Exploring the mental health and psychosocial problems of Congolese refugees living in refugee settings in Rwanda and Uganda: a rapid qualitative study

Anna Chiumento,M Tasdik Hasan,Ross G White,Paul Bangirana,Peter Ventevogel,Rachel Nabirinde,Rosco Kasujja,Theoneste Rutayisire,Stefan Jansen,Jude Robinson,Emmanuel Sarabwe,Joseph Mugarura,Daniel M Kagabo

doi:10.1186/s13031-020-00323-8

Abstract

BackgroundRefugees fleeing conflict often experience poor mental health due to experiences in their country of origin, during displacement, and in new host environments. Conditions in refugee camps and settlements, and the wider socio-political and economic context of refugees’ lives, create structural conditions that compound the effects of previous adversity. Mental health and psychosocial support services must address the daily stressors and adversities refugees face by being grounded in the lived reality of refugee’s lives and addressing issues relevant to them.MethodsWe undertook a rapid qualitative study between March and May 2019 to understand the local prioritisation of problems facing Congolese refugees living in two refugee settings in Uganda and Rwanda. Thirty free list interviews were conducted in each setting, followed by 11 key informant interviews in Uganda and 12 in Rwanda.ResultsResults from all interviews were thematically analysed following a deductive process by the in-country research teams. Free list interview findings highlight priority problems of basic needs such as food, shelter, and healthcare access; alongside contextual social problems including discrimination/inequity and a lack of gender equality. Priority problems relating to mental and psychosocial health explored in key informant interviews include discrimination and inequity; alcohol and substance abuse; and violence and gender-based violence.ConclusionsOur findings strongly resonate with models of mental health and psychosocial wellbeing that emphasise their socially determined and contextually embedded nature. Specifically, findings foreground the structural conditions of refugees’ lives such as the physical organisation of camp spaces or refugee policies that are stigmatising through restricting the right to work or pursue education. This structural environment can lead to disruptions in social relationships at the familial and community levels, giving rise to discrimination/inequity and gender-based violence. Therefore, our findings foreground that one consequence of living in situations of pervasive adversity caused by experiences of discrimination, inequity, and violence is poor mental health and psychosocial wellbeing. This understanding reinforces the relevance of feasible and acceptable intervention approaches that aim to strengthening familial and community-level social relationships, building upon existing community resources to promote positive mental health and psychosocial wellbeing among Congolese refugees in these settings.

Highlights

More than 70 million people are displaced, with over 80% in countries neighbouring their country of origin [1], many in low- and middle-income countries (LMICs) with limited resources
Findings foreground the structural conditions of refugees’ lives such as the physical organisation of camp spaces or refugee policies that are stigmatising through restricting the right to work or pursue education
Our findings foreground that one consequence of living in situations of pervasive adversity caused by experiences of discrimination, inequity, and violence is poor mental health and psychosocial wellbeing

Summary

Introduction

More than 70 million people are displaced, with over 80% in countries neighbouring their country of origin [1], many in low- and middle-income countries (LMICs) with limited resources. Mental health is impacted by a complex interplay of social determinants [3], which play out in unique ways in the social ecology of refugee settings This includes structural conditions of adversity such as insecure asylum status, restricted opportunities to work or pursue education, and limited access to services, all of which can compound pre-displacement exposure to conflict or traumatic events and exacerbate psychological distress and mental health problems [4,5,6]. In some settings refugees face restrictions on the right to work, to cultivate land, or pursue higher education Such conditions diminish the agency of refugees and may create dependency on outside institutions.

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Conclusion