Understanding How Precarity and Marginalisation Affect Refugees’ Vulnerability to, Experiences of and Responses to Scabies in Nguenyyiel Refugee Camp, Ethiopia

Abstract

Scabies is a contagious skin-neglected tropical disease (skin-NTD) caused by a mite Sarcoptes scabiei. It is prevalent in tropical regions where socio-economic challenges including poverty, weak health systems, conflict and overcrowding persist. Ethiopia has seen several large-scale outbreaks of scabies since 2013. Studies have documented the prevalence and risk factors of scabies and estimated a national prevalence rate of 14.5%. However, there is limited data on scabies in refugee camps in Ethiopia. With the aim of understanding refugees’ vulnerability to, experience of and responses to scabies, ethnographic research involving patients, caregivers, refugee stakeholders, healthcare providers was conducted in Nguenyyiel Refugee Camp from March to August 2022. Scabies is a prevalent yet neglected disease within the camp. The crux of refugees’ vulnerability to scabies lies within the shortcomings of the international refugee regime. The regime is grappling with the competing interests of refugee actors who prioritise economic and national security concerns over the human-rights of refugees. In 2019, Ethiopia reformed its refugee law to shift the camp-based protection approach to a rights-based approach. The country is also committed to out-of-camp policies and local integration of refugees. However, the refugee protection system has not seen fundamental change and encampment remains the de facto solution to refugees’ problems, as evidenced in Nguenyyiel. Refugees are subjected to a strict encampment policy and highly regulated service provision. Service provision, including healthcare, falls short of national and international standards, compelling refugees to endure precarious and vulnerable lives in the camp. Prolonged stays in the camp have reduced them to bare life in which mere survival rather than durable solutions, remains the priority. Camp situations have contributed to scabies becoming a symbol of structural violence and marginalisation of refugees. Lack of clear integration strategies between national health policy and refugee policy has undermined local coordination against scabies. This neglect of scabies has fostered precarity and powerlessness among refugees, who view scabies as an inevitable facet of camp life. Scabies is, therefore, trivialised and normalised by refugees who believe that nothing can be done about. This perception has shaped illness experience, the dynamics of stigma and responses to the disease in the camp. This thesis calls for a holistic intervention: advocating for refugee rights, strengthening and integrating the refugee health system into the national health system, fostering collaboration among stakeholders and refugee actors, and undertaking community awareness. These approaches are intended to complement biomedical treatment in addressing the challenges of scabies in the camp.

Date of Award	Sept 2024
Original language	English
Awarding Institution	Brighton and Sussex Medical School
Supervisor	Gail Davey (Supervisor), Prof Hayley MacGregor (Supervisor) & Prof Getnet Tadele (Supervisor)