Pathways to care: IDPs seeking health support and justice for sexual and gender-based violence through social connections in Garowe and Kismayo, Somalia and South Kivu, DRC

Self Cite

IntroductionTraditional, complementary and alternative medicine (TCAM) providers are central for many when seeking healthcare. Internally Displaced Persons (IDPs) are no exception. This paper seeks to better understand the use of TCAM by IDPs and its connection with the local integration of IDPs into the social fabric of the communities where they have taken refuge. We compare IDPs and non-IDPs access to TCAM providers and their level of confidence in having their healthcare needs met by these sources in Uvira and Kabare territories of South Kivu, Democratic Republic of Congo (DRC).MethodsWe draw from a mixed method, social connections design comprised of participatory workshops with 111 participants; a survey with 847 participants capturing exploring access and trust of TCAM and other wealth and demographic indicators; 24 interviews with traditional healthcare providers; and 56 in-depth life history interviews with IDPs. Collected data were analysed using both qualitative and quantitative approaches. Descriptive statistics (mean, percentage, and standard deviation) and statistical tests (proportions test and t test) were used as quantitative analysis tools whereas thematic content analysis was used for qualitative data.ResultsWe show that IDPs use TCAM more than non IDPs. Access to and trust in traditional healers seems dependent on the exact nature of the services they offer, which varies across our sample. As such, processes of recognition and integration of both IDPs and TCAM providers into formal healthcare systems should be treated cautiously with an understanding of the socio-economic rationales that displaced people and TCAM providers operate under. While many of these TCAM providers are not highly trusted sources in South Kivu, their highly valued treatment of certain conditions such as what is locally known as “mulonge” (and bears similarities with the Buruli ulcer) suggest there may be potential specific areas where collaboration could be successful between biomedical health workers and TCAM providers.

Section: Methodsmentioning

confidence: 99%

Section: Existing Researchmentioning

confidence: 99%

Traditional, complementary, and alternative medicine and the provision of health care to internally displaced persons in South Kivu, Democratic Republic of the Congo

Kazamwali,

Kisanga,

Balegamire

et al. 2024

Self Cite

“…The data collection was conducted in Garowe and Kismayo between 2020 and 2021. The study adapted the Social Connections Mapping Tool methodology to the displacement context Somalia (Strang and Quinn, 2021;Boeyink et al, 2022). The mapping tool combined participatory workshops (of 178 participants) which asked what people or institutions (social connections) people in their community turned to for health, mental health, and sexual and gender-based violence support.…”

Section: Methodsmentioning

confidence: 99%

Rethinking (local) integration: domains of integration and their durability in Kismayo and Garowe, Somalia

Bile,

Boeyink,

Ali-Salad

et al. 2024

Self Cite

Amidst the ever-expanding debates in various academic and policy fields around migrant and refugee integration and local integration, we bring these two concepts in conversation with one another. Until very recently, theories of integration have had a state-centric focus in the Global North. This article expands and complicates this literature to focus on displaced Somalis within Somalia and its borderlands living in the cities of Kismayo and Garowe using mixed qualitative and quantitative methods in five displacement settlements. Toward this end, we use the often- engaged term “domains of integration” to frame integration. In our conceptualization, however, we incorporate the concept of “local integration” as a durable solution. In brief, we see the domains of integration as a productive concept in the Somali context. However, in Somalia, where clans are interwoven into the state, which lacks resources and power, clan affiliation represents social connections domains, yet also influences the state's role in the foundational domain of rights and citizenship and makers and means (employment, housing, education, health). International donors and NGOs, as well as international capitalist urban expansion also have a large role in these processes. As such, we argue that the ten domains of integration (discussed in detail below) intersect and blur to an even greater extent than in European and North American contexts, particularly around crucial issues such as housing, land, and property; a key factor in people's decisions to remain or leave.

Perceptions of health: (dis)integration and (mis)integration of refugees in Nairobi, Kenya

Boeyink,

Metobo,

Wanga

et al. 2024

Self Cite

This article utilizes 40 in-depth interviews of healthcare workers (HCWs) including Kenyan nurses, medical doctors, psychologists, pharmacists, refugee NGO officers, and others based in Nairobi who come in professional contact with Congolese and Somali refugees on a regular basis. They were asked to describe barriers to healthcare, care seeking behaviors, and pathways to care that refugees experience. These responses are juxtaposed with 60 life-history interviews, exploring the same topics with Congolese and Somali refugees living in Kawangware and Eastleigh estates. In short, this article argues that refugees and HCWs have a shared understanding of the barriers to healthcare for displaced people, such as poverty, refugee documentation issues, and inadequacy of Nairobi’s healthcare system for marginalized populations. However, there is a significant disconnect in perspectives for how healthcare integration should take place regarding major causes of ill health, such as malnutrition and poor hygiene. Refugees understand oppression as a primary structural determinant of health, whereas many HCWs take an individualized view, advocating for modifications of knowledge and behaviors of refugees rather than adjusting structural issues. This is reflective of larger processes, whereby refugees are actively “(dis)integrated” by state and society and are observed by many Kenyans as “(mis)integrating,” or integrating “wrongly” or “badly,” which has major implications for how to shape possible policy interventions.