CFD Interview With Anne Merewood and Farzana Hakimi from CHEER in Greece
CHEERing is an international NGO based in Athens, Greece, dedicated to improving maternal child health and promoting preventive health in refugee populations. [CHEERing] provides direct support in refugee camps and communities, training for students, medical professionals and volunteers who work daily with refugee populations, and evaluation and monitoring. Their Grow Clinics support mothers and babies in camps and shelters in greater Athens, in collaboration with other NGOs, and they in September, CHEERing expanded to Afghanistan. Each week the CHEERing team weigh, measure, and track infant growth, support breastfeeding, and offer additional nutritional support and counseling to families. They do preventive health screening for large groups of individuals and refer to support services such as dentists and prenatal care. They also offer training on Infant Feeding in Emergencies to organizations working with refugees in Greece, and provide sessions for beneficiaries about breastfeeding, sexual health, nutrition, and infant development. In 2021 they launched a soccer program which is now supported by the Barca Foundation, offering Barca’s Futbolnet training as well as league teams to about 200 girls, boys, and young men. They hire mostly refugee employees and help with integration into the workplace.
As the director of CHEER in Greece, Anne Merewood, PhD, MPH, oversees and manages CHEERing’s work at all levels. Dr. Merewood also directs CHEER, the Center for Health Equity, Education, and Research, at the Boston University School of Medicine, and the Communities and Hospitals Advancing Maternity Practices (CHAMPS) project, an initiative that promotes best practices in maternity care, increases breastfeeding rates, decreases racial and ethnic disparities.
Dr. Merewood is an Associate Professor of Pediatrics at the Boston University School of Medicine and an Associate Professor of Community Health Sciences at the Boston University School of Public Health. She is currently consulting for UNICEF and the World Health Organization and is a former consultant to the US Department of Health and Human Services’ Indian Health Service.
Farzana Hakimi, a former refugee from Afghanistan, leads the CHEERing girls soccer program, and acts as the prime coordinator of CHEERing Grow Clinics at three refugee camps in greater Athens. She is also a peer counselor and Farsi translator for CHEERing. Farzana has a mathematics diploma and studied first aid and pharmacology in Iran.
The CFD research team invited Dr. Merewood and Hakimi for a conversation about the impacts of forced displacement on children and family refugees.
CFD (to Dr. Anne Merewood): What drove you to founding CHEERing?
Dr. Anne Merewood: I’ve been doing the CHEER center in Boston in one format or another for almost thirty years. We’ve worked in the past with American Indian populations, we’re working still with African American populations in Mississippi, and international work for me was the next step – the next challenge. We have been grounded in nutrition, maternal child health, and breastfeeding work for a long time, and to be honest when I started CHEERing for refugees in Greece 2018, my plan was to do breastfeeding support in a place where it was even more critical. Well, it’s critical everywhere, but if you don’t breastfeed in America usually the baby doesn’t die, whereas if you don’t breastfeed in some of these other situations the baby can die. So, at this point in my career, I wanted to work somewhere where I felt it was really important to promote breastfeeding. It’s evolved very quickly into a lot more than that because there’s a lot more need here. I think one thing I’ve learned is that while you have a few pregnant women and a few breastfeeding women and a few children under one [years old] at any given point, you have many, many more children between one and fifteen [years old]. So we can get things like diapers and clothes and things for little babies all the time but it’s much more difficult to supply the need for older children. I’m not just talking about physical needs – I’m talking about medical care, nutrition, preventive health and things like that. So that’s why I came to this, and it has evolved away from just breastfeeding and into generally public health. The need is tremendous, and the need is bigger than I ever anticipated.
CFD (to Farzana Hakimi): Could you speak to your experience as a refugee and a parent? Do either of these experiences inform your work at CHEERing?
Farzana Hakimi: As a mom, as a parent, and as a refugee in the camp I know what problems people have, what problems they have in the camps, and what they need: what they want people to help them [with]. Sometimes I see they need food. Sometimes I see they need healthcare. Sometimes they don’t know how they can get their vaccinations. Sometimes they ask for information about starting and stopping breastfeeding.
CFD: The CHEER international group works very closely with refugees in camps. How are families and children impacted by living in these camps? What displays of strength do you see?
Dr. Merewood: There’s no one impact, it’s a way of living. They’re not living a normal life where something’s impacted it. I mean, they have to adapt their entire living situation to being in a camp, which is basically a kind of emergency survival.
Hakimi: I think people in the camp’s residence are not in a normal situation like people in cities. They have a completely different situation for food, clothes, education, health, and all the other things that [non-refugees] have in their lives.
Dr. Merewood: To sort of give you a picture, one camp we go to is huge old factory building that has been divided into small rooms. We have coped with cases of worms, head lice, everything. And it is about a twenty minutes’ drive from the nearest town with no bus or service. Many people in this camp have four or five children. They don’t have strollers – they have milk crates on suitcase wheels. So they can’t actually go anywhere at all, they can’t get out of the camp. They don’t have public transportation so they’re just dependent on what is given to them by the authorities and pretty much all the authorities give them is food. So it’s really impacting every single aspect of all of their lives.
Now, when you ask about displays of strength, to me it’s strength that they actually keep going. We have one lady who has four children and weighs 40 kilos [about 88 pounds]. She’s been hospitalized with tuberculosis. We have another lady who has had three late term miscarriages and is pregnant again. I don’t know how they do it – just getting one foot in front of the other every day is a display of strength. And then we have stars like Farzana who managed to not only get one foot in front of the other but rise up and help other people in a way that’s really quite impossible to do unless you’ve gone through it yourself.
Hakimi: Refugees in our community lived in a very closed culture in their country, and now they want to update themselves with the new country, new culture, and [build a] new life. They come out to school or to the football [soccer] field. They see other [non-refugee] children. They want to learn and they want to have the same life like that. After about one year of football training, our kids –
Dr. Merewood: We have football training – we have about 200 kids playing with us.
Hakimi: Yeah, our children are children in the camps, and they are learning many things for their lives. And when they scored [in a football match], a girl and a boy had a nice high-five. They were about twelve or thirteen [years old]. It was very new for our community.
Dr. Merewood (agreeing with Hakimi): [It was new] for a twelve-year-old and a thirteen-year-old boy and girl to be playing on the same team without a hijab or anything. We’re actually more advanced and integrated than the Greek teams, we have a lot more girls playing for us. It was just a moment, you know, they did a high-five, these two young teenagers, and I just thought, you know, two years ago that would not have happened. The girls were not even playing in the same space as the boys. So we see a lot of changes.
CFD: How does conducting such humanitarian field work impact the two of you? Do you have particular tactics for practicing self-care?
Dr. Merewood [laughing]: No. It makes me more cynical and aggressive than I’ve ever been.
Hakimi: I don’t think of me when I’m in the field or the camps, or in the girls’ clinic, or when I’m working in the cooking class or the football field. I feel like I’m the mom for all of the kids.
Dr. Merewood: We’ve had volunteers ask before they come, if we provide psychological help, and we don’t frankly right now. We’re not a big enough organization. I try [to convey this] when I interview people [interns and volunteers] who come here from all different places. You know, they really have to be able to cope with this stuff. The very big organizations have backup, but to be honest we don’t.
CFD: What are areas of weakness that have yet to be addressed in refugee interventions that help children and families?
Dr. Merewood: The world is not supportive of refugees. People like you, and us, we come from a place of assuming that people want to help. We’re assuming that people actually want to improve the situation for refugees. That is not actually the case much of the time. Many countries don’t want refugees to be there. They want to make life as unpleasant as possible for refugees. I mean, they want to make it unlivable, so they don’t actually try to [help]. So it’s not a question of “does the intervention work or not?”, it’s like, “how can we get these people to leave as quickly as possible?” I’m not saying that specifically for Greece – look at what’s happening in the US. It’s exactly the same in England: they’re trying to send refugees to Rwanda. England even considered ‘wave machines’ to make big waves in the English Channel between France and the UK to repel boats. There’s a lot of blame directed at Greece from other European countries for how Greece treats refugees, but none of the other countries accept refugees. So the situation of refugees is not one where they go to a country and someone is sitting there saying, “oh, how can we help you make your life better?” It’s not like that. So, we don’t even know if these interventions work because they’re not intervening very much. They’re putting refugees in miserable places.
So a lot of it comes down to NGOs like ours. We are small. There are a lot of big NGOs as well. A lot of them don’t work here anymore because Greece is no longer considered an absolute emergency. They all go to Ukraine, or something like that. So the gaps of that – well, there’s no gaps. There’s just one big hole, frankly.
If you were to ask us what kinds of interventions work, well, we could use the ones that we have as an example. I would say definitely the ones right here on the ground, really in touch with the people. I think that the requirement of funding wages for competent people is really underestimated, because it’s always like, “how many diapers did we give out?” or “how much food did we give out?”, but actually, you need people like Farzana who are there helping. We have a peer counselor from Democratic Republic of Congo in Athens as well, who is in the city doing breastfeeding support. She’s invaluable. She speaks the language. We pay all our refugee team members. So I think it’s community-based; you have to do community-based work. You have to fund the people that work for you, ideally from the community themselves.
You know, I’ve been a researcher at BU for thirty-odd years. Any research that’s done needs to be evaluative. You know: “is it working?” And we worked with a big international organization last year (I won’t say the name) about psychological help for the football players. What I feel is that football itself is the psychological help. It’s them coming every week to the field, three times a week, somebody being nice to them, somebody giving them food and football shoes and letting them play a game which takes them out [of the camp]. To me, those are the most successful interventions, where you’re actually on the ground, helping them be happy for a while, not doing some sort of psych analysis.
Hakimi: Yeah, I agree. When they are not in the camp, they are out of the problems. When they are out of the camp, they don’t think about their parent’s problems. Because, usually, it’s for all the families in the camp, when they see other families they talk about their papers, police papers, the interviews, Greek acceptance, or their passport, these things. And all the children in the camp, they are hearing these things. But when they go out of the camp, they are in a nice football field, they are happy. They play, they do football training, they see people not in the refugee camps, they don’t think about their parents’ problems which are not up to them at all. But when they are in the camp, they have to hear about these issues. Because all people are talking about these problems. I think it’s better than a psychological class in the camp. The psychologists came to the camp and held a class: “Do this when you are stressed. Do this technique when you get anxious”. It doesn’t make sense for them. But the practical activities like football games and training –
Dr. Merewood: Or cooking!
Hakimi: Yes, and cooking.
Dr. Merewood: So cooking – that’s where we’re headed tonight. We found, when we did a health screening of many of the kids in the camps we found that they are nutritionally deprived. What everyone wants to do is to have a lesson where we say “don’t eat donuts, eat oranges”. But they don’t actually have any oranges. And who are we to say don’t eat donuts. We eat donuts! Anyway, what we did instead is we started cooking classes. Twice a week. Farzana led them. And we had loads and loads of kids come! And they’re enjoying themselves! All the parents would say “my kids don’t eat”, but when they came to Farzana’s class –
Hakimi: [The parents] would say “I cannot feed them.” Now [the kids] will say, “second round, please!” or “third round, please! We want some more. I want some more potatoes or I want some more chicken”. We say, “of course! It’s all for you! We cook because we like to feed you”. They feel more relaxed and comfortable when they come, they help me with cooking, they learn something about the food, fruit, vitamins. We talk about the vegetables, we talk about dairy, and they learn and they eat. And then they go happy, with big smiles.
Dr. Merewood: We’ve had some BU students come out as volunteers. This summer we had Zeinab, a masters student from BUSPH doing her practicum, she speaks Arabic, and was from a refugee background herself, and she was really quite good at cooking and even taught them to make sushi. You know, this really takes them out of themselves. And they love it. And we do other types of entertainment. We did TikTok dancing, we did, um…
Hakimi: We did beading.
Dr. Merewood: Yes! We did beading, we did painting, these things. And nutrition, like what vitamins are. They are really hungry for knowledge, because only half of them actually go to school. Farzana’s daughter went to school last year in this area, and for example, at the end of the year, the school said, “the picnic is only for Greek children. You can’t come if you’re not Greek”. This is regular Greek public school. So you have seven-year-olds coming to you and saying “it’s the graduating party tomorrow, and they said wear nice clothes, but it’s only for the Greek children.”. So now Farzana’s daughter is in a new school, and she said to me last week, “hey, in this school everyone can go to the party!” I mean, where do you start? Where do you start?
CFD: So, is there hope for any improvement in conditions or policy?
Dr. Merewood: I think from my perspective, as an outsider, a BU person, one of the things that we really do that we think helps is that we get loads of students coming through. I’ve got two medical students and a pharmacist here now. We have four or five school of public health students every year. We have medical students and Erasmus students and nutrition students. Not hundreds, but at any given time we have three or four here for four to six months. It’s a lot of work for us, because we’re having to train them. But, we had a doctor come out from England and tell us that she learned more in six weeks with us than from a year of global health training. So one of my hopes is not just for the population here but the fact that we’ve got a generation of young people who hopefully will take this to heart and do something about it in the future, because our only hope, from the perspective of an outsider, is young people like you.
Hakimi: [The hope comes from] just coming and continuing this job. I don’t think we can give them their dreams, but we can make life easier for them. We can do head lice shampoo, we can do worm medication, we can give them diapers for the kids that wet their bed at night. It makes their life easier.
Dr. Merewood: Bearable, yes. We did a class – I wasn’t there, but Farzana and one of our medical students did a class on periods last week. A focus group with the girls, and they don’t know. We literally took out the pads and said, “don’t worry, you can have a period while you’re at football, if your period starts we’ve got female coaches, et cetera, et cetera”. So we do that kind of stuff with them. It’s very hands-on and our biggest challenge is funding.. It’s difficult to get money for refugees, especially with Ukraine. People don’t want to give. We don’t have a very big budget but it’s very very hard to get funding.
Hakimi: You know, people think [funding] is for emergencies or priorities. But sometimes, when a young twelve-year-old girl gets a period and she doesn’t know what to do, it is a priority. They need to learn. They need to have knowledge and education about their body, which they don’t know. When a teenager at twelve years is stressed and cries and shakes her hands and doesn’t know what to do, this is the priority.
CFD: Are there any future plans for CHEERing going forward? What are your next steps and goals?
Dr. Merewood: Well, funding is a big priority. We’ve expanded a lot since we started. We have. We started just doing breastfeeding in one or two camps. Now we’re going every week to three of the camps for three full days. We’re doing community work. We started with thirteen girls in the camp with Farzana’s playing football. Now we have about two hundred young girls, boys, and men playing football. So we really like to expand. I do hope that we can work with the new center [CFD]. I have decreased my time at BU because I need to do this work more. But if we have the funding we have a good recipe for success. We can do a lot.
We started a program in Afghanistan as well, in Herat, a Grow Clinic, it’s with Afghan kids. We spoke with them this morning. We would like to do more internationally.
Hakimi: The only hope I think we can have is funding. If we’re funded, we can continue our projects in different cities like I’ve got. We’ve started in Afghanistan. We can expand it or start somewhere else. Or we can build a huge program in Afghanistan, in one city or different places.
Dr. Merewood: We started in Afghanistan to do food and support for moms and infants. We have like twenty women who are pregnant, and the only care they get is through the center we run there. And now they’re going to start doing some literacy work for girls and boys, and also sewing and beading and things so they can make products to sell locally. I mean, the children are starving. We have a ten-year-old who weighs ten kilos [about 22 pounds], so the kids are starving. So that’s part of our project. That’s a new piece.
CFD: Is there anything else you would like to mention that wasn’t covered in the interview?
Dr. Merewood: Well, a lot of the projects that people think about are for young people. Like girls that are coming out of Afghanistan with no education, we need to help them. But I mean, I think older women like Farzana (not old, she’s not old, she’s much younger than I am actually), and not just women but actually all of the people coming out – many are not literate themselves, or they’ve not been able to further their education beyond elementary or high school level. I think we’ve got a lot of kids whose parents are not literate at all. So there should be some focus in general, not just in children but also the parents and adults that support them. Because they’re not old, they’re thirty to forty. They’re not past it, you know, they’re not eighty. They’re forty, so they’ve got a load of life left. And like first generation immigrants everywhere, they’re very, very hard-working and they’re desperate to help their children. So that’s what I think I would add, that we should not ignore that older group that is coming out without any qualifications but is very willing to get them.
Hakimi: For the older people, older refugees my age, for sure. It can be a big opportunity to continue their studying, their education, to improve themselves, and then they can help more people. For example, my community people, when they see that I’m trying for me and my children and my community, they will get power and energy to start and to do well for their families. It starts with one person, one family, and then all people can learn later.
Dr. Merewood: I think you have understood, too, that the perspective from the refugee population we work with is very different from ours. This is another thing we’ve worked on when a larger NGO came to collaborate with us on some mental health assessments with refugee children. There were a lot of questions to the refugees about self-esteem, which Farzana didn’t know how to translate that word. These people, from Afghanistan, which is who we work with mostly, they are very community-based, very population-based, ‘greater good’ philosophy. The children didn’t have a clue what was meant by self-esteem. It’s not the same as we think. The thinking is different, and we have to sort of make space for that, and understand that when we do these programs people are coming from very different kinds of perspectives. The mom I mentioned earlier, who has four children and only weighs 40 kilos – She came for weeks with her children to the Grow Clinic. You know, I finally said to her “look, I’m not worried about your children, they’re bouncing off the walls. I’m worried about you”. And she said, “this week, I came for me”. And to me this was a huge change in the way she approached the problems, because I bet she’s never thought about herself at all before.
You know, we get it. When people get to other countries the biggest issue for health care centers treating them is mental health issues. We know that. But here it’s just getting from day to day. It’s just getting through, you know? Maybe when they get to Canada they have time to reflect a little bit. And then suddenly all the mental health problems emerge. But here it’s just survival. It’s really survival, even here in Greece, in Europe, it’s survival.