Intergenerational Impact of Population Shocks on Children’s Health: Evidence from the 1993–2001 Refugee Crisis in Tanzania

Soazic Elise Wang Sonne and Paolo Verme

World Bank Policy Research Working Paper 9075 (2019)


Between 1993 and 2001, northwestern Tanzania hosted large numbers of refugees from Burundi, Rwanda and Congo, the majority in temporary camps near the border and a short distance to Tanzanian villages. This paper examines whether Tanzanian children born to mothers who spent their early childhood in high refugee-receiving areas have poorer health outcomes. The analysis is based on the geocoded 2015/16 Tanzanian Demographic and Health Survey (DHS) capturing migration histories of mothers and fathers.

Key results:

  • Children of mothers exposed to the 1993-2001 refugee crisis in northwestern Tanzania are more likely to be stunted. Almost 15 years after the refugee influx, children under five year’s of age born to mothers who were themselves under five during the 1993-2001 refugee crisis and living closer to refugee camps have lower Height-for-Age Z-scores and are more likely to be stunted than a comparable sample of children whose mothers were more than five years old at the time of the refugee crisis.
  • Mothers who were in utero and less than 24 months at the time of the high refugee influx period (1993-1996) are more likely to give birth to children who are stunted.
  • No differentiated impacts between male and female children.


The authors suggest several possible mechanisms to explain these results. Previous studies on the impact of refugees in Tanzania have shown that wellbeing increased for host households living near the refugee camps, in particular by increasing employment opportunities. However, there was also a reallocation of labor away from primary health care and education services and towards low-skilled services to the aid community during a period characterized by increased demand for these services and a general downgrading of schools and health centers. This could have resulted in an intra-household reallocation of labor, with increased demands on women and possibly negative effects on childcare, and leading to children experiencing a combination of decreased standards in education, health care and home care services. Using additional data from the 1991 and 1996 DHS, the authors show that:

  • There was an increase in female labor force participation during the refugee crisis. Grandmothers in 2015/16 who were mothers in 1996 (during the crisis) had higher labor force participation than those who were mothers in 1991(before the crisis). There was no increase in the labor market participation of grandfathers during the same period.
  • Mothers exposed to the refugee crisis during their first five years were less likely to complete more than secondary education, less likely to own land and a house, and more likely to participate in the labor market later in their life. Increased labor force participation can potentially translate into reduced child care at home and poorer anthropometrics of their under five-year-old children.
  • Parents in their early age during the refugee influx suffered from decreased nutritional standards and increased morbidity. Children in refugee receiving areas in 1996 had lower Weight for Age, Weight for Height and Biomass Index scores, and were more likely to be wasting, underweight, have diarrhea or fever. This is expected to affect the anthropometrics of their own children in 2015-2016.