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\"From conflict-torn Somalia, to the massive Dadaab Refugee Camp in Kenya, and finally to a new home in Sweden, Fatuma's family is used to constant change. Still, Sweden's cold winters and difficult language have required a lot of adjustment. There is hope, but also fear. Fatuma's story gives readers a glimpse of how, even in countries that accept refugees, not everyone is fully accepting\"-- Provided by publisher.

Objectives. We sought to understand the problems, strengths, and help-seeking behaviors of Somali Bantu and Bhutanese refugees and determine local expressions of mental health problems among youths in both communities. Methods. We used qualitative research methods to develop community needs assessments and identify local terms for child mental health problems among Somali Bantu and Bhutanese refugees in Greater Boston and Springfield, Massachusetts, between 2011 and 2014. A total of 56 Somali Bantu and 93 Bhutanese refugees participated in free list and key informant interviews. Results. Financial and language barriers impeded the abilities of families to assist youths who were struggling academically and socially. Participants identified resources both within and outside the refugee community to help with these problems. Both communities identified areas of distress corresponding to Western concepts of conduct disorders, depression, and anxiety. Conclusions. There are numerous challenges faced by Somali Bantu and Bhutanese youths, as well as strengths and resources that promote resilience. Future steps include using culturally informed methods for identifying those in need of services and developing community-based prevention programs.

The mechanisms linking refugee parents’ trauma onto their children’s functioning are not well understood. The current study sought to identify how Somali refugee mothers’ past trauma and current mental health impact their children’s psychosocial adjustment. One hundred and ninety-eight Somali mothers (M age = 39 years) and their children (M age = 10 years; 56% male) were studied. On average, mothers spent 7 years in refugee camps, experienced significant trauma, and some had been tortured. Measures of mothers’ posttraumatic stress and depression were analyzed as three symptom clusters: volatility/panic, withdrawn/detached, and depressed mood. Most children were born in the U.S. and their indirect exposure to trauma was statistically controlled. Results from structural equation modeling indicated that there was no direct association between trauma of the mother and their children’s wellbeing, however, mothers’ posttraumatic stress and depressive symptoms significantly mediated the effects of mothers’ past torture on their children’s adjustment—a pattern indicative of intergenerational traumatization. Findings enhance our understanding of how refugees’ traumatization lingers and possibly affects their and their children’s health and well-being.

A powerful, evocative and deeply personal journey into the refugee crisis past and present. In 2015, journalist Aamna Mohdin travelled to Calais to report from the frontlines of the refugee crisis. It was on her return to London, when she discussed her experiences with her parents, that she came face-to-face with a reality she had been outrunning for nearly two decades: that she had been a refugee herself. Aamna herself had arrived in the UK aged seven, after her parents fled war-torn Somalia. Determined to piece their scattered family history together in the present, she set off on a mission: first into the past, to uncover her parents' experience of displacement in their own words; and then on the road, first to Somalia, and then to the refugee camp in Kenya that was her home in early childhood.

Somalia has been affected by conflict since 1991, with children aged <5 years presenting a high acute malnutrition prevalence. Cash-based interventions (CBIs) have been used in this context since 2011, despite sparse evidence of their nutritional impact. We aimed to understand whether a CBI would reduce acute malnutrition and its risk factors. We implemented a non-randomised cluster trial in internally displaced person (IDP) camps, located in peri-urban Mogadishu, Somalia. Within 10 IDP camps (henceforth clusters) selected using a humanitarian vulnerability assessment, all households were targeted for the CBI. Ten additional clusters located adjacent to the intervention clusters were selected as controls. The CBI comprised a monthly unconditional cash transfer of US$84.00 for 5 months, a once-only distribution of a non-food-items kit, and the provision of piped water free of charge. The cash transfers started in May 2016. Cash recipients were female household representatives. In March and September 2016, from a cohort of randomly selected households in the intervention (n = 111) and control (n = 117) arms (household cohort), we collected household and individual level data from children aged 6-59 months (155 in the intervention and 177 in the control arms) and their mothers/primary carers, to measure known malnutrition risk factors. In addition, between June and November 2016, data to assess acute malnutrition incidence were collected monthly from a cohort of children aged 6-59 months, exhaustively sampled from the intervention (n = 759) and control (n = 1,379) arms (child cohort). Primary outcomes were the mean Child Dietary Diversity Score in the household cohort and the incidence of first episode of acute malnutrition in the child cohort, defined by a mid-upper arm circumference < 12.5 cm and/or oedema. Analyses were by intention-to-treat. For the household cohort we assessed differences-in-differences, for the child cohort we used Cox proportional hazards ratios. In the household cohort, the CBI appeared to increase the Child Dietary Diversity Score by 0.53 (95% CI 0.01; 1.05). In the child cohort, the acute malnutrition incidence rate (cases/100 child-months) was 0.77 (95% CI 0.70; 1.21) and 0.92 (95% CI 0.53; 1.14) in intervention and control arms, respectively. The CBI did not appear to reduce the risk of acute malnutrition: unadjusted hazard ratio 0.83 (95% CI 0.48; 1.42) and hazard ratio adjusted for age and sex 0.94 (95% CI 0.51; 1.74). The CBI appeared to increase the monthly household expenditure by US$29.60 (95% CI 3.51; 55.68), increase the household Food Consumption Score by 14.8 (95% CI 4.83; 24.8), and decrease the Reduced Coping Strategies Index by 11.6 (95% CI 17.5; 5.96). The study limitations were as follows: the study was not randomised, insecurity in the field limited the household cohort sample size and collection of other anthropometric measurements in the child cohort, the humanitarian vulnerability assessment data used to allocate the intervention were not available for analysis, food market data were not available to aid results interpretation, and the malnutrition incidence observed was lower than expected. The CBI appeared to improve beneficiaries' wealth and food security but did not appear to reduce acute malnutrition risk in IDP camp children. Further studies are needed to assess whether changing this intervention, e.g., including specific nutritious foods or social and behaviour change communication, would improve its nutritional impact. ISRCTN Registy ISRCTN29521514.

Pre- and post-migration stressors can put resettled refugee children at risk of poor mental health outcomes. The Family Strengthening Intervention for Refugees (FSI-R) is a peer-delivered preventative home visiting program for resettled refugees that aims to draw upon families’ strengths to foster improved family communication, positive parenting, and caregiver-child relationships, with the ultimate goal of reducing children’s risk of mental health problems. Using an explanatory sequential mixed methods design, this study draws upon qualitative interviews with caregivers (n = 19) and children (n = 17) who participated in a pilot study of the FSI-R intervention in New England, as well as interventionists (n = 4), to unpack quantitative findings on mental health and family functioning from a randomized pilot study (n = 80 families). Most patterns observed in the quantitative data as published in the pilot trial were triangulated by qualitative data. Bhutanese caregivers and children noted that children were less shy or scared to speak up after participating in the FSI-R. Somali Bantu families spoke less about child mental health and underscored feasibility challenges like language barriers between caregivers and children. Interventionists suggested that families with higher levels of education were more open to implementing behavior change. In both groups, families appreciated the intervention and found it to be feasible and acceptable, but also desired additional help in addressing broader family and community needs such as jobs and literacy programs.

ObjectivesTo examine the mental health of unaccompanied refugee minors prospectively during the asylum-seeking process, with a focus on specific stages in the asylum process, such as age assessment, placement in a supportive or non-supportive facility and final decision on the asylum applications.DesignThis was a2½ year follow-up study of unaccompanied minors (UM) seeking asylum in Norway. Data were collected within three weeks (n=138) and at 4 months (n=101), 15 months (n=84) and 26 months (n=69) after arrival.SettingInitially in an observation and orientation centre for unaccompanied asylum-seeking adolescents, and subsequently wherever the UM were located in other refugee facilities in Norway.ParticipantsMale UM from Afghanistan, Somalia, Algeria and Iran.Main outcome measuresMental health symptoms assessed by Hopkins Symptom Checklist-25 and Harvard Trauma Questionnaire.ResultsAt the group level, the young asylum seekers reported high levels of psychological distress on arrival and symptom levels that stayed relatively unchanged over time. According to age-assessment procedures, 56% of the population were not recognised as minors. Subsequent placement in a low-support facility was associated with higher levels of psychological distress in the follow-up period. Those who were placed in a reception centre for adults had higher levels of psychological distress symptoms both after 15 months and 26 months compared with the remaining participants who were placed in reception centres for youth. Refusal of asylum was highly associated with higher levels of psychological distress.ConclusionMental health trajectory of young asylum seekers appears to be negatively affected by low support and refusal of asylum.

This study reviews: (1) how levels of donor financing of the health sector in Somalia varied over the decade 2000-09, (2) which health interventions were prioritized by donors, and (3) how evenly health sector aid was distributed to the different zones of Somalia. The overall aim of the study was to create evidence for donors, implementers, and health specialists involved in allocation of financial resources to the Somalia health sector. The results of the study are based on quantitative data collected from 38 Development Assistance Committee (DAC) donors and implementing agencies active in Somalia. Quantitative data were collected between March and May 2007 and in March 2010, with response rates of 96 and 95 percent, respectively. The report is organized in five chapters. Chapter one provides the background to the study, along with its aims and objectives, and contextualizes the study area, Somalia. Chapter two provides the conceptual framework for the research by looking at aid financing trends in developing countries, in the health sector, in fragile states, and in Somalia. Chapter three describes the methodology, the data collection process, types of data collected, and methodological limitations. Chapter four presents the quantitative findings in terms of total health sector aid financing, and expenditure by disease and by zone. Chapter five offers conclusions linked to the four primary study objectives and provides recommendations for future funding.

Background Despite child marriage receiving increased attention over the past two decades, research on child marriage in humanitarian settings remains scarce. This study sought to quantify child marriage among Somali adolescent girls residing in Kobe refugee camp in Ethiopia and to identify its correlates and consequences. Methods A cross-sectional survey was conducted using multi-stage cluster-based sampling with probability proportional to size. We randomly sampled households that have at least one female aged 15–49 and at least one adolescent female aged 10–19. In addition to calculating the proportion of girls married under age 18, we used survival methods – namely Kaplan Meier graphs and Cox proportional hazard models – to identify risk factors associated with child marriage in this context. We also used descriptive statistics to describe marital age preferences among female adults and presented measures of important sexual and reproductive health indicators among married adolescent girls. Results A total of 603 adult women were surveyed and a household roster was created with information on 3319 household members, of whom 522 were adolescent girls aged 15–19. Of those, 14% were currently married (95% Confidence Interval [CI] 0.11–0.18), and 11% were ever married under age 18 (95% CI 8–15%). Several variables were found to be significantly associated with hazard of child marriage including schooling, sex and employment status of head of household, as well as number of girls under age 18 in the childhood home.. Adult women tended to incorrectly identify minimum legal age at marriage and preferred low marital age for boys and girls – particularly in households of child brides. Among married adolescent girls, contraceptive use was very low (11%; 95% CI 4.94–22.40), and early childbearing was common (60%; 95% CI 45.56–72.89). Conclusions This research contributes to the evidence base on child marriage in humanitarian settings. Insights generated from this study have the potential to inform programs and interventions aiming to prevent and mitigate the impacts of this harmful practice.