Improving healthcare at the intersection of gender and protracted displacement amongst Somali and Congolese refugees and IDPs

This project aims to help displaced people to access appropriate healthcare for long-term physical and mental health conditions associated with protracted displacement, conflict, and gendered violence. The category of Sexual and Gender-Based Violence (SGBV) receives a great deal of attention. However, there is limited research on how gendered violence, including violence relating to sexuality, is experienced in displacement contexts. There is also limited understanding of how gender, sexuality, and related violence affect access to healthcare, and how that can result in neglected chronic health conditions, particularly mental ill-health. Similarly, much attention is devoted to immediate healthcare needs following SGBV, but longer-term physical and mental health conditions are not adequately addressed. Displaced people face multiple barriers when seeking healthcare in protracted displacement settings, with the result that long-term health conditions are often misdiagnosed and mistreated or undiagnosed and untreated.

This project examines access to care and the responsiveness of healthcare providers for displaced Congolese and Somalis in Eastern Democratic Republic of Congo (DRC), Somali, Kenya, and South Africa. Eastern DRC and Somalia have both experienced long-term conflict and displacement since the early 1990s, leading to large populations of Internally Displaced People (IDPs) within these countries and large refugee populations across the region. Conflict and displacement in Eastern DRC and Somalia are characterised by high rates of sexual and gender-based violence, and victims are stigmatised through prevailing gender and sexual norms. Existing health research tends to focus on the immediate aftermath of violence rather than on long-term mental and physical health conditions. The project has eight field sites in four countries. The four IDP field sites are one formal camp and one informal settlement each in Eastern DRC and Somalia, both of which have weak health systems. The four refugee field sites are Congolese and Somali settlements in Kenya and South Africa, which have different health systems and different refugee laws and policies.

The project brings together researchers and practitioners from international development, migration studies, gender studies, medical anthropology, public health and health policy, and medical sciences to undertake interdisciplinary empirical research in these protracted displacement contexts. Panzi Foundation (DRC) and War Trauma Foundation (Netherlands) will guide teams of researchers based at the University of Edinburgh (UK), the University of Kinshasa (DRC), the Somali Institute for Development and Research (Somalia), Amref International University (Kenya), and the University of Witwatersrand (South Africa). Project activities are designed to: 1) enhance the capacity of partner organisations; 2) support the inclusion of displaced people in healthcare systems; 3) foster international networks.

This project aims to have a direct impact on the health of those affected by displacement in Eastern DRC, Somalia, Kenya, and South Africa. It will:
* improve diagnosis, provision, and accessibility of healthcare for neglected chronic physical and mental ill-health conditions amongst displaced populations.
* help develop resilient, responsive, inclusive health systems which ultimately contribute to strong and welcoming societies.
* support the development of mechanisms and organisations that empower displaced communities when they seek healthcare.

Through interactive knowledge exchange with key stakeholders, this project will influence working practices in health systems and among those who organise and/or support displaced people in protracted situations. In-country and cross-country workshops during the initial and final stages of the project will foster dialogue and knowledge exchange between key knowledge users (activists, health practitioners, academics, policy-makers, and displaced people). Phase I workshops will also allow us to better identify the stakeholders' priorities and willingness to implement change, which are relevant for the refined research design and maximisation of research uptake. Finally, the workshops will improve our mapping of the key stakeholders, including (grassroots) groups and the private sector that are less visible to us at the moment. The project will impact upon three main user categories:

A. Internally Displaced Persons (IDPs) in Somalia and Eastern DRC and refugees and asylum seekers in Nairobi and Johannesburg, and the wider public living in the region. The project will generate positive health and societal impacts, including:
* developing displaced peoples' (and medical personnel's) awareness of neglected chronical health conditions in their communities. This increases the chances of proper diagnosis, and then treatment.
* improving the understanding of chronic health issues affecting displaced communities amongst the wider public and civic society (through dissemination events and social media), which is key to building a coalition for increasing displaced people's rights and access to healthcare services.

B. NGOs, civil society, local organisations of displaced people and/or working on access to healthcare. The project's innovative methods of engagement will enhance the impact and effectiveness of support structures for displaced populations:
* the co-design and co-delivery of the project will enhance the research and advocacy capacity of the project partners and civil society organisations involved in our workshops. It will also help identify areas for further work, during and beyond the project, on chronic neglected conditions.
* long-lasting relationships amongst project collaborators will be fostered through the project's activities, thereby contributing to refining and circulating approaches that make healthcare services more responsive to the needs of displaced people during and beyond the project.

C. Policymakers including those responsible for governing and reforming health systems and/or IDP/refugee policies: Ministries of Health, United Nations agencies (particularly WHO, IOM and UNHCR), and influential patients/displaced people's groups and networks such as Refugees International or the People Health's Movement:
* dedicated outputs and policy engagement workshops will feed directly into national policies and national health plans, with clear proposals for accruing effective access to healthcare for displaced people. Health plans, which are developed every 4-6 years in our target countries, and WHO, IOM, and UNHCR strategies guide governmental and non-government interventions.
* engagement between country-based practitioners and transnational actors will enable networks with a lobbying remit to uptake our research insights into best practices on health and displacement and campaign for change outside our countries of focus.