This Doctoral Dissertation Research Improvement award examines the health implications in a region of long-term refugee settlement. The process of creating and maintaining refugee settlements has a significant impact on local landscapes, both physical and social, and therefore has implications not only for refugees, but for also for the people who live in the areas where refugees have been forced to settle. This project will specifically consider the health outcomes of refugee communities and their neighbors, as well as illuminate the relationship between the political acts needed to create refugee camps and the outcome of those acts as related to health and mortality. This project will consider the case of Congolese refugee communities in western Uganda to investigate this issue. The investigators will conduct an analysis of epidemiologic surveillance data for 1992-2012 from clinics in the study area to identify morbidity rates and trends for key populations. The investigators will also conduct a household survey, focus groups and semi-structured interviews with refugees, their local neighbors, and representatives from the authorities that run the camps in order to understand the local political process of refugee camp settlements.
This project will contribute epidemiologic information that will be of use to groups involved in providing humanitarian aid in refugee areas. It will produce findings that have the potential to inform governments and humanitarian aid organizations including those from the United States, the United Nations, and relevant non-governmental organizations. Furthermore, the project will contribute to the ongoing debate about the status and treatment of refugees regionally and globally. Worldwide, violent conflicts continue to displace millions of people, many of whom subsist precariously in poor places near conflict zones. Both the health and wellbeing of the displaced and those they come to live among are impacted by this process and this investigation will shed lights on ways to improve the outcomes of these communities. As a Doctoral Dissertation Research Improvement (DDRI) award this project will provide critical career support to a promising student researcher.
This study examined the intersection of politics and health care provision in the context of two sites in Uganda where large numbers of refugees live alongside Ugandan neighbors. The researchers employed a mix of survey research, archival review of health center data and qualitative methods such as interviews and structured group discussions. The goal of the project was to investigate the how land use, access to health services and refugee-Ugandan relations affect each other holistically. The intellectual merit of this project lies in bringing together disparate approaches from medical/health geography and political geography, and promises to contribute to refugee studies by providing a better framework for understanding host-refugee reactions. Rather than considering refugee and Ugandan communities in isolation, this study explicitly focuses on what the communities share (specifically health services, locale, and civil society institutions) and how they interact with each other. The broader impact of this study lies in its potential to contribute to ongoing efforts to provide humanitarian care and reduce political and social instability due to forced migration. As of 2015, Uganda hosts over 350,000 refugees from the Democratic Republic of the Congo, South Sudan and other neighboring countries. Uganda has been an important and welcoming host for refugees for decades, and the refugee-oriented programs in Uganda receive important support from the United States government. (Most US government support is channeled via the United Nations High Commission for Refugees [UNHCR], but a significant amount is also provided by direct grants to non-governmental service providers.) At a time when many states are reducing the number of refugees they are willing to accept, the Ugandan government continues to welcome refugees and to provide them land on which to sustain themselves. Unusually, refugee health services in Uganda are integrated with Ugandan government health services, and both Ugandans and refugees who use the health clinics in refugee-hosting areas benefit from the pooled resources of the Ugandan Ministry of Health, UNHCR and other partners. However, since 2012 there have been protests and political tension in some refugee-hosting areas due to local Ugandan objections to land being given to refugees. This study is intended to provide actionable information for improving Ugandan and refugee health care, as well as understanding how and why refugees and Ugandan host communities may come in to conflict. Analysis of the results of this study is ongoing. Preliminary findings indicate that establishment of a refugee community in Uganda can lead to a rapid increase in access to health care and use of health services among Ugandans living in the area. There is a broad sympathy toward refugees among Ugandans in the refugee-hosting areas, but there is also concern that refugees may receive privileged access to health care and other services. Land remains an intensely controversial issue for both Ugandans and refugees. Both survey research and qualitative research indicates that Ugandans and refugees can and do maintain important connections through social, business and religious institutions that fall outside the supervision of service providers like the Government of Uganda, the UN and partnering NGOs. These connections are intensely important in maintaining positive Ugandan-refugee relations, and although they cannot be created by government and NGOs, they may be fostered and protected.
