Impacts of Polytrauma in Complex Emergencies: Role of Natural Disaster Exposure on Social Functioning Among Urban Somali Refugee Youth

Background: Somalia has endured a protracted humanitarian crisis driven by complex emergencies (CEs) involving civil conflict, mass displacement, and recurrent natural disasters. Over 2.6 million Somalis were displaced in 2021, with nearly 900,000 more displaced in just the first half of 2023 due to exposures to natural disasters (END). Repercussions stemming from ENDs magnify Somalis susceptibility for experiencing complex health problems, including common mental disorders, compounded by multiple traumas such as violence, forced migration, childhood adversities. This polytrauma - the cumulative impact of multiple interrelated traumatic events - is understudied, particularly regarding how END, alongside existing traumas, worsen mental health challenges. This study explores the effects of END on social functioning - an indicator of mental and physical health - for Somali refugees in urban Kenya who have experienced polytrauma across multiple domains.

Methods:This cross-sectional survey utilized snowball sampling of Somali refugee youth (ages 15-35) living in Eastleigh, Kenya (N=336). Measures assessed trauma exposure (12-item checklist including natural disasters), psychosocial factors (sense of community, social support, substance use), and social (mal)functioning (trouble socializing, social roles, coping). Demographics included gender, age, education, residency, documentation status. Community oversight, translation/back-translation, and informed consent procedures were employed. We adopted multiple bivariate analyses to examine trauma exposure differences by END, and multiple regression analyses to model how polytrauma affects social functioning.

Results: The sample included 109 UNHCR-registered and 219 non-registered youth (mean age 20.03 years), with 26.2% exposed to natural disasters. END was associated with higher rates of pre-migration (e.g. war χ2=11.468, p=.001), post-migration (e.g. arrest χ2=22.746, p<.001), family (e.g. child abuse χ2=77.130, p<.001), individual (e.g. sexual abuse χ2=35.783, p<.001) and gender-based traumas (e.g. FGM χ2=10.605, p=.001). Participants with END had higher malfunctioning, impairment, PTSD, anxiety and depression. Multiple regression analysis (N=230) found being male (β=-.197, p<.001), lacking documentation (β=-.116, p=.049), help-seeking (β=-.152, p=.019), sense of community (β=-.138, p=.028) and substance use (β=.265, p<.001) predicted social malfunctioning, explaining 27% variance. Experiences of END predicted poorer social functioning (β=.147, p=.020) but other trauma variables did not.

Discussion: Results highlight the profound impact of polytrauma, exacerbated by the experience of END, on social functioning among Somali refugees in urban Kenya. END was associated with heightened pre-migration, post-migration, family and individual trauma exposures. While END itself did not independently predict social functioning, it interacted with factors like gender, documentation status, social support, substance use and help-seeking behaviors. The adverse effects were more pronounced among documented Somalis, underscoring complex relationships between legal status, coping resources and psychosocial outcomes. Findings emphasize needs for holistic, community-based interventions enhancing help-seeking, strengthening social support networks, combating stigma, and promoting economic/social integration. Culturally-grounded, multi-sectoral responses are crucial for addressing immediate and long-term mental health needs of polytraumatized Somali refugees impacted by complex emergencies involving natural disasters.