Implementation of the national GBV policy in Uganda to address refugee survivors’ psychosocial needs (original) (raw)
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Conflict and Health, 2019
Background: Multi-sectoral, integrated interventions have long been recommended for addressing mental health and its social determinants (e.g., gender-based violence) in settings of ongoing adversity. We developed an integrated health and protection intervention to reduce psychological distress and intimate partner violence (IPV), and tested its delivery by lay facilitators in a low-resource refugee setting. Methods: Formative research to develop the intervention consisted of a structured desk review, consultation with experts and local stakeholders (refugee incentive workers, representatives of humanitarian agencies, and clinical experts), and qualitative interviews (40 free list interviews with refugees, 15 key informant interviews). Given existing efforts by humanitarian agencies to prevent gender-based violence in this particular refugee camp, including with (potential) perpetrators, we focused on a complementary effort to develop an integrated intervention with potential to reduce IPV and associated mental health impacts with female IPV survivors. We enrolled Congolese refugee women with elevated psychological distress and past-year histories of IPV (n = 60) who received the intervention delivered by trained and supervised lay refugee facilitators. Relevance, feasibility and acceptability of the intervention were evaluated through quantitative and qualitative interviews with participants. We assessed instrument test-retest reliability (n = 24), inter-rater reliability (n = 5 interviews), internal consistency, and construct validity (n = 60). Results: We designed an 8-session intervention, termed Nguvu ('strength'), incorporating brief Cognitive Processing Therapy (focused on helping clients obtaining skills to overcome negative thoughts and self-perceptions and gain control over the impact these have on their lives) and Advocacy Counseling (focused on increasing autonomy, empowerment and strengthening linkages to community supports). On average, participants attended two-thirds of the sessions. In qualitative interviews, participants recommended adaptations to specific intervention components and provided recommendations regarding coordination, retention, safety concerns and intervention participation incentives. Analysis of the performance of outcome instruments overall revealed acceptable reliability and validity.
Psychosocial Support and Protection for Refugee and Host Communities in Uganda: A Needs Assessment
Afrika Focus, 2022
Introduction: Established in 1964 and hosting over 76,000 refugees, Rwamwanja Refugee Settlement in Western Uganda was the focus of this study of existing structures and systems providing for the psychosocial and protection needs of both refugees and host communities. Methodology: The cross-sectional study with both qualitative and quantitative elements used focus group discussions (fgd s) and in-depth interviews with key informants working with organisations supporting refugees and host communities. Further, an individual household assessment of refugees (n=200) and host communities (n=100) was carried out using a free-listing questionnaire. Results: The traumatic situations of both refugees and host communities has led to high levels of fear, mood changes, stress and anxiety. This is further compounded by stressful situations such as competition for meagre resources and weak community-based interventions for psychosocial support and protection. Conclusion: Community resource mobil...
A mental health framework from the voices of refugees
2021
BACKGROUND Refugee groups fleeing war and violence and resettling in the West are one of the population groups that are poorly understood. Understanding their mental health challenges and providing effective and evidence-based interventions continue to be formidable challenges. AIM This study presents a refugee mental health framework [RMHF] that was developed to address the gaps in understanding and responding to the needs of refugee populations by prioritizing their voices, and incorporating lessons learned from working with these refugee communities into the development of the framework. METHOD A RMHF was developed, presented and refined with input from refugee communities, multiple stakeholders and an expert panel. RESULTS/CONCLUSIONS This paper presents the process and finalized framework, and discusses its utility as a mapping, planning and intervention tool in supporting refugee communities with their resettlement and promoting mental wellbeing.
Lived Experiences Of GBV Survivors, As They Try Seeking For Help In Emergency Communities, Kyaka II Refugee Settlement, Southwestern Uganda, 2022
Introduction Gender-Based Violence (GBV) has been recognised as a global phenomenon. In emergencies, the situation is even worse. Purpose This study sought to understand the lived experiences of GBV survivors in Kyaka II refugee settlement, South Western Uganda. Methods This qualitative study used key informant interviews to collect primary data from 36 respondents; female GBV survivors (n = 18) and local leaders (n = 9). Findings Of the interviewed survivors; a) they have experienced multiple forms of GBV (physical. phycological sexual and economic), b) majority of the GBV incidences happened after reaching Uganda, c) majority were perpetrated by non-partners, d) GBV negatively affected them (stress & depression, imposed psychological torture on their children, stigma & discrimination, physical harm, medical problems and suicidal thoughts, e) some GBV incidences have gone unreported, f) survivors require help (Economic support, Counselling, re-allocation & medical support), g) majo...
PLoS ONE, 2021
Introduction The complex relationship between intimate partner violence and psychological distress warrants an integrated intervention approach. In this study we examined the relevance, acceptability, and feasibility of evaluating a multi-sectoral integrated violence- and mental health-focused intervention (Nguvu). Methods We enrolled 311 Congolese refugee women from Nyarugusu refugee camp in Tanzania with past-year intimate partner violence and elevated psychological distress in a feasibility cluster randomized trial. Women were recruited from local women’s groups that were randomized to the Nguvu intervention or usual care. Participants from women’s groups randomized to Nguvu received 8 weekly sessions delivered by lay refugee incentive workers. Psychological distress, intimate partner violence, other wellbeing, and process indicators were assessed at baseline and 9-weeks post-enrollment to evaluate relevance, acceptability, and feasibility of implementing and evaluating Nguvu in ...
Refugees are often exposed to various interrelated stressors including the loss of resources and belongings, death of, or separation from, loved ones as well as direct exposure to armed conflict and violence. Psychological distress is common amongst refugees, with a substantial percentage developing mild to moderate mental disorders such as depression or anxiety disorders. A small percentage of people in refugee settings have severe mental disorders (often exacerbations of pre-existing disorders) and they are especially vulnerable. This chapter outlines complex challenges in addressing the mental health and psychosocial support (MHPSS) needs of refugees and describes key global guidelines, programmatic elements and recommendations in the areas of MHPSS including situational assessments, coordination of services and functional integration of mental health interventions within existing health systems. Various
2020
Psychological disturbance is highly prevalent among victims of gender-based violence who can present a complex and severe symptomatology. And very few such victims actually dare to seek care in the face of stigmatisation. The limited number of health professionals in the field, and the lack of mental healthcare training specific to the disturbances of this vulnerable group, make it very difficult for patients to access psychiatric care. Therefore, humanitarian programmes should include awareness-raising campaigns and psychological education in the communities alongside the training of primary healthcare professionals and reliable community members, as well as supervision provided by mental health specialists. A framework characterised by multidisciplinary collaboration needs to be chosen if a complex, trauma-informed care for victims of gender-based violence is to be achieved.