School of Social Work, Virginia Commonwealth University, Richmond, VA, USA.
Center for Research on Ending Violence, The State University of New Jersey, Rutgers, NJ, USA.
Ethn Health. 2024 Nov;29(8):963-986. doi: 10.1080/13557858.2024.2385112. Epub 2024 Aug 1.
Forced migration and its subsequent sequelae have caused refugees to face significant adversities throughout the displacement process, making them susceptible to significant health issues. Refugees displaced in Africa are a group especially vulnerable to poor health outcomes, experiencing a documented decline in overall physical and mental health status and rise in mortality from non-communicable diseases (NCDs). Despite the heightened health risks experienced by Somali refugees, particularly women, research into their complex illness experiences and co-/multimorbid health conditions is scarce, leaving a gap in our understanding of the multifaceted health challenges of this population.
Using structural vulnerability theory, this study explores how the broader host context shapes illness experiences for Somali refugee women in Kenya. Specifically, we describe the factors associated with illness experiences of urban Somali refugee women and how this compares with women with other similarly situated identities, such as Somali Kenyan women, other/non-Somali refugees, and Kenyan women. In-depth interviews were conducted with 43 women in Eastleigh, Kenya.
Using hybrid thematic analysis, the emergent themes were grouped into three distinct domains: (1) multimorbid, complex illness experiences, (2) embodiment of structural vulnerability, and (3) distinct/shared vulnerability among refugee/non-refugee women. Results suggest that illness experiences of displaced refugee women are inextricably linked to traumatic experiences before displacement, as well as the experiences of transmigration stressors and the hostile socio-legal dynamics encountered post-displacement.
Our findings also have implications for the need to consider intersectional identities when examining for differential exposure to structural risks and the susceptibility to poor health experiences as well as supports the need for urgent change and improvement in systems of social protection and basic care for refugees experiencing prolonged displacement.
被迫迁移及其后续后果使难民在流离失所过程中面临重大困境，使他们容易受到重大健康问题的影响。在非洲流离失所的难民尤其容易受到健康状况不佳的影响，他们的整体身心健康状况明显下降，非传染性疾病（NCD）的死亡率上升。尽管索马里难民，尤其是妇女，面临更高的健康风险，但对他们复杂的疾病经历和共病/多种健康状况的研究很少，这使得我们对这一人群的多方面健康挑战的理解存在空白。
本研究使用结构脆弱性理论，探讨更广泛的宿主环境如何塑造肯尼亚索马里难民妇女的疾病经历。具体来说，我们描述了与城市索马里难民妇女疾病经历相关的因素，以及这与其他具有类似身份的妇女（如索马里肯尼亚妇女、其他/非索马里难民和肯尼亚妇女）的疾病经历相比有何不同。在肯尼亚东利阿雷进行了 43 名妇女的深入访谈。
使用混合主题分析，出现的主题分为三个不同的领域：（1）多种复杂的疾病经历，（2）结构脆弱性的体现，（3）难民/非难民妇女之间的独特/共同脆弱性。结果表明，流离失所难民妇女的疾病经历与流离失所前的创伤经历以及移民压力源的经历以及流离失所后面临的敌对社会法律动态密切相关。
我们的研究结果还表明，在检查结构性风险的差异暴露和对健康状况不佳的易感性时，需要考虑交叉身份，并且支持迫切需要改变和改善难民经历长期流离失所的社会保护和基本护理系统。
