Embodiment of structural vulnerability: illness experiences among Somali refugee women in urban displacement.

Objectives: Forced migration and its subsequent sequelae have caused refugees to face significant adversities throughout the displacement process, making them susceptible to significant health issues. Refugees displaced in Africa are a group especially vulnerable to poor health outcomes, experiencing a documented decline in overall physical and mental health status and rise in mortality from non-communicable diseases (NCDs). Despite the heightened health risks experienced by Somali refugees, particularly women, research into their complex illness experiences and co-/multimorbid health conditions is scarce, leaving a gap in our understanding of the multifaceted health challenges of this population.

Design: Using structural vulnerability theory, this study explores how the broader host context shapes illness experiences for Somali refugee women in Kenya. Specifically, we describe the factors associated with illness experiences of urban Somali refugee women and how this compares with women with other similarly situated identities, such as Somali Kenyan women, other/non-Somali refugees, and Kenyan women. In-depth interviews were conducted with 43 women in Eastleigh, Kenya.

Results: Using hybrid thematic analysis, the emergent themes were grouped into three distinct domains: (1) multimorbid, complex illness experiences, (2) embodiment of structural vulnerability, and (3) distinct/shared vulnerability among refugee/non-refugee women. Results suggest that illness experiences of displaced refugee women are inextricably linked to traumatic experiences before displacement, as well as the experiences of transmigration stressors and the hostile socio-legal dynamics encountered post-displacement.

Conclusions: Our findings also have implications for the need to consider intersectional identities when examining for differential exposure to structural risks and the susceptibility to poor health experiences as well as supports the need for urgent change and improvement in systems of social protection and basic care for refugees experiencing prolonged displacement.