The offering of culturally and linguistically appropriate health education through interpersonal communication is one key strategy that MSIY's centres draw on to bolster the health of Yemen's Somali refugees. One reason that this strategy is so crucial to the programme is that social and traditional beliefs among the Somali people can make it difficult for them to plan or decide on their desired family size (large families are, according to MSIY, desirable among this population).

In this context, MSIY team members trained 20 community leaders (identified in collaboration with Somali community groups) to lead health education sessions; these leaders, in turn, trained community representatives. The trained health educators now lead what MSIY characterises as "culturally sensitive" discussions on a wide range of primary health and RH subjects in addition to tackling misconceptions about FP methods, male attitudes, and female genital cutting. The educators use printed pictoral materials, as well as material that has been translated into Somali.

Attending to gender issues in the context of RH decision-making is another key strategy in the development of the health education component of this programme. Separate male and female training sessions were conducted; integrated sessions were held where appropriate. In addition, a male health educator was recruited to implement the male refugees' RH education, including condom use. He also raised awareness of free services for female refugees and their children, urging men to accept (and encourage their families to use) these services. This strategy, MSIY explains, is vital; women in Yemen often need permission from their husbands and/or to be accompanied by a male family member to access health services.

When it comes to actually providing health care services, attending to cultural issues is also crucial, according to MSIY's model. MSIY states that, at the start of the project, Yemeni clients expressed concerns about the development of an integrated facility serving both Yemeni and Somali clients. The MSIY team has worked to overcome animosities between the communities - in part through awareness-raising work with Yemeni clients about the refugee communities - and to ensure equitable access to services (all clients at the MSIY centres have access to the same range of services). In line with MSI's policy of developing sustainable services, there is a sliding scale of charges for both Yemeni and refugee clients, although the majority of refugees receive free services. The offering of subsidised or free treatment is an effort to ensure that no one is ever turned away, while also ensuring that services are valued and will not falter when donor funding finishes.

Health, Sexual and Reproductive Health, Women, Gender, Population.

Data from UNFPA show that reproductive health indicators in Yemen are among the worst in the Arab World. The infant mortality rate stands at 64 per 1,000 live births and the maternal mortality ratio is 570 per 100,000 live births. Less than one in 10 women in Yemen uses a modern method of contraception.

An initial needs assessment was carried out in 2001 in response to concerns that Somali refugees were not able to access RH services. Somali refugees continue to arrive in Yemen and very often remain outside the Yemeni health system. In the southern city of Aden, most refugees live either in the isolated UNHCR camp in Al Kharaz, which officially holds 10,145 Somali refugees, or in Al Basateen, a poor area of Almansoura district in Aden where many refugees live in squatter camps. MSIY has been approached by UNHCR to co-finance and set up a clinic in Al Basateen that would provide subsidised RH and primary health care services. It also hopes to address the need in Al Kharaz by using existing staff from the clinic to provide outreach service to these refugees who are living in greater poverty and are more vulnerable. MSIY also intends to extend its current activities and services to address refugees between the ages of 13 to 20 and to focus on information activities.