Towards more inclusive urban health systems for refugee wellbeing

The British Academy’s Cities and Infrastructure programme funded IIED to work with partners in Kampala, Uganda and Nairobi, Kenya to undertake research on access to healthcare and other basic services for urban refugees.

September 2017 - March 2019
Lucy Earle

Director, Human Settlements

Urban health equity
Multifaceted partnerships to promote the social, environmental and political determinants of urban health
A woman sitting on steps, with colourful handkerchiefs arranged in front of her

A Congolese refugee sells handkerchiefs in Kampala. Uganda is known internationally for its positive policy towards refugees (Photo: Will Monteith, IIED)

Men, women and children who are forced to flee their homes often bear the mental or physical scars of conflict. Refugees’ arduous journeys to urban areas and the conditions they encounter there can present further health challenges.

Many face significant obstacles to accessing adequate healthcare, including cost, lack of documentation and language barriers.

Living conditions are another concern: overcrowded housing with inadequate water, sanitation and energy can negatively affect refugees’ health. Tensions with host communities can also negatively affect wellbeing.

This research project looked for ways to dismantle the barriers that prevent urban refugees accessing the healthcare, housing and infrastructure they need.

What IIED did

IIED partnered with two organisations in the two cities to gather data on how refugees access healthcare and other services, and the barriers they face.

In Kampala, IIED’s Human Settlements research group worked, for the first time, with a small civil society organisation, Young African Refugees for International Development (YARID). In Nairobi, IIED worked with a long-standing partner and research institution, the African Population and Health Research Centre (APHRC). In addition to the different nature of the organisations, the methods employed in each city were also diverse.

In Kampala, Congolese, South Sudanese, Somalian and Burundian refugees were trained to gather qualitative data on how refugees access basic services, including healthcare and water and sanitation, and reflect on the results.

The research included interviews and focus group discussions with urban refugees, and interviews with agencies and frontline workers who interact with refugees.

The data shed light on some of the challenges refugees face in accessing basic services. In addition, the approach gave refugee researchers insights into the trajectories and experiences of other communities in the city and strengthened links between all the communities involved.

As a result, leaders from each refugee community have tried and tested skills in research and participatory methods that can be developed and applied beyond the life of the project.

In Nairobi, APHRC worked with refugee community representatives to identify refugee households and collected primary data using focus group discussions, interviews and a cross-sectional household survey. Specifically, they sought to assess refugee access to shelter and vital infrastructure and services, including water, sanitation and energy.

APHRC introduced a comparative element into the research looking at key health challenges facing newly arrived and longer-term refugees, and by using secondary data analysis to compare refugee access to healthcare and other vital infrastructure and services with that of residents in Nairobi’s informal settlements. Key policy recommendations stemming from the work included how municipal authorities should prioritise refugee access to healthcare by addressing the most significant barriers, including cost, documentation and language.

At the end of the project, IIED held a workshop in Kampala, bringing together refugees and local community leaders, and representatives from the Kampala Capital City Authority, the Office of the Prime Minister (the national body with responsibility for refugees), and UN refugee agency UNHCR. Also in attendance was the mayor of Koboko, a city in the north of the country that hosts refugees from both the Democratic Republic of Congo and South Sudan.

Participants recognised that it was rare to have this configuration of actors in the room, and the discussions were lively. Refugees spoke movingly of their difficulties of accessing healthcare but their determination to pursue a future for themselves and their families in the city – not in a rural refugee camp.

Municipal representatives demonstrated their concern to provide support for refugees, recognising that Ugandans have in the past sought sanctuary in neighbouring countries.

Overall the workshop brought to light the tensions involved in hosting refugees in a city where basic services are already stretched, but confirmed the prominent and positive position that Uganda holds within the international community for its relatively open policy towards refugees.