(Reuters Health) - Girls and women forced to flee their homes in Myanmar and Syria lack menstruation supplies and safe, private toilets, a new study finds.

In 2015, researchers interviewed emergency-response staff and about 150 females from two groups receiving humanitarian aid – Syrian Muslim refugees living in tents and makeshift structures across Lebanon and internally displaced adolescent girls and women living in camps in Myanmar – about their menstruation needs.

A basic part of life for females, menstruation has been a neglected challenge for an estimated 30 million girls and women displaced due to worldwide conflicts and disasters, said Marni Sommer, a professor of sociomedical sciences at Columbia University’s Mailman School of Public Health in New York.

“It has been an overlooked issue,” Sommer said in a phone interview. “People say this is not life or death, so why should we pay attention to this?”

She is paying attention because girls skip school and other activities when they lack menstruation supplies and facilities in which to change.

Displaced females in Myanmar described shared latrines in camps as unsafe, uncomfortable, dirty, without water or door locks, just bamboo walls with gaps through which intruders could peer inside, according to the report by Sommer’s team in the journal Conflict and Health.

Poorly lit paths made it difficult for girls and women to find toilets at night. Moreover, they avoided using them after dark for fear of being assaulted, kidnapped or bitten by snakes, researchers learned.

Refugee girls in Lebanon described the toilets as cramped and dirty and said they preferred to change their menstrual materials in their shelters, though the shelters provided no privacy.

“The walls that make the tents and separate them are normally just blankets, plastic sheeting and transparent,” said one adolescent girl from Lebanon. “Someone from the outside can see you in there.”

Emergency workers and the girls and women told researchers that they had not been adequately consulted about menstruation practices and preferences.

“It really is essential that you talk to women and girls,” Sommer said. “They just need to be consulted.”

Regular provision of disposable pads and cloths presented a challenge in both Myanmar and Lebanon, researchers found. But the challenges went beyond menstruation supplies to facilities and who should lead an effort to assist females with their periods.

Interviews of girls in refugee camps in Myanmar revealed they rarely were educated about menstruation, leading to distress and embarrassment at the onset of bleeding, the report found.

Syrian adolescent girls reported more basic knowledge about menstruation before getting their first periods. But not everything they were taught was true. One misconception, for example, was believing they could not shower while menstruating, researchers learned.

Bethany Caruso, a postdoctoral fellow in environmental health at Emory University in Atlanta who was not involved with the research, described it as an overdue assessment of the female refugee experience.

“These are girls coming to age and having their periods for the first time in an emergency setting, which makes it all the more complicated,” she said in a phone interview.

“Amidst all the things to think about, all the things that need to be done, where does this fall?” she asked.

For Caruso, it’s a priority.

She agreed with the researchers that aid workers should ask displaced girls and women about their menstruation needs, and not just about whether they prefer cloth or disposable pads.

“There’s always this focus on pads, but there’s so much more that women and girls need at this time,” Caruso said. “Pads are an inexpensive, tangible good that people can distribute with a fair amount of ease. But the provision of safe and secure spaces for changes is a lot harder to come by and create.”

“They need to have privacy, safety, security. They need access to water and soap,” she said.

She also stressed the need for aid groups to coordinate work on menstruation needs and for identification of which group should take the lead in addressing the issue.

“It seems like people want to respond well,” she said. “They just don’t know how.”

SOURCE: bit.ly/2zc1eCt Conflict and Health, online October 15, 2017.