Exploring sources of insecurity for Ethiopian Oromo and Somali women who have given birth in Kakuma Refugee Camp: A Qualitative Study

English version

Autoři: Amber Trujillo Lalla ^aff001; Katherine Farrell Ginsbach ^aff002; Naomi Penney ^aff003; Arsity Shamsudin ^aff004; Rahul Oka ^aff005
Působiště autorů: University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America ^aff001; Eck Institute of Global Health, University of Notre Dame, Notre Dame, Indiana, United States of America ^aff002; Indiana University–Purdue University, Indianapolis, Indiana, United States of America ^aff003; Community Member, Kakuma Refugee Camp, Turkana, Kenya ^aff004; Anthropology Department, University of Notre Dame, Notre Dame, Indiana, United States of America ^aff005
Vyšlo v časopise: Exploring sources of insecurity for Ethiopian Oromo and Somali women who have given birth in Kakuma Refugee Camp: A Qualitative Study. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003066
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1003066

Souhrn

Background

According to the United Nations High Commissioner for Refugees, 44,000 people are forced to flee their homes every day due to conflict or persecution. Although refugee camps are designed to provide a safe temporary location for displaced persons, increasing evidence demonstrates that the camps themselves have become stressful and dangerous long-term places—especially for women. However, there is limited literature focused on refugee women’s perspectives on their insecurity. This qualitative study sought to better understand the ways in which women experienced insecurity at a refugee camp in Kenya.

Methods and findings

Between May 2017 and June 2017, ethnographic semi-structured interviews accompanied by observation were conducted with a snowball sampling of 20 Somali (n = 10) and Ethiopian Oromo (n = 10) women, 18 years and older, who had had at least 1 pregnancy while living in Kakuma Refugee Camp. The interviews were orally translated, transcribed, entered into Dedoose software for coding, and analyzed utilizing an ethnographic approach. Four sources of insecurity became evident: tension between refugees and the host community, intra -⁠ or intercultural conflicts, direct abuse and/or neglect by camp staff and security personnel, and unsafe situations in accessing healthcare–both in traveling to healthcare facilities and in the facilities themselves. Potential limitations include nonrandom sampling, the focus on a specific population, the inability to record interviews, and possible subtle errors in translation.

Conclusions

In this study, we observed that women felt insecure in almost every area of the camp, with there being no place in the camp where the women felt safe. As it is well documented that insecure and stressful settings may have deleterious effects on health, understanding the sources of insecurity for women in refugee camps can help to guide services for healthcare in displaced settings. By creating a safer environment for these women in private, in public, and in the process of accessing care in refugee camps, we can improve health for them and their babies.

Klíčová slova:

Health care facilities – Labor and delivery – Pregnancy – Qualitative studies – Rape and sexual assault – Somalian people – Oromo people – Ethnic groups

Zdroje

1. United Nations High Commissioner for Refugees. Global trends: forced displacement in 2018. Geneva: United Nations High Commissioner for Refugees; 2019 [Cited 2019 Sep 29] Available from: https://www.unhcr.org/globaltrends2018/

2. Lischer SK. Dangerous sanctuaries: refugee camps, civil war, and the dilemmas of humanitarian aid. Ithaca (NY): Cornell University Press; 2015.

3. Guttieri K. Humanitarian space in insecure environments: a shifting paradigm. Strategic Insights. 2005;6(11):1–7.

4. Mwaruvie J, Kirui P. The dilemma of hosting refugees: a focus on the insecurity in north-eastern Kenya. Int J Business Soc Sci. 2012;3(8):161–71.

5. Crisp J. A state of insecurity: the political economy of violence in Kenya’s refugee camps. Afr Aff (Lond). 2000;99(397):601–32.

6. Nilsson HM. Sudanese and South Sudanese refugee women’s sense of security in Kakuma refugee camp [thesis]. Uppsala: Uppsala University; 2013 [cited 2020 Feb 21]. Available from: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-203455

7. Mwangi CW. Women refugees and sexual violence in Kakuma Camp, Kenya [thesis]. The Hague: International Institute of Social Studies; 2012.

8. Macassa G, Winersjö R, Wijk K, McGrath C, Ahmadi N, Soares J. Fear of crime and its relationship to self-reported health and stress among men. J Public Health Res. 2017;6(3):1010. doi: 10.4081/jphr.2017.1010 29441331

9. Bonomi AE, Anderson ML, Rivara FP, Thompson RS. Health outcomes in women with physical and sexual intimate partner violence exposure. J Womens Health. 2007;16(7):987–97.

10. Masterson AR, Usta J, Gupta J, Ettinger AS. Assessment of reproductive health and violence against women among displaced Syrians in Lebanon. BMC Womens Health. 2014;14(1):25. doi: 10.1186/1472-6874-14-25 24552142

11. Vemuru V, Oka R, Gengo R, Gettler L. Refugee impacts on Turkana hosts: a social impact analysis for Kakuma Town and Refugee Camp, Turkana County, Kenya. Washington (DC): World Bank; 2016. doi: 10.1596/25863

12. United Nations High Commissioner for Refugees. Kakuma Camp & Kalobeyei Settlement: visitors guide. Geneva: United Nations High Commissioner for Refugees; 2018 [cited 2020 Feb 2]. Available from: https://www.unhcr.org/ke/wp-content/uploads/sites/2/2018/02/UNHCR-Sub-Office-Kakuma-Visitors-Guide.pdf

13. United Nations High Commissioner for Refugees. Camp population statistics by country of origin, sex, and age group. Geneva: United Nations High Commissioner for Refugees; 2017 [cited 2019 Sep 18]. Available from: https://data2.unhcr.org/en/documents/download/57210

14. Oka R. Unlikely cities in the desert: the informal economy as causal agent for permanent “urban” sustainability in Kakuma Refugee Camp, Kenya. Urban Anthropol Stud Cult Syst World Econ Dev. 2011;40(3/4):223–62.

15. Creswel JW. Research design: qualitative, quantitative, and mixed methods approaches. 3rd edition. Thousand Oaks (CA): Sage Publications; 2009.

16. Corps Mercy. Analysis of host community–refugee tensions in Mafraq, Jordan. Portland (OR): Mercy Corps; 2012 [cited 2019 Sep 17]. Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/Mercy%20Corps_JordanSyriaRefugee_ConflictReport_0213.pdf

17. Search for Common Ground. A victory for coexistence. Washington (DC): Search for Common Ground; 2016 Jan 15 [cited 2020 Jan 1]. Available from: https://www.sfcg.org/victory-for-coexistence/

18. Felix Da Costa D. “You may think he is not a human being”: refugee and host community relations in and around Nduta and Mtendeli refugee camps, western Tanzania. Copenhagen: Danish Refugee Council; 2017 [cited 2019 Oct 3]. Available from: https://drc.ngo/media/4428144/drc-tanzania-relationships-between-refugees-and-host-communities-december-2017.pdf

19. Gengo RG, Oka RC, Vemuru V, Golitko M, Gettler LT. Positive effects of refugee presence on host community nutritional status in Turkana County, Kenya. Am J Hum Biol. 2018;30(1):e23060. doi: 10.1002/ajhb.23060 28976046

20. Jacobsen K. Livelihoods in conflict: the pursuit of livelihoods by refugees and the impact on the human security of host communities. Int Migr. 2002;40(5):95–123. doi: 10.1111/1468-2435.00213

21. Loescher G, Milner J. Protracted refugee situations and state and regional insecurity: analysis. Conflict Security Dev. 2004;4(1):3–20. doi: 10.1080/1467880042000206831

22. Brankamp H. ‘Occupied enclave’: policing and the underbelly of humanitarian governance in Kakuma refugee Camp, Kenya. Polit Geogr. 2019;71 : 67–77. doi: 10.1016/j.polgeo.2019.02.008

23. Wirtz E. The inhumanity of humanitarian aid: gender and violence in a Kenyan refugee camp [dissertation]. West Lafayette (IN): Purdue University; 2017.

24. Sakaria PA. Gendered approach to security and violence in refugee camps [undergraduate thesis]. New York: Pace University; 2017 [cited 2020 Feb 21]. Available from: http://digitlacommons.pace.edu/honorscollege_theses/162

25. Oluoch-Aridi J, Smith-Oka V, Milan E, Dowd R. Exploring mistreatment of women during childbirth in a peri-urban setting in Kenya: experiences and perceptions of women and healthcare providers. Reprod Health. 2018;15(1):209. doi: 10.1186/s12978-018-0643-z 30558618

26. Warren CE, Njue R, Ndwiga C, Abuya T. Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions. BMC Pregnancy Childbirth. 2017;17(1):102. doi: 10.1186/s12884-017-1288-6 28351350

27. Gill O. Greek hospitals deepen trauma for refugee women giving birth. The Guardian. 2016 Dec 19. Available from: https://www.theguardian.com/global-development-professionals-network/2016/dec/19/greek-hospitals-deepen-trauma-for-refugee-women-giving-birth

28. Clark C, Ryan L, Kawachi I, Canner MJ, Berkman L, Wright RJ. Witnessing community violence in residential neighborhoods: a mental health hazard for urban women. J Urban Health. 2008;85(1):22–38. doi: 10.1007/s11524-007-9229-8 17965940

29. Mansour H, Rees DI. Armed conflict and birth weight: evidence from the al-Aqsa Intifada. J Dev Econ. 2012;99(1):190–9. doi: 10.1016/j.jdeveco.2011.12.005

30. Rich-Edwards JW, Grizzard TA. Psychosocial stress and neuroendocrine mechanisms in preterm delivery. Am J Obstet Gynecol. 2005;192(5):S30–5. doi: 10.1016/j-ajog.2005.01.072 15891710

31. Zapata BC, Rebolledo A, Atalah E, Newman B, King MC. The influence of social and political violence on the risk of pregnancy complications. Am J Public Health. 1992;82(5):685–90. doi: 10.2105/ajph.82.5.685 1566947

32. Oka RC. Coping with the refugee wait: the role of consumption, normalcy, and dignity in refugee lives at Kakuma Refugee Camp, Kenya. Am Anthropol. 2014;116(1):23–37. doi: 10.1111/aman.12076

Článek Illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh: A cross-sectional study

Článek Safety, tolerability, and immunogenicity of influenza vaccination with a high-density microarray patch: Results from a randomized, controlled phase I clinical trial

Článek Associations of adverse childhood experiences with educational attainment and adolescent health and the role of family and socioeconomic factors: A prospective cohort study in the UK

Článek Maternal and child gluten intake and association with type 1 diabetes: The Norwegian Mother and Child Cohort Study

Článek Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study

Článek Factors affecting the electrocardiographic QT interval in malaria: A systematic review and meta-analysis of individual patient data

Článek Mapping and characterising areas with high levels of HIV transmission in sub-Saharan Africa: A geospatial analysis of national survey data

Článek Paediatric emergency department utilisation rates and maternal migration status in the Born in Bradford cohort: A cross-sectional study

Článek Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013–2017: A cross-sectional study

Článek Evaluation of a very brief pedometer-based physical activity intervention delivered in NHS Health Checks in England: The VBI randomised controlled trial

Článek Long-term trends in death and dependence after ischaemic strokes: A retrospective cohort study using the South London Stroke Register (SLSR)

Článek Conscientious vaccination exemptions in kindergarten to eighth-grade children across Texas schools from 2012 to 2018: A regression analysis