2005). After an assassination attempt

on an Egyptian minister by a Palestinian group, Egyptian

laws and regulations were changed to take away the rights

to education, employment and residency for Palestinians.

A Palestinian woman shared her story of being expelled from

a public high school and forced to go to a private one to nish

her secondary education. Her two adolescent children go to

a private Egyptian high school; she pays 3,000 EGP ($495)

per year for each child. Another Palestinian woman told us

that she and her older brother attended an Egyptian public

school for several years until someone found out that they

were Palestinian and had them thrown out of school. “I don’t

know,” she said, “how we were able to slip through the system

for as long as we did.” She indicated that her father might have

bribed a school ocial when he signed them up for school.

4.3 Access to Higher Education

Public higher education is free for Egyptian citizens. Private

university education is much more expensive. Major

universities include Cairo University, Ain Shams University,

Helwan University and the 1,000-year-old Al-Azhar University,

one of the world’s major centers of Islamic learning. Several

Egyptians commented on the exceptional quality of

government-supported universities while stressing that

these public institutions of higher education are becoming

increasingly more expensive. Egyptians also despaired

that, with the exception of the American and the German

CH4: Education

28

Universities in Cairo, colleges do not provide students

with practical skills suitable for the modern job market.

Many service providers indicated that access to higher

education was a real problem for all refugees, including

Iraqi households with relatively ample household wealth.

Iraqi college students are treated as foreign students and

charged foreign student tuition, which often has to be paid

in U.S. dollars. Service providers did not seem to have a good

understanding of the tuition costs; they mentioned rates of

15,000-20,000 EGP ($2,400-3,200) per year, while refugee

parents suggested that tuition averages over twice that:

40,000 EGP or $7,000. One Iraqi father said that although

his son was the smartest in his class, he has no prospects

for further education, as the family cannot aord college

tuition. “He just sleeps all day,” the father said concerned

that his son is slipping into depression. A small number of

families reported to our researching team that they sent

their college-aged children back to Iraq alone to nish

their university degrees, despite the safety risks they faced.

The high cost of college education in Egypt has inuenced

Iraqi refugees desire to resettle in the West. College-aged

Iraqis we spoke with expressed a preference for settling in

Europe or Canada, as they were aware both of the high cost

of college education in the United States and the emphasis

of the U.S. refugee resettlement system on attaining early

economic self-suciency. Many Iraqi parents and youth were

alarmed by reports coming from friends and relatives resettled

in Dearborn, for example, about the need to undertake

employment, often not commensurate with their education

and/or aspirations, instead of pursuing college degrees.

It is very dicult for African refugees to be eligible for university

and harder still to aord attending institutions of higher

learning. A new law recently granted Sudanese students

the ability to enter Egyptian universities without rst taking

the national exam administered to all secondary students in

Egypt. This is a positive development, and refugee schools

are now focusing on helping Sudanese students graduate

from high school so that they might be eligible to attend.

However, due to the low quality of refugee schools many

Sudanese attend, it will take time before large numbers of

Sudanese youth are truly prepared for a university education

in Egypt. Beyond this, it is unclear how refugee students

would be able to aord the fees of Egyptian universities.

In addition, non-Sudanese refugees are not covered by

this new law; they would rst need to take the dicult

entrance exam before applying to universities. Even if they

found nancial resources—a very unlikely proposition—

they would not be able to pass entrance examinations

since, by and large, they do not attend accredited schools.

4.4 Recommendations

Although UNHCR’s Urban Policy (2009) states that when

working in urban areas, UNHCR will avoid the establishment

of separate and parallel services for refugee beneciaries,

parallel educational structures do exist in Cairo. There are

currently three dierent types of educational structures that

refugees access: public Egyptian schools, private Egyptian

schools (often with stipends from CRS) and refugee schools

run by the community with various kinds of assistance from

UNHCR-Egypt and its implementing partners. Each type

of educational system facilitates access to education for

refugee children and fullls the needs of Cairo’s dierent

refugee populations in varying ways. For UNHCR-Egypt

to achieve its goal of mainstreaming refugee students,

dramatic changes would need to take place to dismantle

these parallel systems. On the macro-level, UNHCR-Egypt

will need to continue to push the Government of Egypt to

clarify the right of refugee children to attend schools and

to train local schools on these policies. As opportunities to

attend public schools widen, CRS will need to reduce its

support for private schools except for those children who

are legally or otherwise unable to attend public schools.

UNHCR has listed Egypt as one of its 13 “priority countries”

for education for 2012-2016. During these years, UNHCR

will work to develop “multi-year, multi-sectoral educational

strategies” to improve the instruction and protection

of refugees that have suered from a lack of quality,

gender equality, geographic location and operational

setting. UNHCR will provide training, technical assistance,

monitoring and evaluation, advocacy, fundraising, data

collection and capacity development to Egypt to address

educational shortcomings. This is a prime time to make new

recommendations to improve refugee education and take

advantage of this momentum and progress in education.

In the short-term there are smaller, practical steps that

can be taken to provide and/or improve the quality of

education to meet the needs of Cairo’s refugee children.

t Streamline School Admission Requirements. The

Ministry of Education should lift the requirement

to provide school records in order to admit refugee

children to school. Placement tests and an interview

with parents or guardians should be sucient.

t Capacity Building. Capacity building should be a key

priority for stakeholders and development agencies

working with refugee education in Egypt. Egypt’s public

school system suers from overcrowding, few quality

checks, and an emphasis on rote memorization. Low

teacher salaries encourage the growth of a private

lesson industry that has become all but required for

students to pass exams. Capacity building projects in

the public school system can benet both the local

population and the refugee population if the rights of

refugee students to attend public schools are claried.

t Trainings for Egyptian Teachers and

Administrators. Local teachers need to

understand legal rights of refugee students

to attend Egyptian schools. Rights training

along with cultural sensitivity trainings will

facilitate refugees’ access of existing educational

CH4: Education

29

institutions and promote the mainstreaming

and social integration of refugee youth.

t Training for Refugee Teachers. There are also many

opportunities to promote capacity building in

refugee schools. Grants should be made available

to refugee schools to provide ongoing training and

professional development for refugee teachers and

to allow schools to hire more qualied instructors.

Curricula coordination with the governments

of Sudan and South Sudan will help ensure the

quality of instructional content and the relevance

of Sudanese students’ education for those

families hoping to return. A strong emphasis on

English instruction can also be included to attract

those families most interested in resettlement.

t Involve Educated Refugee Adults to Enhance

Capacity of Local Schools. Highly-educated

refugee parents or other adult refugees

should be provided with the opportunity

to serve as teachers’ assistants in public

schools that are lacking adequate resources.

t “Private Tutors.” CRS should consider

providing stipends to highly-educated

refugee adults to provide tutoring to refugee

children who are expected to enroll in private

tutoring sessions and whose parents have

to pay out-of-pocket for these services.

t Build Additional Schools. As indicated, Egyptian

schools are extremely overcrowded. BPRM ought to

consult with AID and other donors and development

actors on the possibility of joining resources and

building new schools or expanding existing school

buildings to accommodate the growing population

of students, both local and refugee children.

t Involve UNICEF. BPRM and UNHCR-Egypt

should consult with UNICEF regarding their

involvement in improving the quality of education

in Cairo for both local and refugee children.

t Additional Training for Adult Refugees. Our research

indicates that refugee adults lack basic nancial and

health literacy knowledge and skills. INGOs are well

positioned to provide these adult educational classes

for Iraqi as well as African refugee adults. These

classes would have not only an educational value,

but also psychosocial benets; they would promote

socialization and community-building. Members of

the refugee communities could be trained as health

advocates or nancial counselors, providing them

with practical skills that would benet them whether

they were resettled, returned or locally integrated.

CH4: EducationCH4: Education

CH4: Education

30

CH5: Aordable Healthcare

Chapter 5: Access to

Quality Aordable Healthcare

Access to quality and aordable healthcare is one of the

most dicult challenges facing refugees in Cairo. A range of

healthcare services, including private and refugee-specic

health facilities, does exist to provide medical care for

eligible refugees. However, nancial limitations and legal

restrictions seriously limit refugees’ access to healthcare.

Refugees interviewed in the course of this research indicated

that health is one of the most pressing needs, and yet it is

also one of the areas where UNHCR-Egypt has considerable

work to do to mainstream healthcare services for refugees in

accordance with the goals of its 2009 urban refugees policy.

5.1 Health Insurance

There is a wide array of health services available in Egypt,

though access and quality of care vary and depend very much

on refugees’ legal status and nancial resources. In general,

the Egyptian government, UNHCR-Egypt, INGOs, religious

institutions, private hospitals and clinics or some combination

of the above can provide medical care for refugees in Cairo.

In 2005, Egypt granted all foreign residents access to

public health services in government primary care clinics

and hospitals at the same cost as uninsured Egyptians.

Despite this laudable and landmark expansion of healthcare

access to refugees, recognized refugees tend to prefer

the care provided by NGOs or private clinics. Interviewed

refugees deemed these services of better quality than

care provided in government facilities. Only a small

percentage of registered refugees seek treatment at public

facilities, despite the lower cost and relatively easy access.

Refugees registered with UNHCR-Egypt are entitled to care

from a wide range of healthcare providers. Recognized

refugees are eligible for primary care through NGO medical

clinics (Refuge Egypt and Caritas, primarily). For tertiary

care, refugees can seek medical referrals to specialists and

private hospitals through Caritas, who also subsidizes a

signicant percentage of treatment costs. Unregistered

or rejected refugees are largely restricted from receiving

NGO-provided medical care and must pay for their own

treatment through public or private clinics and hospitals.

In 1964, the Egyptian government established the

Health Insurance Organization (HIO), which initially

provided government employees and industrial workers

with health benets in public healthcare facilities. This

coverage was expanded to include pensioners and

widows. By 1993, there were 5 million beneciaries,

who paid a small percentage of their salaries as a

premium (between 1-4%) and small co-pays while the

government providing the rest. This insurance provides

only curative treatment, not preventative (Nandakumar

et al. 2000a). HIO is currently available only to citizens.

A huge expansion of public insurance took place in

1992, when insurance benets, funded through a tax on

cigarettes, government contributions, co-pays and private

donations, were extended to school children. In 1997, the

Ministry of Health issued a decree that further expanded

public health insurance to children from birth until school

age (www.hio.gov.eg). This insurance covers preventative

and curative primary care as well as eye and dental services.

As a result, all students in public schools are eligible for

health insurance through the government. Few refugees

attend public schools, and so few benet from this school-

based insurance. At the same time, community-based

refugee schools often operate health clinics on site and

refugee children are able to receive free or inexpensive

healthcare from these providers (Nandakumar et al. 2000b).

Originally, this governmental insurance scheme was

designed to provide benets for treatment in public

facilities only. However, in certain cases, the government

has also partnered with private clinics and hospitals to

ensure adequate access for school children to health

services, especially in rural areas where there may not

be a sucient number of public clinics or hospitals.

The precedent set by the government in providing

subsidized, public health insurance for a broad population

to access both public and private healthcare is an important

starting point for envisioning what a refugee insurance policy

scheme could look like in Egypt. As we will explore in greater

depth in the recommendations section, a refugee insurance

scheme that provides both public and private options is

best suited to overcome the myriad of obstacles currently

obstructing refugees’ access to health services in Egypt.

5.2 Healthcare Services

According to the World Health Organization (WHO), Egypt

has a broad network of easily accessible healthcare services,

including public clinics and hospitals, private healthcare

facilities, charitable healthcare services provided through

mosques and churches, and NGO-provided healthcare for

refugees. Public clinics and hospitals provide inexpensive

services to Egyptians and foreigners alike. However,

both Egyptians and refugees complain about the low

quality of public health services and as a result many

locals and refugees choose to utilize parallel systems of

private medical facilities and NGO- or faith-based clinics.

Healthcare: Obstacles to

Quality Aordable Care

t Low quality public services

t Expensive private health services

t Inconvenient refugee specic health services

t No dental services in refugee specic clinics

t Variable quality of all types of health services

t Refugees with closed cases are not eligible for

most NGO health services

31

Public Health Services

Governmental medical facilities are the most numerous in

Egypt, yet they are the least popular among Egyptians and

refugees alike. One Egyptian told us, “The public health

services, like those at the university, are so overcrowded

that the doctors can barely give each patient two minutes of

their time. Doctors barely look at their patients and quickly

write a prescription for something. This leads to constant

misdiagnoses.” Refugees repeated many similar claims about

public facilities, and as a consequence, overwhelmingly

chose alternative medical centers for treatment.

Private Health Services

All refugees interviewed for this project perceived private

clinics as the highest quality of care. Those who were able

to aord private healthcare through their own means—

Iraqis, mostly—often elected to do so without taking a

time-consuming trip to Caritas for a referral and subsidy.

Refugees without adequate nancial means were able to

access private clinics for secondary and tertiary care with

assistance from Caritas. In a study by the WHO and Egypt’s

Ministry of Health (2009), 63 per cent of Iraqis preferred

private sector treatment, whether paid for through their own

resources or with subsidies from Caritas. Sixty-two per cent

of Iraqis participating in the WHO study had never visited

a public health facility. When it came to advanced care, an

Urban refugees in Cairo

Figures