Case Study: Understanding Psychological and Nutritional Impact of Refugee Presence and Activities on Host Communities in Kakuma Refugee Camp, Kenya


This ethnographic research, carried out by Principal Investigator Rahul Oka along with Rieti Gengo and Lee Gettler (all anthropologists from the University of Notre Dame), was intended to assist the World Bank and UNHCR in understanding the psychosocial and physical impact of refugee presence and activities on the Turkana Host Community living near Kakuma Refugee Camp in Northern Kenya. Like most refugee camps, Kakuma Refugee Camp is in northwestern Turkana County that is characterized by arid and harsh landscapes, usually not conducive to high-density settlement and any socio-economic activity such as pastoralism (livestock herding) and minimal subsistence horticulture. The Turkana people, who live around the camp, have coexisted with the refugees for over 25 years, but are economically marginalized and politically disenfranchised. They are among the most impoverished groups of people across the world. They have welcomed the refugees and over the years have developed a complex system of interaction that has resulted in mainly peaceful coexistence through the development of a patron (refugee) – client (Turkana) relationship mitigating exchange of food, labor, and commodities, and occasionally inter-personal or inter-group violence.

In 2014, UNHCR, the office of the Governor of Turkana County, and the Government of Kenya called a roundtable to discuss the idea that the refugees and the host community of Kakuma (total pop. 220,000) could pool their various skills, expertise, and forms of capital to convert Kakuma into a self-sustaining ‘city.’ There was a lot of anecdotal data and ethnographic observations that suggested that this idea was not inconceivable. The first step was to measure the impact of refugees on the Turkana community. The World Bank gathered a team to look at both the social and the economic impacts of the refugees on the local Turkana peoples and economy. Oka and colleagues led the field work and data collection/analysis of the Social Impact Assessment at Kakuma from May to July 2015.


The primary approach for the social impact analysis was through ethnographic engagement, building on previous trust relationship established by the Notre Dame team with the Turkana and refugee communities (see Ethnographic Case Study on Food Assistance and Dignity). We decided to use semi-structured interviews, focus group discussion, and structured interviews with the Turkana and refugees of Kakuma, and the Turkana communities of three other settlements: Lodwar (County Capital, 96 km SE from Kakuma), Lorugum (Developed Area 150 km S of Kakuma), and Lokichoggio (UN base of Sudan Relief efforts until 2008, 120 km NE of Kakuma) (Figure 1). The approach paralleled the economic team that was comparing the economic well-being of the Turkana of Kakuma with that of Turkana sites similar to Kakuma prior to the establishment of the refugee camp in 1992.

However, we also decided to add a survey-based interview and questionnaire in addition to the longer ethnographic interviews that would elicit data on psycho-social and nutritional well-being of the Turkana in four sites: Kakuma, Lorugum, Lokichoggio, and Lorengo (a small pastoral village 50 km SE of Kakuma). We wanted to measure the impact of engagement and interactions on Turkana perceptions of psychosocial well-being, and health (measured through nutrition). Respondents were asked to free-list worries or concerns regarding their daily ‘lived’ experiences, the presence and activities of refugees, and they were also asked to speak to their own reactions to refugee presence, whether the refugee presence was good/ bad, or if it brought benefits/harm. These questionnaires were devised with a team of Turkana researchers and interpreters and then data was collected from 75 men and 75 women from each site, for 600 individuals in total. This data was analyzed in conjunction with the ethnographic data.

Figure 1: Turkana County, Kenya


Our previous ethnographic work had served as the basis for our prediction that the Turkana living close to the camp and interacting with refugees would have more nuanced interaction, engagement, and hence more complex perceptions of refugee presence and activities, and would also be benefiting from the presence of the refugees through the exchange of food, labor, services, and commodities, as well as the refugee commercial and black market economy (see Ethnographic Case Study #1). Specifically, our ethnographic research in all the aforementioned sites seemed to suggest that the Turkana living close to the camp and who engaged with the refugees on a daily basis saw the refugees as friends, neighbors, partners, and fellow sufferers. In addition, they also saw the refugees as the violent ‘other,’ as interlopers, as recipients of aid that should be given to the Turkana and not foreigners. We also concluded that given periodic and frequent famines affecting Turkana County, the Turkana of Kakuma, who received cereals and food from refugees as gifts or in exchange for commodities, labor, or services, would show greater nutritional well-being.

The analysis of both the ethnographic and survey data showed:

  • Turkana men and women of Kakuma showed significantly greater energy status measured by body fat content (Sum of Skinfolds) than the Turkana of Lokichoggio or Lorengo, but not Lorugum, a relatively developed area (see Figure 2). This indicated that refugees and the relief mission at Kakuma might be filling the development gap seen in Lokichoggio and Lorengo. In particular, we conclude that the Turkana of Kakuma show greater nutritional well-being than their compatriots due to their access to relief food through the networks of exchange with the refugees.

Figure 2: a) Average SSF for men and women across Turkana County; b) Average SSF for young, middle-aged, and older women across Turkana County, and c) Average SSF for young, middle-aged, and older men across Turkana County.

  • Turkana men and women of Kakuma showed greater variation and number of worries compared to Lorengo, Lokichoggio, or Lorgum, but this was primarily due to worries about education, employment, and social mobility (as seen in Figure 3). These worries were not present at the other sites where the predominant worries were food, water, security, and health. This suggested that the presence of the refugees and relief mission might have resulted in reduction of concerns over basic necessities, opening the Turkana of Kakuma to opportunities and goals that their compatriots concerned with basic needs could not envision.

Figure 3: Number and Diversity of Worries and Psycho-Social Stressors by Location

  • The perceptions of refugees was directly correlated with distance and hence interaction/engagement. As seen in Figure 4, while the negative perceptions of refugees are not significantly affected by distance/interaction, the positive perceptions are highly affected by distance/interaction. This was one of the key findings, that suggested that communities hosting and regularly interacting with refugees developed nuanced ideas towards the refugees and are more likely to have coexisting positive and negative perceptions than communities that live far away and do not interact with refugees, who tend to have predominantly negative perceptions.

Figure 4: Trends in Positive and Negative Perceptions of Refugees among the Turkana of Kakuma, Lorengo, Lokichoggio, Lodwar, and Lorugum


This study was highly lauded by various scholars and policy-makers as a complete study that showed that refugees have a positive impact on their hosts. In the case of Kenya, this study was seminal in convincing both the local Turkana and the national Kenyan government that refugees can be beneficial for local and even national host populations. This study along with the economic assessment (that came to similar conclusion) was also foundational in the current UNHCR proposals to convert Kakuma Refugee Camp into a self-sustaining settlement for both refugee and host communities alike.


Gengo RG, Oka RC, Vemuru V, Golitko M, Gettler LT. Positive effects of refugee presence on host community nutritional status in Turkana County, Kenya. Am J Hum Biol. 2017;e23060.

Vemuru, V., Oka, R., Gengo, R., & Gettler, L. (2016). Refugee Impacts on Turkana Hosts. A Social Impact Analysis for Kakuma Town and Refugee Camp Turkana County, Kenya. World Bank Press, Washington D.C.