Violence against women and girls (VAWG) is now recognised as a serious and widespread global health issue. During a humanitarian crisis, the risk of such violence is heightened, often continuing after the early phases of a crisis – reports of gender-based violence (GBV) are common in camps for refugees and displaced populations. However, there is limited evidence on how to provide effective response services to survivors of violence in humanitarian contexts.
One approach – comprehensive case management – builds on existing evidence from other fields and contexts (social work, legal, healthcare) as well as years of field experience by humanitarian agencies to improve survivors’ health and psychosocial outcomes.
In the Dadaab refugee camps, the International Rescue Committee (IRC) and CARE International (CARE) have developed a comprehensive case management approach to address the needs of GBV survivors. Both humanitarian agencies implement programmes in Dadaab that aim to both respond to and prevent GBV. A cornerstone of this work has been to develop a broader implementation of traditional GBV outreach, community mobilisation, and case management to include task sharing with refugees known as refugee community workers. These refugee community workers are trained by IRC and CARE to carry out specific aspects of outreach, service delivery, and referral support to assist national humanitarian staff.
To date, there has been limited research on this broader GBV case management plus task sharing approach in the context of a refugee camp setting.
To address this key gap in evidence, the London School of Hygiene and Tropical Medicine (LSHTM) and the African Population and Health Research Centre (APHRC), in collaboration with IRC and CARE, have sought to assess this model to understand its feasibility, acceptability, and influence on wellbeing, health, and safety outcomes among female survivors of GBV accessing care. Additionally, the research sought to better understand the context of GBV in a refugee camp context, including the distinct violence that refugee community workers face in their dual role of community members and GBV activists living side-by-side with survivors and perpetrators of violence. Data for this mixed-methods study were collected in the Dadaab refugee camps between 2014 and 2017, which coincided with a temporary decision to close the camp and repatriate Somali refugees.
The research confirms the magnitude and complexity of the violence that women and girls experience in the camps in Dadaab.
Both service providers and women accessing IRC and CARE services reported that VAWG is common, with intimate partner violence (IPV), rape, sexual exploitation, and early and forced marriage reported as the most common forms. In the year leading up to this study, 47% of women accessing the GBV centres for case management reported experiencing IPV and 39% reported experiencing non-partner violence (NPV).
In addition, the study highlights the specific risks, challenges, opportunities and rewards experienced by refugee community workers in providing GBV response services and programmes in Dadaab.
Solely related to their work as GBV caseworkers, one in three refugee community workers reported experiencing non-partner violence in the last 12 months. Additional burdens reported included heavy workloads, challenging and at times violent community resistance, logistical challenges of transportation within the camp, and slow and sometimes ineffective referral systems. Overall, national staff and refugee community workers reported a good working relationship, but some national staff expressed tensions related to the accuracy of translations by refugee community workers, while refugee community workers expressed the desire for long-term recognition of their work through certification. Despite this, 93% of refugee community workers stated their work was rewarding or extremely rewarding.
This research confirms that these factors must also be considered within the wider context of GBV response as these refugee community workers are refugees themselves, already facing extreme conditions related to long-term displacement, likely to have experienced violence themselves, and carrying their own personal responsibilities to family members and other dependants.
Survivors reported that the GBV case management model with task sharing was satisfactory. 82% reported that their interactions with refugee community workers had a positive effect and 66% reported that working with refugee community workers was helpful. However, having refugee community workers deliver services to their own community was not without its challenges, and survivors raised issues on confidentiality, mistranslations, and perceived biases based on clan differences.