By Anna Pujol-Mazzini
LONDON, March 8 (Thomson Reuters Foundation) - When Sarah started menstruating in Egypt during the months-long journey that would take her from Eritrea to Britain, she had to use "toilet paper, tissue, anything" to soak up the blood.
She was preparing to make the journey across the Mediterranean from Egypt to Italy and did not have access to sanitary products.
"You're traveling with a small bag, an empty bag because when you go to the boat they ask you to make it lighter," Sarah told the Thomson Reuters Foundation in London, highlighting the added struggles women face in their perilous journeys to Europe.
On the road, Sarah, who did not want to give her real name, found it hard even to ask for what she needed.
"How can I describe products to men, especially if I don't speak the language? They don't know the word," she said.
On any given day, more than 800 million women between 15 and 49 have their period. However, globally 1.25 billion women do not have access to a toilet during menstruation, according to the charity WaterAid.
For refugee women, fleeing their homes for safety, the challenges of a period can be even greater.
"There's no dignity in having your period when you're a refugee," Terri Harris, of the Muslim women-led development charity Global One told the Thomson Reuters Foundation.
PIECES OF MATTRESS
A study conducted by Global One in displacement and refugee camps in Syria and Lebanon found that almost 60 percent of female refugees did not have access to underwear, and many more had no sanitary products for when they had their period.
"Can you imagine having your period without knickers and without sanitary items?" said Harris, who conducted the survey of more than 800 women.
"Not having access to products means that you use items which are not necessarily hygienic, so we had reported cases of women using old rags, pieces of moss, pieces of mattress."
The use of such items coupled with poor water and sanitation facilities can lead to infections and other health problems.
Over half of the women interviewed had suffered from urinary tract infections which were often left untreated, the study found.
The lack of sanitary supplies can also stop women from walking around the camps because of the stigma surrounding menstruation and the risk of leakages.
"They're not able to access food, get services, information, interact with other people," said Ugochi Daniels, a humanitarian chief at the U.N. population fund (UNFPA).
"It has a dramatic effect on their wellbeing, on their mental state of mind," she added.
NOT A PRIORITY
The specific needs of women and girls in emergencies still tend to be overlooked despite some progress, researchers say.
"We always have difficulties getting resources to meet menstrual hygiene needs," said Ann Burton, an official with the U.N.'s refugee agency, UNHCR.
Although supplies of underwear, soap, basins along with safe toilets with locks and clean water are essential for women menstruating, these may not be seen as priorities.
"It doesn't rank with the same level of importance because it affects women and girls and oftentimes the decision makers are men," Daniels from UNFPA said.
"It's getting better now because things were so bad."
Aid agencies have distributed "dignity kits" to women in Iraq, Nigeria and Bangladesh amongst other countries, containing underwear, soap and sanitary pads.
In Zaatari refugee camp in Jordan, a small factory was set up for refugees to produce sanitary pads, training them to use machines bought with the help of online donations.
Such initiatives are important, as stigma around menstruation also prevents women and girls from seeking help from aid agencies when they are affected by health issues.
This leads to many health providers only seeing women when they are pregnant, while being unable to collect information on how their periods may affect them, especially young unmarried women.
"A woman is not going to stop menstruating because there's a crisis," Daniels said.
"We have no excuse for not making sure women and girls' menstrual hygiene needs are taken care of."
(Reporting by Anna Pujol-Mazzini @annapmzn, Editing by Ros Russell. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters that covers humanitarian news, women's rights, trafficking, property rights, climate change and resilience. Visit http://news.trust.org)