Intersection of War, Daily Stressors, and Community Adversity: Mental Health Risk Among Urban Somali Refugees in Kenya

Background: Refugee literature tends to focus on experiences related to resettlement in high-income or refugee camp contexts, leaving a gap in understanding the unique needs of refugees who resettle in low-income countries or urban settings. As a consequence of war trauma, urban refugees face increased rates of mental health and substance abuse issues, along with other sociopolitical adversities, such as lack of access to resources, safety and legal protection. As increasingly more refugees resettle in urban contexts in effort to obtain means for livelihood and education, understanding the unique conditions, stressors and adversities from war trauma and forced migration and urban settlement is imperative to ensuring contextually relevant and competent practice with these communities. This study explores major stressors perceived by Somali refugees in Nairobi, Kenya, in order to understand unique needs and gaps in mental health and psychosocial support faced by urban refugees in low resource settings.

Methods: This study adopted a qualitative rapid appraisal method, using focus group interviews with key stakeholders and community leaders in Eastleigh, Kenya Using snowball sampling, total 12 focus groups were formed: community leaders, religious leaders, teachers, parents, traditional healers, health and mental health providers, Kenyan civic service providers including law enforcement, youth leaders, at-risk youth (male and female separately), and local community-based organization staff. Each group, except for one, consisted of 10 Somali refugees. The civic service group included officers from Kenyan government offices and Kenyan local district representatives surrounding Eastleigh area. A thematic analysis was utilized in effort to reveal meaning as it emerged from the data. The authors extracted themes after in vivo coding, which were arranged into one of the two thematic categories:  individual and interpersonal challenges that obstruct individual social functioning; and collective and societal issues that create structural barriers to the refugee community as a whole.

Findings: Somali refugees in urban Nairobi face numerous stressors that impede individual functioning and mental health. Common risk factors for mental health issues at individual and interpersonal levels include a paucity of resources, lack of support, and cumulative interpersonal traumas leading to behavioral issues, substance abuse and community breakdown. Structural adversities within the community create barriers to effective intervention, community unity and participation, and increased conflicts both within and outside the refugee community. Urban Somali refugees fall into social margins of urban life, constantly exposed to dual sources of violence: clan and gang violence on one hand and police harassment and exploitation on the other hand.  Both war trauma and daily stressors, coupled with multiple individual and structural adversities, lead to mental health concerns of both individuals and the community as a whole.

Discussion: These findings revealed complex needs of mental health among Somali refugees in urban Kenya, highlighting the intersection between war trauma and daily stressors and its impact on mental health and community violence. This study suggests interventional strategies to be informed within the broader ecological context of community adversity by being both contextually and culturally informed and responsive to the unique needs of this marginalized and underrepresented population.