Work Package 3
In order to map the types of healthcare providers that displaced people turn to for treatment for chronic physical and mental health conditions associated with protracted displacement, conflict, and gendered violence, we deployed social connections analysis via a social mapping methodology developed at Queen Margaret University (QMU). The mapping incorporated individuals across our different field sites (i.e. camp and informal settlements in Somali and Eastern DRC, and Somali and Congolese refugee settlements in Nairobi and Johannesburg).
Social mapping draws on individual interviews to identify: a) all existing support resources (within and outwith formal health system structures) identified by displaced people with neglected health conditions; b) how they use these resources; and c) the relative importance they attribute to each of these available resources. This illuminates the relative importance of each health provider both in terms of volume but also in symbolic values (where do people choose to go, and for which conditions). Where possible we hope to be granted access to primary healthcare centre archives and usage data (e.g. Health Information System) that can be used to complement our work on these questions.
In the second stage, we turned to those providers to understand how they operated. Through a documentary review and semi-structured interviews with health personnel working at different centres/levels of the healthcare system setting (that will have been identified via the survey), we produced an overall analysis of the health systems structure, management, and functioning.
Somalia and DRC
- Much research on IDP health focuses on the barriers that IDPs face in accessing healthcare. While these obstacles are myriad, we used a social connections methodology to analyse what IDPs actually do and where IDPs actually turn in times of need, within and beyond the formal healthcare system.
- Comparing Somali and Congolese IDPs in four field sites in Somalia and the Democratic Republic of Congo, we see significant similarities and overlaps in pathways to care.
- While taking into account the significant lack of resources and capacity of the formal healthcare systems of these countries, we found that the pathways to care IDPs take is also contingent upon cultural and gendered beliefs and practices.
- When individuals and households need to seek support, they toggle through possible social connections in an almost algorithmic fashion based on the nature of health issue; their understandings of what caused the health problems; and the social, cultural, and material capital at their disposal.
- For Congolese and Somali Migrants “deep sadness” is exacerbated by mistrust, GBV and a fear of the future: Mental health challenges considered in terms of failure, committing-sin, breaking with the norm; Mental health is stigmatised – people laugh and ridicule.
- Migrants generally do not seek help from formal, public health services: Awareness they will not be seen or treated well; Stigma around mental health; Lack of information and resources; Do not trust/belief in formalised (Westernised) health systems.
- Role of churches and faith is supportive and stigmatising: Many migrants seek support through churches and the communities within; However, churches sometimes increase stigma, judgement and deter migrants from seeking formal help.
- Support networks are critical to responding to mental health but vary: Congolese migrants are part of “disorganised and disjointed” communities in comparison to the tight support networks amongst Somali communities.
Main banner photo by: SIDRA