Title: Improving healthcare at the intersection of gender and protracted displacement amongst Somali and Congolese refugees and IDPs
Funder: Economic and Social Research Council

Abstract: The International Organisation for Migration (IOM) has developed a framework for addressing the health-related objectives in the Global Compact on Safe, Orderly, and Regular Migration (GCM), and has indicated how responses to migration and health - including in the context of protracted displacement - will support action on the Sustainable Development Goals (SDGs). Our development-based approach to neglected, chronic, gendered mental health conditions associated with violence and conflict amongst IDPs in Eastern DRC and Somalia, and Congolese and Somali refugees in Kenya and South Africa has two principal Aims: to support the right to healthcare and Universal Heatlh Coverage (UHC) in contexts of protracted displacement and vulnerability (SDG3) and to improve gender equality in the context of gendered access to healthcare services (SDG5). In sequential order, our Objectives are: 1. To identify and analyse current policy processes that respond to the health needs of forcibly displaced people and thereby identify existing models for integrating those populations into health systems that could be made applicable to our various protracted displacement contexts. 2. To identify key neglected chronic mental health conditions (and comorbid chronic physical health conditions) associated with protracted displacement, conflict, and gendered violence. 3. To map the types and locations of healthcare providers that displaced people turn to for treatment for chronic mental health conditions (and comorbid physical health conditions). 4. To document how gender and other factors influence health seeking by displaced people for physical and mental health conditions associated with displacement, conflict and violence. 5. To indicate how displaced people can be supported to help reshape healthcare systems and delivery mechanisms that are more resilient and responsive to their needs. 6. To analyse how access to healthcare for displaced women and men (including LGBTIQ+ people) is affected by local, national, regional, and global health systems and refugee policy. 7. To establish how to support plural healthcare systems to encompass diagnosis and treatment of neglected chronic physical and mental health conditions associated with protracted displacement, conflict, and gendered violence.

Lay abstract: This project aims to help displaced people to access appropriate healthcare for long-term physical and mental health conditions associated with protracted displacement, conflict, and gendered violence. The category of Sexual and Gender-Based Violence (SGBV) receives a great deal of attention. However, there is limited research on how gendered violence, including violence relating to sexuality, is experienced in displacement contexts. There is also limited understanding of how gender, sexuality, and related violence affect access to healthcare, and how that can result in neglected chronic health conditions, particularly mental ill-health. Similarly, much attention is devoted to immediate healthcare needs following SGBV, but longer-term physical and mental health conditions are not adequately addressed. Displaced people face multiple barriers when seeking healthcare in protracted displacement settings, with the result that long-term health conditions are often misdiagnosed and mistreated or undiagnosed and untreated. This project examines access to care and the responsiveness of healthcare providers for displaced Congolese and Somalis in Eastern Democratic Republic of Congo (DRC), Somali, Kenya, and South Africa. Eastern DRC and Somalia have both experienced long-term conflict and displacement since the early 1990s, leading to large populations of Internally Displaced People (IDPs) within these countries and large refugee populations across the region. Conflict and displacement in Eastern DRC and Somalia are characterised by high rates of sexual and gender-based violence, and victims are stigmatised through prevailing gender and sexual norms. Existing health research tends to focus on the immediate aftermath of violence rather than on long-term mental and physical health conditions. The project has eight field sites in four countries. The four IDP field sites are one formal camp and one informal settlement each in Eastern DRC and Somalia, both of which have weak health systems. The four refugee field sites are Congolese and Somali settlements in Kenya and South Africa, which have different health systems and different refugee laws and policies. The project brings together researchers and practitioners from international development, migration studies, gender studies, medical anthropology, public health and health policy, and medical sciences to undertake interdisciplinary empirical research in these protracted displacement contexts. Panzi Foundation (DRC) and War Trauma Foundation (Netherlands) will guide teams of researchers based at the University of Edinburgh (UK), the University of Kinshasa (DRC), the Somali Institute for Development and Research (Somalia), Amref International University (Kenya), and the University of Witwatersrand (South Africa). Project activities are designed to: 1) enhance the capacity of partner organisations; 2) support the inclusion of displaced people in healthcare systems; 3) foster international networks.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: MENTAL HEALTH;GENERIC HEALTH RELEVANCE