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This paper argues that access to quality education and skills development programs for refugees, returnees and Internally Displaced Persons (IDPs) is not only one of the fundamental human rights that states and non-state actors have obligations to fulfill; it is also an integral part of sustainable development efforts which will have significant contributions to socio-economic transformation in host countries, countries of origin and countries of destinations in the event that refugees become migrant, which is sometimes the case. The Intergovernmental Authority on Development (IGAD) region, consisting of eight member states, namely, Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda, host more than 13 million forcibly displaced people. This results from protracted and devastating conflicts; drought and famine and other natural or man-made calamities. Within the IGAD region, Somalia, South Sudan and Sudan produce 80 to 90% of displacement due to protracted civil wars. However, almost all the member states have refugees, IDPs or migrants sheltered in their territories. Access to higher education among refugees, returnees and IDPs is very low at only 3% compared to 36% globally. The figure for Africa is still dismal, at less than 1%; and the same holds true for the IGAD region. In an effort to address this major challenge facing these population categories, the Intergovernmental Authority on Development (IGAD) convened a high level regional (Ministerial Conference) on refugee education held in Djibouti, 12-14 December 2017. That Conference adopted what is now called the Djibouti declaration and Plan of Action for refugee education in the IGAD region. The major purpose of this paper was is to outline the refugee situations in general and the state of higher education in the region in particular.

In this interview, Dr. Ozen Guven talks to Dr. Mary Mendenhall, Sonia Gomez, and Emily Varni about their research on teachers and teaching practices in contexts of forced displacement. Mendenhall, Gomez, and Varni recently authored "Teaching Amidst Conflict and Displacement: Persistent Challenges and Promising Practices for Refugee, Internally Displaced, and National Teachers," a background paper for the 2019 Global Education Monitoring Report on the challenges and opportunities available to teachers working in forced displacement settings. Drawing from their paper, which includes case studies from countries as diverse as Germany, Kenya, Chad, and Iraq, the authors discuss such topics as education planning, teacher professional development, teacher well-being and motivation, and teacher agency. Throughout the discussion, they highlight practices and policies that could be leveraged to strengthen support for teachers working in displacement contexts. Mendenhall, Gomez, and Varni are scholar-practitioners whose work focuses on the challenges faced by teachers in crisis contexts, and on the policies and practices that provide these teachers with comprehensive support. Guven's work examines teaching practices among Syrian refugees in Turkey.

While there is growing attention to language as a central issue in education for refugees, this policy area still appears to be dominated by an apolitical, technical, and instrumentalist perspective. Through a comparison of language-in-education policies in two refugee camp contexts, Kakuma Refugee Camp in Kenya and the refugee camps along the Thai-Myanmar border, this paper demonstrates how language policies are always deeply political in nature. In refugee contexts in particular, language policies in education reflect and reproduce existing power dynamics that can exclude refugees from decision-making processes about their own future. In Kakuma, language issues in education are decided by the international humanitarianism regime based on efficiency and cost-effectiveness over the linguistic rights of the refugee community. Even when refugees are in control in the Thai-Myanmar refugee camps, decisions over the language of instruction are still political choices that serve to exclude many people.

In this paper, we studied the implementation of a course on global history as a blended section of a massive open online course (MOOC) and the learning challenges faced by the students in three crisis contexts: Azraq refugee camp (Jordan), Kakuma refugee camp (Kenya), and Amman urban refugee center (Jordan). The results showed that poor Internet connection in the camps severely impacted both students' and instructors' experience of the course. In the context of chronic Internet connectivity issues, the instructors had difficulties assessing their students' needs and challenges. The results also showed that in light of these intermittent connection problems, the collaborative learning environment helped students navigate the challenges of a blended course. Also, the onsite visit by the online tutors and the face-to-face interactions that resulted from it had a noticeable impact on the human dynamics of the course by allowing instructors to provide targeted solutions to students' problems as well as by building rapport between the students and the instructional team.

As the number of refugees has continued to grow in post-independence Africa, host governments across the continent have developed stringent refugee policies that are detached from historical transborder relationships in which refugees and host communities interact. The stringent policies are underpinned by the assumption that host communities view refugees from the state-centric perspective of non-citizens as undesirable foreigners or outsiders. Host governments' insistence that the solution lies in refugees eventually repatriating to their countries of origin drives refugee policies that undermine solutions instead of building and capitalizing on solutions generated at the level of host communities. The exclusion of local histories and social dynamics in host regions has led to policies that neither hold up to humanitarian standards nor serve their intended non-integration objectives. Some host governments are reluctant to implement local integration and have maintained exclusionary policies for a long period of time when the realities in the host communities show that refugees are included and participate in various community activities. Host governments perpetuate this disjuncture between policy and local practice by assuming or pretending that refugees will wait for repatriation instead of finding solutions in the host countries where some of them have lived for decades. Contrary to the non-integration objectives of official encampment policies and scholarship that assumes that the absence of official integration policies deters integration, many refugees have defied the stereotypical portrayal of refugees as "bare life" which denotes prioritization of mere survival as opposed to the quality of life. They have managed to find solutions and live their lives as active and productive members of their host countries. This article specifically addresses the situation of Somali refugees in Ethiopia and Kenya. It argues that the absence of local integration policies or reluctance by host governments to implement them where they exist does not automatically mean that refugees are unable to integrate in their host countries. Host government policies against integration are mediated by refugees' self-initiative and resourcefulness. These characteristics are facilitated by host communities whose ties and mutual dependence with refugees, cultivated pre- and post-flight, play an important role in engendering solidarity and circumventing policies that hamper refugees' quest for long-term solutions. Based on the research findings, the paper recommends that host governments pursue policies that are informed by the shared needs and interests between refugee and host communities and that build on the social dynamics and relationships in refugee-hosting regions. [ABSTRACT FROM AUTHOR]

Background: Community engagement is crucial for the design and implementation of community-based early childhood development (ECD) programmes. This paper aims to share key components and learnings of a community engagement process for an integrated ECD intervention. The lessons shared are drawn from a case study of urban informal settlement with embedded refugees in Nairobi, Kenya., Methods: We conducted three stakeholder meetings with representatives from the Ministry of Health at County and Sub-County, actors in the ECD sector, and United Nations agency in refugee management, a transect walk across five villages (Ngando, Muslim, Congo, Riruta and Kivumbini); and, six debrief meetings by staff from the implementing organization. The specific steps and key activities undertaken, the challenges faced and benefits accrued from the community engagement process are highlighted drawing from the implementation team's perspective., Results: Context relevant, well-planned community engagement approaches can be integrated into the five broad components of stakeholder engagement, formative research, identification of local resources, integration into local lives, and shared control/leadership with the local community. These can yield meaningful stakeholder buy-in, community support and trust, which are crucial for enabling ECD programme sustainability., Conclusion: Our experiences underscore that intervention research on ECD programmes in urban informal settlements requires a well-planned and custom-tailored community engagement model that is sensitive to the needs of each sub-group within the community to avoid unintentionally leaving anyone out., (© 2022. The Author(s).)

The global spread of the coronavirus pandemic has particularly dramatic consequences for the lives of migrants and refugees living in already marginalised and restricted conditions, whose ongoing crisis is at risk of being overlooked. But refugees are not only extremely vulnerable and at risk of infection, as several reports show, quickly develop their own protection measures like the production of hygienic products, the publication of their situation and calls for action and help. Therefore, this paper aims to research the effects of the coronavirus crisis on refugees in camp settings with a special ethnographic focus on how refugees actively deal with this crisis and if they, through already developed resilience, are capable of adapting to the restrictions as well as inventing strategies to cope with the difficult situation. To account for the variety of refugee camps as well as the different living conditions due to their locality, history and national asylum politics, we will look at three different locations, namely refugee asylum homes in Germany, hotspots on the Greek islands as well as one refugee camp in Kenya. The main questions will be how, under structurally and institutionally framed conditions of power and victimisation in refugee camps, forms of agency are established, made possible or limited. The goal is to show which strategies refugees apply to cope with the enhanced restrictions and exclusion, how they act to protect themselves and others from the virus and how they present and reflect their situation during the coronavirus pandemic. Finally, this discussion offers a new perspective to consider refugees not only as vulnerable victims, but also as actively engaged individuals. [ABSTRACT FROM AUTHOR]

Large-scale development interventions have long failed to accommodate the needs and preferences of pastoralists or the systems of resource governance and land tenure upon which they rely. However, advocates of rights-based approaches to development emphasise the importance of community participation in planning and agenda-setting, and in Kenya, public participation is a formal constitutional requirement for government decision-making processes. In 2015, the United Nations High Commissioner for Refugees concluded negotiations with local stakeholders about the use of 15 km2 of communal rangelands to build a new refugee settlement in Turkana County, Kenya. Negotiations entailed a community dialogue process involving local people living in the vicinity of the proposed settlement. This paper retrospectively examines the inclusivity of the dialogue process, with particular attention to the involvement of pastoralists and the representation of their interests. Interviews and focus groups conducted with a range of key informants and community stakeholders highlighted two key problems. First, negotiations relied upon a simplistic approach to communal land tenure that overlooked the complexity of overlapping and often contested access rights. Second, there was an over-reliance on urban professionals and politicians as intermediaries between rural communities and development actors. Even where elite intermediaries act in good faith, they may introduce an 'oppidan bias' into development policies, thereby marginalising the viewpoints of non-urban, non-sedentary demographics, such as pastoralists. I conclude with recommendations for the UNHCR to develop a more explicit strategy for direct engagement with host community stakeholders in Turkana and with increased attention to the interests of livestock producers and the nuances of pastoralist land use. [ABSTRACT FROM AUTHOR]

This paper presents the results of a case study that analyses the critical factors that influence the implementation of professional health education via blended learning in Dadaab refugee camp. It explores innovative solutions to the issues facing refugees looking for professional health training, namely the health workforce shortage and lack of training opportunities. It outlines social and political factors that impact professional health education for refugee youth. It outlines barriers and facilitators on the implementation of 'Distance Basic Training of Healthcare Professionals', a blended training course provided by the University of Geneva to junior health care personnel in Dadaab Refugee camp., Methods: This case uses mixed methods. Descriptive statistics drawn from online surveys, learning analytics data, and exchanges on online forums and student chat groups are all used. Qualitative methods consist of two focus groups, comprising of all students (n = 27) were convened, as well as, individual semi-structured interviews with 14 of the 27 students; three with managers from the health service who supervised enrolled students; and two with senior managers who were responsible for staff and training decision-making. Qualitative data was transcribed, and thematic analyses were applied., Results: The results demonstrate that barriers for the implementation of professional education in a refugee camp emerged not only from the constraints on the environment, but also from barriers stemming from legislation and administrative procedures. Data suggested weaknesses on the education system could be addressed by providing students with extra-curricular support, information and communications technology (ICT) literacy, and promoting mechanisms for peer support while broadening entry requirements to increase the enrolment of female students. Finally, providing internationally credentialed courses and transferable skills enables professional pathways for refugee students., Discussion: Blended learning enables the design and delivery of high-quality medical education that is sustainable and relevant in a particular environment, e.g. refugee camps. Furthermore, the research reveals that building education pathways could enhance numbers of health workers with the appropriate skillset to serve communities.

Background: Humanitarian practitioners have recently expanded their focus from the provision of assistance only to working to ensure refugees and internally displaced peoples (IDPs) can develop sustained 'self-reliance'. However, few tools measure self-reliance, and even fewer capture non-financial dimensions of self-reliance or measure the construct within refugee and IDP populations. To help address these gaps in measurement and provide organizations with a tool to track households' self-reliance over time, the Self-Reliance Index (SRI) was developed. The index component of the tool comprises 12 domains of self-reliance, including housing, food, education, healthcare, health status, safety, employment, financial resources, assistance, debt, and savings, and social capital. This paper presents the methodology used to evaluate the tool's internal consistency and scoring validity, shares the corresponding findings, and offers a practical approach for developing a culturally relevant and robust tool for humanitarian settings. Results: Data were collected from 57 and 59 refugee households in Nairobi, Kenya, and Palenque, Mexico, respectively; repeat follow-up interviews were held with 34 and 33 households in Kenya and Mexico after a period of 3 months. Cronbach's alpha was found to be 0.66 in Kenya and 0.64 in Mexico, both of which met the a priori minimum threshold for internal consistency of 0.6. A data-driven process was used to inform the design of the scoring rubric for the SRI, prioritizing the tool's validity such that the final score would signal useful information about a household's overall level of self-reliance while also keeping the process as straightforward for users as possible. Final descriptive statistics and score distributions, considered alongside organizational knowledge of sample households and sensitivity analyses, suggest good score validity. Conclusions: The SRI aims to serve as an important step in measuring the complex subject of self-reliance in a comprehensive way and over time. Results suggest that, with some contextualizing for each setting, the universal tool offers a measurement approach that is feasible, reliable, and valid. By encouraging relevant stakeholders to more holistically conceptualize and measure self-reliance, the SRI also aims to promote a more cross-sector, all-inclusive approach to programming. [ABSTRACT FROM AUTHOR]

COVID-19 remains an income shock of significant economic consequence to many households across the world. The situation among refugees can be pathetic due to their inherent economic deprivations and vulnerability to income shocks. This paper analyzed the dynamics of poverty among refugees in Kenya during the COVID-19 pandemic and determined their correlates. The data were the first to fifth waves of the COVID-19 Rapid Response Phone Surveys that were conducted among refugees. The data were analysed with heteroscedasticity consistent Ordered Probit model. The results showed that with only 8.14% of the refugees never entering poverty within the survey periods, majority of the refugees were transiently (46.27%) and chronically (45.59%) poor. The error variance differed across household sizes, and heteroscedasticity was properly corrected. Movement from never being poor to chronic poverty was significantly promoted by urban residence, household size, educational levels, and camp of residence (Kakuma, Dadaab and Kalobeyei), while asset disposal income, amount of credit, remittance, and other gifts reduced it. It was concluded that efforts to reduce poverty vulnerability among refugees should among others address maternal fertility and promotion of policies to allow formally educated refugees to be gainfully engaged in the Kenyan labour markets. [ABSTRACT FROM AUTHOR]

Background and Aims: Accurate assessment of any patient relies on the use of appropriate measurements which are culturally‐ and linguistically‐applicable and valid. The following study aimed to translate, cross‐culturally adapt and test the nomological validity, structural validity, internal consistency, test‐retest reliability, sensitivity‐to‐change and feasibility of the Swahili version of the Pain Catastrophizing Scale (Swa‐PCS) among refugees who survived torture/war trauma living with chronic pain in Kenya. Methods: An observational study was conducted. Translation and cultural adaptation of the original PCS for the Swahili‐speaking refugee population in Kenya, who survived torture or war trauma was undertaken. Following this process, a validation study was conducted on the newly‐adapted instrument, to ascertain the psychometric properties (nomological validity, structural validity, internal consistency, test‐retest reliability, sensitivity‐to change, and ceiling and floor effects). Results: Fifty participants were included in this study. Correlations between pain catastrophization and fear‐avoidance behavior measures were significant (r = 0.538, p < 0.01). Ceiling effects were 42−48% with no floor effects. Standard errors of measurement values were between 0.938 and 3.38. Minimal‐detectable‐change values were between 2.17 and 7.82. Internal consistency was satisfactory to good, for the whole and subsections respectively (range α = 0.693−0.845). Magnification had the lowest α. Test−retest reliability was also satisfactory to good (range ICC = 0.672−0.878). Confirmatory factor analysis confirmed that the Swa‐PCS had three factors which explained the majority of the variance. Root mean square error of approximation and comparative fit index were calculated for goodness‐of‐fit assessment, and were 0.18 and 0.83, respectively. Conclusion: This study showed that the adapted Swa‐PCS displayed overall satisfactory to good internal consistency, test‐retest reliability and sensitivity‐to‐change. Furthermore, the Swa‐PCS scores were related to fear‐avoidance behavior scores as expected (nomological validity). Structural validation of the Swa‐PCS requires further investigation. Further testing of the psychometric properties of the Swa‐PCS is however warranted. [ABSTRACT FROM AUTHOR]

Involuntary displacement from conflict and other causes leads to clustering of refugees and internally displaced people, often in long-term settlements. Within refugee-hosting countries, refugee settlements are frequently located in isolated and remote areas, characterized by poor-quality land and harsh climatic conditions. Yet, the exposure of refugee settlements to climatic events is underresearched. In this article, we study the exposure of the 20 largest refugee settlements worldwide to extreme variations in climatic conditions. The analysis integrates exposure of camp locations compared to the national trends for both slow- and rapid-onset events and includes descriptive statistics, signalto- noise analyses, and trend analyses. Our findings show that most refugee settlements included face relatively high exposure to slow-onset events, including high temperatures (for settlements in Kenya, Ethiopia, Rwanda, Sudan, and Uganda), low temperatures (in the case of Jordan and Pakistan), and low levels of rainfall (in Ethiopia, Rwanda, Kenya, and Uganda) compared to national averages. Our findings for rapid-onset events--heatwaves, coldwaves, and extreme rainfall--are less conclusive compared to country trends, although we find relatively high exposure to extreme rainfall in Cox's Bazar, Bangladesh. Our analyses confirm that refugee populations are exposed to extreme weather conditions postdisplacement, which, in combination with their sociopolitical exclusion, poses a threat to well-being and increased marginalization. Our findings call for an inclusive and integrated approach, including refugees and their host communities, in designing climate adaptation and sustainable development policies, in order to promote equitable sustainable development pathways in refugee-hosting countries. [ABSTRACT FROM AUTHOR]

This paper summarises a public health intervention in Sydney, NSW in late 2006 that resulted from the potential exposure of a number of refugees to polio virus while in transit in Nairobi, Kenya. The intervention involved the attempted follow-up of 113 persons at risk, assessment for symptoms and immunisation where indicated. No symptomatic cases were found. Seventy-five people were immunised with inactivated poliomyelitis vaccine. The intervention highlighted the importance of close collaboration between health services, the Department of Immigration and Citizenship and settlement service agencies, and provided several lessons to consider when assessing newly arrived refugees.

Involuntary displacement from conflict and other causes leads to clustering of refugees and internally displaced people, often in long-term settlements. Within refugee-hosting countries, refugee settlements are frequently located in isolated and remote areas, characterized by poor-quality land and harsh climatic conditions. Yet, the exposure of refugee settlements to climatic events is underresearched. In this article, we study the exposure of the 20 largest refugee settlements worldwide to extreme variations in climatic conditions. The analysis integrates exposure of camp locations compared to the national trends for both slow- and rapid-onset events and includes descriptive statistics, signal-to-noise analyses, and trend analyses. Our findings show that most refugee settlements included face relatively high exposure to slow-onset events, including high temperatures (for settlements in Kenya, Ethiopia, Rwanda, Sudan, and Uganda), low temperatures (in the case of Jordan and Pakistan), and low levels of rainfall (in Ethiopia, Rwanda, Kenya, and Uganda) compared to national averages. Our findings for rapid-onset events--heatwaves, coldwaves, and extreme rainfall--are less conclusive compared to country trends, although we find relatively high exposure to extreme rainfall in Cox's Bazar, Bangladesh. Our analyses confirm that refugee populations are exposed to extreme weather conditions postdisplacement, which, in combination with their sociopolitical exclusion, poses a threat to well-being and increased marginalization. Our findings call for an inclusive and integrated approach, including refugees and their host communities, in designing climate adaptation and sustainable development policies, in order to promote equitable sustainable development pathways in refugee-hosting countries. [ABSTRACT FROM AUTHOR]

Introduction: Sexually minoritized men in the East, Horn, and Central Africa continue to flee from their countries, because of actual or feared persecution, to neighboring Kenya to seek protection and safety. However, there is limited research on their experiences and needs. Therefore, this study aimed to describe the persecution experiences of gay and bisexual asylum seekers and refugees in the Nairobi Metropolitan Area. Methods: We adapted McAdam's Life-Story Interview (LSI) to develop a semi-structured interview guide. We used the interview guide to conduct one-time anonymous in-depth interviews with 19 gay and bisexual men recruited by purposive sampling. The study also included a photovoice component and written reflections. We transcribed the interviews verbatim, uploaded them to NVivo 12 plus, and analyzed the data using Braun and Clarke's six-step thematic analysis framework. Results: The mean age of the participants was 26, with the largest age group being 18–24 (n = 9, 47%). We found six major themes: (1) The Anti-Homosexuality Act, (2) death punishment, (3) physical abuse, (4) sexual violence, (5) discrimination, and (6) injuries. Conclusions: Continued multi-layered discrimination across borders may have adverse physical health outcomes for gay and bisexual asylum seekers and refugees in the Nairobi Metropolitan Area. Further collaborative strategies may help to understand and develop culturally sensitive interventions to improve their health and well-being. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is increasing markedly in low- and middle-income countries where over three-quarters of global deaths occur due to non-communicable diseases. Unfortunately, these conditions are considered costly and often deprioritized in humanitarian settings with competing goals. Using a mixed methods approach, this study aimed to quantify the cost of outpatient treatment for uncomplicated type-1 (T1DM) and type-2 (T2DM) diabetes at a secondary care facility serving refugees in Kenya. A retrospective cost analysis combining micro- and gross-costings from a provider perspective was employed. The main outcomes included unit costs per health service activity to cover the total cost of labor, capital, medications and consumables, and overheads. A care pathway was mapped out for uncomplicated diabetes patients to identify direct and indirect medical costs. Interviews were conducted to determine inputs required for diabetes care and estimate staff time allocation. A total of 360 patients, predominantly Somali refugees, were treated for T2DM (92%, n = 331) and T1DM (8%, n = 29) in 2017. Of the 3,140 outpatient consultations identified in 2017; 48% (n = 1,522) were for males and 52% (n = 1,618) for females. A total of 56,144 tests were run in the setting, of which 9,512 (16.94%) were Random Blood Sugar (RBS) tests, and 90 (0.16%) HbA1c tests. Mean costs were estimated as: $2.58 per outpatient consultation, $1.37 per RBS test and $14.84 per HbA1c test. The annual pharmacotherapy regimens cost $91.93 for T1DM and $20.34 for T2DM. Investment in holistic and sustainable non-communicable disease management should be at the forefront of humanitarian response. It is expected to be beneficial with immediate implications on the COVID-19 response while also reducing the burden of care over time. Despite study limitations, essential services for the management of uncomplicated diabetes in a humanitarian setting can be modest and affordable. Therefore, integrating diabetes care into primary health care should be a fundamental pillar of long-term policy response by stakeholders. [ABSTRACT FROM AUTHOR]

Many refugee children face challenges accessing education, but refugee children with disabilities are especially vulnerable to exclusion from school environments as well as social settings. Mainstreaming is considered a best practice but may not always be feasible given the limited resources available in refugee camps. The purpose of this study is to examine the extent to which school setting (i.e., special needs vs. mainstream classrooms) is associated with changes in children's prosocial behaviors (i.e., social skills and ability to get along well with peers) and behavioral difficulties, accounting for disability status. In Kakuma Refugee Camp in Kenya, researchers collected two waves of data (approximately 2.5 years apart) for students enrolled in special needs schools (n = 78) and students who had transitioned from special needs schools into mainstream classrooms (n = 51). Children's average prosocial scores decreased between wave 1 and wave 2, but scores from children in special needs schools decreased at a lower rate indicating potential protective factors in these settings. While children's average total difficulties decreased over time, children's difficulties in special needs schools decreased at a faster rate, also indicating potential protective factors. Neither severity of disability nor gender significantly predicted change in prosocial or difficulties scores. In the context of a refugee camp, mainstreaming alone may not fully address the needs of children with disabilities. Specific factors seen in special education settings, such as individualized services, accessible accommodations, and infrastructure supports, must be considered as a means of creating inclusive educational environments. [ABSTRACT FROM AUTHOR]

Introduction: Many refugees face challenges accessing water, sanitation, and hygiene (WASH) services. However, there is limited literature on WASH access for refugee populations, including for menstrual health services. Unmet WASH access needs may therefore be hidden, amplifying morbidity and mortality risks for already vulnerable refugee populations. The aim of this study was therefore to quantitatively analyze WASH access among refugee camps, with a focus on households with women of reproductive age. Methods: This was a cross-sectional study that utilized the Standardized WASH Knowledge, Attitude and Practice (KAP) Survey. A total of 5632 household questionnaires were completed by the United Nations Refugee Agency in 2019 in 21 refugee camps and settlements in Bangladesh, Kenya, South Sudan, Uganda, and Zimbabwe. WASH access (14 items) and social and geographic stratifiers were analyzed at the household-level including the refugee camp, country of the settlement, having women of reproductive age, members with disability/elderly status, and household size. We calculated frequencies, odds ratios, and performed bivariate and multivariate analyses to measure inequalities. We developed a Female WASH Access Index to characterize WASH access for households with women of reproductive age. Results: Most refugee households had high levels of access to improved water (95%), low levels of access to waste disposal facility (64%) and sanitation privacy (63%), and very low access to basic sanitation (30%) and hand hygiene facility (24%). 76% of households with women of reproductive age had access to menstrual health materials. WASH access indicators and the Female WASH Access Index showed large inequalities across social and geographic stratifiers. Households with disabled or elderly members, and fewer members had poorer WASH access. Households with women of reproductive age had lower access to basic sanitation. Conclusions: Large inequalities in WASH access indicators were identified between refugee sites and across countries, in all metrics. We found high levels of access to improved water across most of the refugee camps and settlements studied. Access to basic hygiene and sanitation, sanitation privacy, waste disposal, and menstrual health materials, could be improved across refugee sites. Households with women of reproductive age, with 4+ members, and without members with disability/elderly status were associated with higher WASH access. The female WASH access index piloted here could be a useful tool to quickly summarize WASH access in households with women of reproductive age. Highlights: Most camps have improved sanitation, albeit often shared and with poor privacy. Most households had access to soap, but few had dedicated hand hygiene facilities. Households with women of reproductive age had lower access to basic sanitation. The Female WASH Access Index summarizes and compares female access across camps. Households with disabled or elderly members, and fewer members had poorer WASH access. [ABSTRACT FROM AUTHOR]

The Somali civil war of 1991 left thousands of refugees scattered in neighbouring countries. This article examines the situation of the 130,000 Somalis in their second decade in Dadaab camps in Kenya, with a particular focus on the role and responsibilities of the refugee regime and the host state. It is argued that these camps are characterized by deprivations of both material and physical security. Research found that refugees' dependency on inadequate aid is due to lack of alternative livelihoods rather than "dependency syndrome." However, participants expressed diminished "self-esteem" resulting from their prolonged encampment. Finally, the paper presents a critique of the failure to explore solutions for protracted refugee situations on the part of the international refugee regime. [ABSTRACT FROM AUTHOR]

Background: Refugees are at increased risk for COVID-19 infection in part due to their living conditions, which make it harder to adopt and adhere to widely accepted preventive measures. Little empirical evidence exists about what refugees know about COVID-19 and what they do to prevent infection. This study explored what refugee women and their health care workers understand about COVID-19 prevention, the extent of their compliance to public health recommendations, and what influences the adoption of these measures. Methods: In October 2020, we conducted 25 in-depth interviews with facility and community health care staff (n = 10) and refugee women attending antenatal and postnatal care services (n = 15) in Eastleigh, Nairobi. Findings: While researchers found a high level of awareness about COVID-19 and related prevention and control measures among refugee women, various barriers affected compliance with such measures, due in part to poverty and in part to rampant misconceptions informed by religious beliefs and political narratives about the virus. Conclusions: These findings indicated that Kenya's Ministry of Health needs to institute a concerted and continuous education program to bring refugee communities up to speed about COVID-19 and its prevention. In addition to disseminating information about the need to wear masks and repeatedly wash hands, supplies—masks, soap and access to water—need to be made available to poor refugee communities. Future research could explore which measures for disseminating factual information work best in refugee populations with different cultural norms and how best to target interventions to these groups. [ABSTRACT FROM AUTHOR]

Background: Post-sexual violence service utilization is often poor in humanitarian settings. Little is known about the service uptake barriers facing male survivors specifically. Methods: To gain insights into this knowledge gap, we undertook a qualitative exploratory study to better understand the barriers to service utilization among male survivors in three refugee-hosting countries. The study sites and populations included refugees who had travelled the central Mediterranean migration route through Libya living in Rome and Sicily, Italy; Rohingya refugees in Cox's Bazar, Bangladesh; and refugees from eastern Democratic Republic of the Congo, Somalia, and South Sudan residing in urban areas of Kenya. Methods included document review, 55 semi-structured focus group discussions with 310 refugees, semi-structured key informant interviews with 148 aid workers and human rights experts, and observation of service delivery points. Data were thematically analyzed using NVivo 12. Results: We identified eleven key barriers and situated them within a social ecological framework to describe impediments at the policy, community (inter-organizational), organizational, interpersonal, and individual levels. Barriers entailed: 1) restrictions to accessing legal protection, 2) legislative barriers such as the criminalization of same-sex sexual relations, 3) few designated entry points, 4) poor or nonexistent referral systems, 5) lack of community awareness-raising and engagement, 6) limited staff capacity, 7) negative provider attitudes and practices, 8) social stigma, 9) limited knowledge (at the individual level), 10) self-stigma, and 11) low formal help-seeking behaviors. Conclusion: The social ecological framework allowed us to better understand the multifaceted ways that the barriers facing male survivors operate and reinforce one another, and may be useful to inform efforts promoting service uptake. Additional research is warranted in other refugee settings. [ABSTRACT FROM AUTHOR]

The article focuses on the group of 630,000 Somali refugees in Kenya with attention paid to Eastleigh neighborhood in Nairobi, Kenya, known as Little Mogadishu due to the number of Somalis that live there. Topics include Somalia-based terrorist group al-Shabab, its terrorist attacks in Kenya, and the establishment of Eastleigh by British colonists in the 1920s. Suspicion against Kenyan Somalis, operations of Kenya Defense Forces, and the illegal money transfer network hawala are also discusses.

Background. The United Nations High Commissioner for Refugees (UNHCR) Health Information System is a primary source of routine nutrition program data and provides a comprehensive assessment of UNHCR selective feeding programs in more than 90 refugee camps in 18 countries worldwide. Objective. To evaluate the coverage and effectiveness of UNHCR supplementary and therapeutic feeding programs for malnourished children under 5 years of age in Kenya and Tanzania refugee camps. Methods. Analysis of Kenya and Tanzania refugee camp population, growth monitoring, and nutrition program data from the UNHCR Health Information System. Results. UNHCR-supported implementing partners in Kenya and Tanzania admitted nearly 45,000 malnourished refugee children in selective feeding programs between January 2006 and May 2009. Average recovery rates of 77.1% and 84.6% in the therapeutic and supplementary programs, respectively, mortality rates of less than 1%, and average readmission below 5% suggest that feeding programs had a beneficial effect on enrolled children. Conclusions. Increasing admission and enrollment in supplementary feeding programs was successful in preventing cases of severe malnutrition in some camps. Further attention to these camps would be likely to yield sizeable benefits in terms of absolute reductions in malnutrition prevalence and mortality rates. [ABSTRACT FROM AUTHOR]

Background. Micronutrient powder is a potential strategy to improve iron status and reduce anemia in refugee populations. Objective. To evaluate the effect of the availability of home fortification with a micronutrient powder containing 2.5 mg of sodium iron ethylenediaminetetraacetate (NaFeEDTA) on iron status and hemoglobin in women and children in the Kakuma Refugee Camp in northwest Kenya. Methods. Hemoglobin and soluble transferrin receptor were measured in 410 children 6 to 59 months of age and 458 women of childbearing age at baseline (just before micronutrient powder was distributed, along with the regular food ration) and at midline (6 months) and endline (13 months) follow-up visits. Results. At the baseline, midline, and endline visits, respectively, the mean (± SE) hemoglobin concentration in women was 121.4 ± 0.8, 120.8 ± 0.9, and 120.6 ± 1.0 g/L (p = .42); the prevalence of anemia (hemoglobin < 120 g/L) was 42.6%, 41.3%, and 41.7% (p = .92); and the mean soluble transferrin receptor concentration was 24.1 ± 0.5, 20.7 ± 0.7, and 20.8 ± 0.7 nmol/L (p = .0006). In children, the mean hemoglobin concentration was 105.7 ± 0.6, 109.0 ± 1.5, and 105.5 ± 0.3 g/L (p = .95), respectively; the prevalence of anemia (hemoglobin < 110 g/L) was 55.5%, 52.3%, and 59.8% (p = .26); and the mean soluble transferrin receptor concentration was 36.1 ± 0.7, 29.5 ± 1.9, and 28.4 ± 3.2 nmol/L (p = .02), in models that were adjusted for age using least squares means regression. Conclusions. In children and in women of childbearing age, the availability of micronutrient powder was associated with a small improvement in iron status but no significant change in hemoglobin in this refugee camp setting. [ABSTRACT FROM AUTHOR]

Resettlement to third countries is regarded as a durable solution to refugee crises. In Kakuma refugee camp in north-west Kenya, seeking a better life in industrialized countries has become a preoccupation for many refugees. In this article the effects of the practice of third country resettlement on the camp population are explored. Increased ease of communication with the diaspora, expanded knowledge of entitlements, and the high visibility of resettlement processing within the camp have increased the demand for resettlement. The article argues that the result is an environment that encourages refugees to cheat through claiming insecurity and negotiating vulnerability. Refugees come to believe that resettlement is something that can be actively achieved, rather than a benefit extended only to the genuinely vulnerable. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of anaemia (haemoglobin<11.0 to 13.0 g dl−1 depending on age and sex group), iron deficiency (transferrin receptor concentration>8.3 μg ml−1) and vitamin A deficiency (serum retinol <0.7 μmol l−1) in adolescent refugees.Design: Cross-sectional surveys.Setting: Kakuma refugee camp in Kenya and seven refugee camps in Nepal.Subjects: Adolescent refugee residents in these camps.Results: Anaemia was present in 46% (95% confidence interval (CI): 42–51) of adolescents in Kenya and in 24% (95% CI: 20–28) of adolescents in Nepal. The sensitivity of palmar pallor in detecting anaemia was 21%. In addition, 43% (95% CI: 36–50) and 53% (95% CI: 46–61) of adolescents in Kenya and Nepal, respectively, had iron deficiency. In both surveys, anaemia occurred more commonly among adolescents with iron deficiency. Vitamin A deficiency was found in 15% (95% CI: 10–20) of adolescents in Kenya and 30% (95% CI: 24–37) of adolescents in Nepal. Night blindness was not more common in adolescents with vitamin A deficiency than in those without vitamin A deficiency. In Kenya, one of the seven adolescents with Bitot's spots had vitamin A deficiency.Conclusions: Anaemia, iron deficiency and vitamin A deficiency are common among adolescents in refugee populations. Such adolescents need to increase intakes of these nutrients; however, the lack of routine access makes programmes targeting adolescents difficult. Adolescent refugees should be considered for assessment along with other at-risk groups in displaced populations. [ABSTRACT FROM AUTHOR]

Background: The study sought to determine the effect of using insecticide-treated clothes (ITCs) on personal protection against malaria infection. The specific objectives were to determine the effect of using ITCs on the rate of infection with malaria parasites and the effect on indoor mosquito density. Methods: This study was done in Dadaab refugee camps, North Eastern Province Kenya between April and August 2002, and involved a total of 198 participants, all refugees of Somali origin. The participants were selected through multi-stage cluster sampling. Half of the participants (treatment group) had their personal clothes worn on a daily basis (Diras, Saris, Jalbaabs, Ma'awis and shirts) and their bedding (sheets and blankets) treated with insecticide (permethrin). The other half (comparison group) had their clothes treated with placebo (plain water). Indoor mosquito density was determined from twelve households belonging to the participants; six in the treatment block and six in the comparison block. During pre-test and post-test, laboratory analysis of blood samples was done, indoor mosquito density determined and questionnaires administered. Using STATA statistical package, tests for significant difference between the two groups were conducted. Results: Use of ITCs reduced both malaria infection rates and indoor mosquito density significantly. The odds of malaria infection in the intervention group were reduced by about 70percent. The idea of using ITCs for malaria infection control was easily accepted among the refugees and they considered it beneficial. No side effects related to use of the ITCs were observed from the participants. Conclusion: The use of ITCs reduces malaria infection rate and has potential as an appropriate method of malaria control. It is recommended, therefore, that this strategy be considered for use among poor communities like slum dwellers and other underprivileged communities, such as street children and refugees, especially during an influx to malaria-prone regions. Further research on cost-effectiveness and sustainability of this strategy is worthwhile. [ABSTRACT FROM AUTHOR]

Examines the problem of insecurity in refugee-populated areas of Kakuma and Dadaab in Kenya. Domestic and community violence; Sexual abuse and violence; Armed robbery; Violent clashes between exiles of the same nationality in refugee-populated areas.

The article focuses on two reports related to global health including one on the role of urban refugees of Nairobi, Kenya in global health and another on the increasing risk of tuberculosis among foreign-borne populations. The former report suggests the need of establishing and strengthening health programs for Kenyan refugees in Nairobi, Kenya. While the later report suggests that worldwide tuberculosis elimination depends on enhanced surveillance and control among foreign-born persons.