“They Have So Much in Themselves”: Recognising the Strengths and Resilience of Youth in Nakivale Refugee Settlement, Uganda

Sexual violence stigma experiences among refugee adolescents and youth in Bidi Bidi refugee settlement, Uganda: Qualitative insights informed by the stigma power process framework

With the growing worldwide refugee crisis, there is a need for evidence-based interventions that specifically deal with the consequences of cumulative trauma-exposure in refugee youth. Refugee children have unique service needs and differ from their non-refugee peers in terms of sociocultural trauma, language, culture, and educational barriers. This article explains the complexities associated with understanding refugee youth and presents a proposal for studying the possible benefits of Tree of Life therapy. At the present time, Tree of Life therapy has no evidence-base because the published studies of Tree of Life with refugee and/or immigrant youth have sample sizes of one, six, eight, and twenty-nine. As a culturally-grounded, strength-based group counseling approach, Tree of Life therapy addresses traumatic experiences, recognizes participants' cultural differences, highlights individual skills, and aids in instilling both confidence and hope for the future. Ncazelo Ncube, the co-founder and main developer of Tree of Life, describes this therapy as a collective narrative practice that considers cultural beliefs and values (2006, 2010, 2018, 2019). The proposed research design is to study the effectiveness of the Tree of Life in Canada, the United States, the United Kingdom, and South Africa. The research plan is to use pragmatic, group-randomized controlled trials in the "real world" settings of schools and agencies in each of the four countries. In addition, the article describes the development of the Roots and Wings Questionnaire for Children and Youth, a culturally relevant, child-friendly questionnaire. The Tree of Life is a readily available therapy with great potential for helping traumatized refugee youth as well as other trauma-impacted young people worldwide.

Purpose Refugee settlements globally experience increased exposure to extreme weather events (EWE) compared with host national settings; however, refugee youth climate-related health experiences in humanitarian settings are understudied. We explored the lived experiences of climate change and EWE related to physical health among refugee youth aged 16–24 in a Ugandan refugee settlement. Methods We conducted a community-based, multi-method study. We purposively sampled refugee youth living in a Northern Ugandan refugee settlement reporting recent (past 14-day) EWE and/or resource insecurity. We conducted 32 refugee youth walk-along interviews to elicit a rich understanding of lived experiences in a target environment. During each interview, the youth brought the research assistant to places where they obtained resources (i.e. food, water, sanitation), took photos of their chosen places on a tablet, and described the photo and the place. We also conducted 12 in-depth interviews with key informants, comprising adults with experience working in this refugee settlement on refugee well-being, food security, water and sanitation hygiene (WASH), and/or climate change. We analysed the findings using template thematic analysis informed by the resource scarcity framework, which examines ecologic, social, and socioeconomic factors associated with resource insecurities. Findings Participants (n = 44) included refugee youth (n = 32; mean age: 20.0, standard deviation [SD]: 2.4; 50% men, 50% women) and key informants (n = 12; mean age: 37.0, SD: 5.8; 75% men, 25% women). Participant narratives identified how flooding, heavy rain, and drought contributed to youth experiencing resource insecurities (food, water, sanitation), in turn increasing malnutrition risks, water-borne diseases, and risks of bodily harm. Flooding and heavy rains also contributed to vector-borne diseases, and drought to dehydration and hygiene-related infections. Conclusions The findings highlight the need for better WASH infrastructure and increased food aid in Ugandan humanitarian settings, along with refugee youth-led initiatives to address the impacts of climate change on refugee well-being.

To the Editor: In their article in the March issue of this journal, Welling et al. [1] performed an admirable job highlighting many of the common pitfalls of humanitarian biomedical interventions and developed a series of prescriptive warnings of specific faults that should be avoided. The accompanying commentary [2] further commends the authors for their unique perspective as both physicians and members of the United States military. In their effort to caution how humanitarian medicine can cause more harm than good, however, the authors may have overstated their argument. An important unmentioned premise of humanitarian interventions is that these ventures are rarely wholly good or bad. These projects typically fall into legal and ethical gray areas that deserve qualification rather than absolute judgments of right or wrong. Welling et al. [1] frame their argument by comparing common humanitarian mistakes to the medieval concept of cardinal sins. By definition, cardinal sins were errors in action or thought that were never justifiable. This concept of moral absolutism seems an inappropriate metaphorical device for the complex relativism inherent to most humanitarian work. The disordered chaos that characterizes most humanitarian crises invites moral ambiguity, and ethical commandments that attempt to dismiss this intrinsic complexity grossly oversimplify the reality of work on the ground. For example, the authors note that politics and medical training often distract from the real ‘‘service’’ component of humanitarian biomedical interventions. To attempt to separate these various elements seems unrealistic and efforts to decouple indirect benefits of humanitarian work from direct service provision may distract from the greater purpose of undertaking such projects in the first place. Given that most humanitarian work requires institutional support (e.g., military, university, faith-based organizations), there will always be special interests beyond direct service that must be evaluated and managed appropriately. But trying to eradicate these secondary objectives is very likely impossible and could very well alienate many of the organizations that currently support such service efforts. Planning and implementing effective and appropriate biomedical humanitarian interventions is fraught with obstacles. Rather than crafting a series of ‘‘thou shalt nots’’ for medical humanitarians, what the greater community needs is a consensus-driven framework for humanitarian intervention. Lists of common mistakes are helpful, but guiding principles that encompass the clinical, educational, logistical, and ethical-legal issues surrounding medical humanitarianism are dearly needed. Such guidelines would recognize the inherent problems of these interventions and provide realistic guidance to managing the complexity and moral ambiguity of such work.

The study examined the effect of animal husbandry agrarian interventions on food security in refugee settlements in Uganda; a case of Nakivale Refugee Settlement. It specifically focused on; assessing the effects of animal husbandry agrarian interventions on food availability in Nakivale Refugee Settlement, assessing the effects of animal husbandry agrarian interventions on food accessibility in Nakivale Refugee Settlement and assessing the effects of animal husbandry agrarian interventions on food quality in Nakivale Refugee Settlement. The study was carried out using a cross sectional survey research design where both quantitative and qualitative research approaches were also used. The data was collected using questionnaires, interviews and observations and during data collection; both purposive and simple random sampling methods were used. A sample size of 400 respondents who are refugees in Nakivale Refugee Settlement and 7 key informants was also used in the study. The study findings revealed that animal husbandry agrarian interventions in Nakivale Refugee Settlement significantly improved food security by enhancing food availability, accessibility, and quality. Livestock distribution, improved breeds, veterinary services, training, and market-linkage programs increased year-round supply, dietary diversity, income generation, and safe, nutritious animal products. Pearson’s correlation confirmed strong positive relationships between these interventions and food outcomes: food availability (r = 0.656, p < 0.05), food accessibility (r = 0.623, p < 0.05), and food quality (r = 0.644, p < 0.05), demonstrating that strengthened animal husbandry programs directly bolster household and community-level food security. Finally, the study recommended the need for expanding livestock distribution and improved breeds, strengthening training in animal husbandry, enhancing veterinary services, promoting market-linkages for livestock products, and institutionalizing monitoring and evaluation mechanisms to sustain livestock productivity, improve food quality and accessibility, increase household income, and ensure long-term food security in Nakivale Refugee Settlement.

BackgroundThere remain key knowledge gaps regarding HIV testing needs and priorities among refugee youth in low and middle-income country (LMIC) humanitarian settings. The HIV prevention cascade framework focuses on three domains (motivation, access, effective use) central to prevention uptake, yet is understudied in relationship to HIV testing, particularly among refugee youth. Uganda is an exemplar context to explore refugee youth HIV testing needs and priorities as it hosts 1.5 million refugees and is Africa’s largest refugee hosting nation. In this study, we explored perceptions and experiences regarding HIV testing among refugee youth living in Bidi Bidi refugee settlement, Uganda.MethodsWe conducted a community-based research study in Bidi Bidi Refugee Settlement, one of the world’s largest refugee settlements with over 195,000 residents. This qualitative study involved four focus groups (2 with young women, 2 with young men) with refugee youth aged 16–24 living in Bidi Bidi refugee settlement. We applied thematic analysis informed by the HIV prevention cascade to understand domains of motivation, access, and effective use that emerged as salient for HIV testing engagement.ResultsParticipants (n = 40; mean age: 20 years, standard deviation: 2.2) included refugee young women (n = 20) and young men (n = 20), of whom 88% had a lifetime HIV test and 58% had ever heard of HIV self-testing. Participant discussions described HIV testing motivation was influenced by dimensions of: HIV treatment and testing knowledge; risk perception; positive and negative consequences of use; and social norms regarding gender and age. Access to HIV testing was shaped by: limited availability; distance and language barriers; confidentiality concerns; and affordability. Effective use of and engagement with HIV testing was related to HIV serostatus knowledge self-efficacy and in/equitable partner dynamics.ConclusionsComplex, multi-level factors shape motivation for, access to, and effective use of HIV testing among refugee youth in Bidi Bidi. Findings align with the HIV prevention cascade framework that helps to identify gaps to inform intervention development with youth in humanitarian settings. HIV testing approaches tailored for refugee youth in contexts such as Bidi Bidi can foster HIV prevention and treatment literacy, gender equity, gender-based violence prevention, and intersectional stigma reduction.

Higher education not only protects refugees from the trenches of socio-economic marginalisation, but it also primes them to contribute robustly to their adopted societies and eventually to their nations when conditions permit a return. However, access to higher education remains a critical challenge for refugees, yet the influence of social and cultural dispositions on such access is often overlooked in policy and practice. We explored how habitus factors, embodied dispositions, values, and orientations shaped by refugees’ prior experiences and socio-cultural contexts, influence access to university education among refugees in Nakivale Refugee Settlement, Uganda. Guided by Pierre Bourdieu’s theoretical framework as the analytic lens, the research interrogates how refugees’ aspirations, perceptions of self-efficacy, cultural orientations toward education, and adaptation to new learning environments shape their pursuit of higher education opportunities. Subscribing to constructivist philosophy and an interpretivist worldview, we used the qualitative single case study research design. We collected data through interviews, review of documents, and focus group discussions with refugee youth, community leaders, and education stakeholders. We interviewed 43 participants. Out of these, 18 were refugee students who participated in the 2 focused group discussions, 16 refugee students who participated in the face-to-face interviews, 3 zonal leaders, 3 representatives from the NGOs, 2 representatives from OPM, and 1 representative from UNHCR. We reviewed eight instructional documents. We used thematic data analysis to make sense of the data. Findings reveal that habitus manifests in both enabling and constraining ways: while strong educational aspirations and resilience drive some refugees toward university education, entrenched socio-cultural beliefs, gender norms, and diminished self-confidence often limit others. The study concludes that understanding refugee education through the lens of habitus provides critical insights into the hidden dispositional barriers and opportunities influencing university access. It recommends that higher education policies and interventions targeting refugees should integrate cultural and psychosocial dimensions alongside structural support mechanisms to enhance equitable access.

BackgroundSuicide is a leading cause of death among young people globally. Although suicidality has been studied in various populations, limited research has focused on refugee youth in low and middle-income countries. This study aimed to assess the prevalence of suicidal ideation, suicide attempts, and methods of attempted suicide among refugee children and adolescents in southwestern Uganda. We also examined risk factors associated with suicidal ideation in this population.MethodsWe conducted a cross-sectional study of 325 refugee children and adolescents selected through simple random sampling in Nakivale Refugee Settlement, southwestern Uganda. Suicidal behavior and post-traumatic stress disorder (PTSD) were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents, version 7.02 (MINI-KID). Additional variables—including war-related trauma and post-migration experiences were measured using structured checklists administered through KoboCollect. The data were then exported to STATA 17 for analysis. Descriptive statistics were used to calculate the prevalence of suicidal ideation, attempts, and means, while bivariate and multivariate logistic regression analyses were conducted to identify factors associated with suicidal ideation.ResultsOf 325 participants, 129 (40%) reported suicidal ideation, and among these, 70 (54%) had formulated a suicide plan. Of those with a plan, 13 (19%; (4.3% of the total sample)) had attempted suicide. The most common method of attempted suicide was self-poisoning (4/13, 31%), followed by hanging or drowning (3/13, 23%), self-stabbing (2/13, 15%), and self-imposed accidents (1/13, 8%). In multivariate analyses, suicidal ideation was significantly associated with exposure to war-related trauma (OR = 2.30, 95% CI: 1.35–3.94, p = 0.002), PTSD (OR = 5.47, 95% CI: 2.15–13.94, p < 0.001), and being an unaccompanied minor (OR = 6.14, 95% CI: 2.13–17.68, p = 0.001).ConclusionSuicidal ideation is highly prevalent among refugee children and adolescents in Nakivale Refugee Settlement. Prevention efforts should prioritize trauma-related factors, PTSD, and the specific needs of unaccompanied minors.Clinical trial numberNot applicable.

There is a dearth of evidence-based post-rape clinical care interventions tailored for refugee adolescents and youth in low-income humanitarian settings. Comics, a low-cost, low-literacy and youth-friendly method, integrate visual images with text to spark emotion and share health-promoting information. We evaluated a participatory comic intervention to increase post-exposure prophylaxis (PEP) knowledge and acceptance, and prevent sexual and gender-based violence, in Bidi Bidi refugee settlement, Uganda. Following a formative qualitative phase, we conducted a pre-test post-test pilot study with refugee youth (aged 16–24 years) (n = 120). Surveys were conducted before (t0), after (t1), and two-months following (t2) workshops. Among participants (mean age: 19.7 years, standard deviation: 2.4; n = 60 men, n = 60 women), we found significant increases from t0 to t1, and from t0 to t2 in: (a) PEP knowledge and acceptance, (b) bystander efficacy, and (c) resilient coping. We also found significant decreases from t0 to t1, and from t0 to t2 in sexual violence stigma and depression. Qualitative feedback revealed knowledge and skills acquisition to engage with post-rape care and violence prevention, and increased empathy to support survivors. Survivor-informed participatory comic books are a promising approach to advance HIV prevention through increased PEP acceptance and reduced sexual violence stigma with refugee youth. Trial registration: ClinicalTrials.gov identifier: NCT04656522.

School psychologists around the world have an important role in advocating for refugee youth, including Muslim refugees who experience increased risk for mental health issues due to discrimination. There are few studies, however, that have examined the resiliency factors that impact Muslim refugee youth’s well-being. This qualitative research study investigated these factors through the voices of humanitarian workers who are the primary source of support for these youth during displacement. Humanitarian workers ( N = 28 ) were recruited using snowball sampling through organizations that serve refugee youth and families during displacement. Using a recursive thematic process, we identified four main themes associated with risk factors: (1) gender norm expectations, (2) challenges in help-seeking, (3) unsafe climate and limited resources, and (4) challenges in collaborating with family. We also identified two main themes of protective factors: (1) faith and culture, and (2) family, peer, and community connections. We discussed these themes in the context of school psychological practice and provided specific recommendations for international school psychologists who support Muslim refugee students.

Behavioral health and refugee youth in primary care: An ecological systems perspective of the complexities of care

Psychosocial stressors related to extreme weather events and multiple resource insecurities: qualitative insights from refugee youth in an Ugandan humanitarian setting

Refugee youth face unique challenges in the resettlement context in Australia, which influence their wellbeing. Poor wellbeing affects individuals, and their family, friends, and the wider community. Little research exists on the relationship between wellbeing and the agency of African refugee youth in the resettlement process. This study examines factors associated with wellbeing to understand how refugee youth navigate resettlement through involvement in community activities. Despite the challenges of resettlement, study participants reported enhanced wellbeing because of community participation in various domains including education and community organisations. Refugee youth perceived themselves as agents of change and took ownership of their settlement journey by developing strategies to improve their own lives, while also supporting their peers. Study participants recognised the transformative role of education and the need for increased employment opportunities. To improve such outcomes, more integrated refugee resettlement approaches are required which recognise the agency of refugee youth and include them on their own terms.

Learning for a Bright Future: Schooling, Armed Conflict, and Children’s Well‐Being

BackgroundIn Australia, the two major pathways of refugee entry are the United Nations High Commissioner for Refugees resettlement programme and irregular maritime arrivals (IMAs) seeking asylum. The Australian Government’s policies towards IMAs since July 2013 are controversial, uncompromising and consistently harsh, with asylum seekers held in detention centres for prolonged periods. Refugees and asylum seekers have distinct and unique stressors that make resettlement difficult.MethodsThis exploratory study examines resettlement experiences for refugee youth in Western Australia using the psychosocial conceptual framework and qualitative methods. Focus group discussions and key informant interviews were undertaken with verbatim transcripts analysed using thematic analysis to identify themes.ResultsThemes documented that language and its impact, and experience with education, health, and social activities, support structures provided to youth and supporting future aspirations as critical to successful resettlement. This exploratory study contributes to developing a broader understanding of the resettlement experiences of refugee youth, drawing on their current and past experiences, cultural differences and mechanisms for coping.ConclusionFluency in English language, especially spoken, was a facilitator of successful resettlement. Our results align with previous studies documenting that support programs are vital for successful resettlement. Although faced with immense difficulties refugee youth are resilient, want to succeed and have aspirations for the future. Strategies and recommendations suggested by refugee youth themselves could be used for developing interventions to assist successful resettlement.