Developing a Culturally Relevant Psychosocial Intervention Model for Urban Somali Refugees in Kenya

Background and purpose: Violent social conflict provokes complex humanitarian emergencies including refugee situation. High prevalence of common mental disorders including PTSD and depression is common among refugees and yet mental health care and psychosocial support for them is meager during migration process. In fact, over 50% of refugees are placed in urban settings in low income countries where mental health care is deprioritized or ignored due to lack of resources and capacity as well as high stigma. Insecurity of a low-resource transit country often deteriorates appropriate assistance while shrinking humanitarian space and aggravates vulnerable situation of refugees. In this regard, the current study was developed to address such gaps in mental health and psychosocial support for refugees in a transit country where resources are limited and to develop a culturally and contextually relevant intervention model that is grounded to the community and thus increases acceptance and sustainability.

Methods: The study was conducted as a community-based participatory research partnering with a local Somali medical center and a Kenyan mental health foundation as well as the Somali refugee community in Eastleigh, Nairobi. Community needs assessment was performed through 12 focus group interviews (FGIs) with 120 key community stakeholders in Somali community, including community/religious leaders, school teachers, parents, health/civic service providers, traditional healers, youth at risk and youth leaders, etc. Template analysis was adopted to analyze the FGI data. Based on the FGI results, the research team developed a culturally sensitive and contextually responsive psychosocial intervention model that consists of Training of Trainer, psychoeducation, and support groups in series.

Results: The needs assessment revealed that mental health issues including PTSD and substance abuse are pervasive among Somali adolescents in Eastleigh, which leads them to easy prey to criminality and extremism, either religious or tribal. Trauma as well as daily exposure to community violence erodes sense of community and cultural identity, and experiences of discrimination and conflicts with locals in the host community exacerbate distrust in local systems/government. Internal conflicts that led to the civil war and Somali diaspora also still remain unsolved and kept alive in the community, which conveys trauma from generation to generation and aggravates mental health issues. The paper will discuss short and long term deliverables that the community stakeholders elaborated to address such issues and to build and rebuild psychosocial support system for enhanced capacity and resilience of the community.

Conclusions and implications: This project corroborates abundant needs for psychosocial and mental health support for urban refugees in low resource settings. Efforts on restoring and developing a culturally sensitive intervention model in the community should not only involve capacity building of community leaders and para-professionals, which is vital to sustainability, but also be embedded to community development planning that can promote livelihood of refugees and local service systems. Policy and legal advocacy for the refugees in protracted situation is also critical in searching for durable solutions for the community. Implications for future research will be discussed along with the challenges in international participatory research and importance of multilateral collaboration.