Health and Vulnerability Among Internally Displaced Persons in Burundi and Somalia
[Thesis]
Rashid, Hira
Knight, Erin K.
University of Delaware
2020
347
Ph.D.
University of Delaware
2020
The number of internally displaced persons (IDPs) around the world today is greater than at any point in human history. IDPs represent some the most vulnerable population groups and have specific needs stemming from their displacement experiences. The inability to meet these needs can have implications for their overall wellbeing and impede their efforts to effectively resolve their displacement. Despite the existence of a substantial body of literature on internal displacement, research on approaches to identify the context-specific conditions that exacerbate vulnerability among IDPs is lacking. This dissertation aims to fill this gap in research by demonstrating the utility of a public health approach to the understanding of vulnerability among IDPs in Burundi and Somalia. Poor health is an essential aspect of overall vulnerability and has been attributed to many of the same underlying displacement related conditions that lead to increased vulnerability among IDPs. This dissertation proposes that using public health concepts to identify the social determinants of health among displaced populations can provide key insights into the understanding of conditions that exacerbate vulnerability. The research approach to demonstrate the proposed overlap between health and vulnerability included the examination of two separate data sources. First, secondary data collected from IDP settlements in Burundi and Hargeisa (Somalia) were analyzed using regression models and latent class analyses to identify the conditions that impact IDP's health status, access to healthcare services and displacement resolution planning as well as to explore the determinants of overall vulnerability. Second, a content analysis of literature produced by key policy actors and stakeholders was conducted to determine the extent to which the conditions that lead to poor health and increased vulnerability among displaced populations are recognized in the displacement narrative relevant to Burundi and Somalia. The research designs of the statistical and content analyses were grounded within Vulnerable Populations Approach (VPA) and existing literature on health and vulnerability among IDPs. The findings of the statistical analysis showed that social determinants of health are key drivers of health status among IDPs in Burundi and Somalia. Furthermore, several indicators of health status also impacted access to healthcare services and influenced IDP's decision making processes related to displacement resolution. Notably, there was substantial overlap between the conditions that influence the health aspects of displacement and those that lead to increased vulnerability among IDPs. Findings from the content analysis showed that while gaps remain with respect to the systematic examination of conditions that shape health and vulnerability in displacement contexts, over half of the indicators of poor health are recognized to influence overall vulnerability among IDPs. The use of a public health approach in displacement research can facilitate the understanding of displacement related vulnerabilities among IDPs. This can allow humanitarian and policy actors to devise effective interventions aimed at improving IDP's wellbeing and facilitating the achievement of sustainable displacement resolution.