All over the world, the occurrence of your first period is a landmark of adulthood; the few spots of murky blood in your underwear a proclamation of puberty with all its significant implications and an important coming of age in many cultures.

Periods usually start at any time between eight and 16 years of age, and continue until around 50 years old which means that, roughly speaking, someone spends around 14,00 days in their lifetime menstruating; the equivalent of nearly four years. And lets face it, that's a bloody long time¹. 

Lots of different factors influence menarche (the medical term for the first occurrence of menstruation), though it’s difficult to pinpoint any definitive determinants². We know that among other things, genetics, nutrition and general health play a role, and stress has a big impact on the menstrual cycle. Getting to grips with menstruation and your experience with your first periods, which are often irregular and unpredictable, has a big impact on how you deal with periods thereafter.

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If you’re a refugee living in a camp without your loved ones (who are often thousands of miles away living in a dangerous situation you’ve risked your life to flee), and with a poor diet, lack of access to good washing facilities, difficult sleeping patterns and freezing weather conditions, managing your period on top of this can be incredibly difficult.

Women and girls living behind the barbed wire fences of Moria and Kara Tepe camps tell me tales of wringing out and reusing old sanitary towels, wearing stained clothing for days. They take half a tablet of paracetamol (a quarter of the recommended dose) to alleviate debilitating cramps, and sleeping for a barely a couple of hours in tents crammed with strangers of both genders, considering themselves lucky if they have a blanket to themselves. It’s dire.

According to the Greek authorities, 12,795 refugees arrived on the shores of Lesbos, a small island in Northern Greece, in 2017. Since January 1st 2018, over a thousand people have arrived by boat on Lesbos, and the boats are showing no signs of slowing down as the refugee crisis continues and people continue to seek asylum.

Most of these refugees come from Syria, Democratic Republic of Congo, Iraq and Afghanistan³. 22% of these refugees are women and 39% are children, many of whom have regular periods in the Greek refugee camps on Lesbos, Moria and Kara Tepe. For many, monthly bleeding is compounded by severe sexual assault and violence in their home countries or en route to Europe. This often leaves physical scarring and significant continuous vaginal bleeding and discharge, as well as an unimaginable psychological impact.

In the UK, it’s easy to take for granted things that make us feel safe without realising it, like running water and soap to wash your hands, a warm and secure place to sleep without ten other people in immediate proximity, a Boots or Tesco Express rarely further than a few minutes away, and 35p to buy a packet of ibuprofen when your uterus is somersaulting like there’s no tomorrow. A safe period is simply enough having the means and resources to handle the practical aspects of menstruating, like regular access to single sex, lockable toilets, sanitary products and washing facilities. 

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A safe period also takes into account the psychological impact and cultural acceptability of managing your period to your own individual standard – for example, being able to ask your Mum for a pad, advice and a hug. Or the recognition that in some cultures tampons aren’t used and so relying on the provision of alternatives you can use.

Living in a refugee camp (let alone bleeding for days on end whilst smuggled in a box in the back of a lorry on the journey itself to seek asylum) throws up unimaginable challenges in almost every way possible, especially in terms of personal hygiene.

Irregular, painful periods are common and difficult to manage in the camps. Easy access to showers, clean running water and availability of menstrual products including pads and simple painkillers are not easy to come by and nearly impossible to purchase (if you’re lucky enough to have money in your pocket) and so refugees are heavily reliant on provisions from NGOs and the local governments.

In the long run, poor and unhygienic menstrual management can cause numerous health problems including reproductive tract and urinary tract infections⁴. This in turn can affect future health and fertility. Even if you’re only living in a refugee camp for only a few months, the effects of poor menstrual hygiene can last long after leaving.

The psychological impact of the situation can last a lifetime, especially for young people and unaccompanied minors (between January and September 2017, 25,379 children arrived in Greece, Italy, Spain and Bulgaria, of whom 14,839 (58%) were unaccompanied or separated children⁵).

Poor social support in a situation like this has a huge impact mental health and this alone can lead to disrupted periods and infertility later in life⁶. Young people living in camps also miss out on vital school years and education that equips them with the knowledge to understand their bodies and learn how to care for themselves¹.  

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The ability to look after your physical and mental health and personal hygiene isn’t a purchase or a privilege; it’s a basic human right. There’s a steady stream of NGOs and projects supporting the refugees all over Europe and continuing to fight the good fight. But it’s bleak and difficult to avoid the political underpinning of the situation which is unlikely to change any time soon, especially with regards to the lack of safe healthcare and period provisions.

A little bit of perspective goes a very long way – a couple of quid in the supermarket or your corner shop isn’t much money at all but put towards sanitary towels, painkillers and basic toiletries it makes a world of difference to someone in need not all that far from home. Making a donation one of your regular habits is a bloody good thing to do.

Spread the word.

Sarah and her pads.JPG

Dr Sarah Simons is a junior doctor from London with a professional interest in global and refugee health. She works full time in the NHS and has volunteered in Lesbos with an NGO providing urgent and primary healthcare for vulnerable refugees since 2017.  She occasionally tweets at @SarahNSimons.

Many thanks to Dr Sarah for providing the images of life at the camp in this post 

References

1.        Sumpter C, T. B., 2013. A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management, s.l.: PLoS ONE.

2.        Rees, M., 1995. The Age of Menarche. Organon's Magazine on Women & Health, pp. 2-4.

3.        UNHCR, 2018. Daily Arrivals in Lesbos - Data Snapshot - 06 Feb 2018, Mytilene: UNHCR.

4.       Budhathoki SS, B. M. C.-S. E. e. a., 2018. Menstrual hygiene management among women and adolescent girls in the aftermath of the earthquake in Nepal. BMC Women's Health, 27(2), pp. 61-66.

5.        UNHCR, UNICEF, 2017. Refugee and Migrant Children in Europe - Accompanied, Unaccompaned and Separated , s.l.: UNHCR.

6.        Jacobs MB, B.-J. R. H. E., 2015. Adverse childhood event experiences, fertility difficulties and menstrual cycle characteristics.. Journal of Psychosomatic Obstetrics & Gynaecology, 36(2), pp. 46-57.