Localising public health: Refugee-led organizations as first and last responders in COVID-19

Alexander Betts, Evan Easton-Calabria, Kate Pincock

World Development, Volume 139 (2021)



Organizations created and led by refugees themselves (‘refugee-led organizations’, RLOs) play an important role in meeting community needs. In particular, refugee-led social protection (activities designed to reduce poverty, vulnerability, or risk), provided by organizations or networks created by refugees, are frequently perceived to be among the most important sources of assistance by refugee communities. During the COVID-19 pandemic, RLOs have frequently found themselves as default providers of assistance and mutual aid, but usually without additional or effective support from international organizations and NGOs.

This short paper draws on the authors’ completed pre-pandemic research covering around 80 RLOs in cities and camps in Uganda (Nakivale and Kampala) and Kenya (Kakuma and Nairobi), using a mixture of semi-structured interviews, focus groups, and participant observation undertaken with RLO staff and beneficiaries, and covering a range of social protection and other activities. The paper also draws on initial findings from a series of follow-up studies, with a particular focus on RLO-led public health and livelihoods activities in the context of the pandemic; the initial work includes interviews and focus groups with key staff at 15 RLOs involved in the original study that are actively involved in providing COVID-19-related support services.

Some RLOs in Uganda and Kenya quickly mobilized in response to the COVID-19 pandemic. Their activities highlight areas in which RLOs could be key ‘first responders’ in the context of the pandemic, including:

  • RLOs can play a crucial role in ensuring the most marginalized refugees are included in health messaging, and receive accurate information about COVID-19. 10 out of the 15 contacted organizations are spreading awareness about COVID-19 and how to prevent infection through mass texts, posters, and YouTube videos shared on social media.
  • RLOs play a significant role in ‘bridging’ gaps in healthcare and assistance. Equally crucial is conducting advocacy to alert agencies of needs and gaps in capacity and other responses.
  • Community health workers can be rapidly trained, affordably equipped, and play a range of roles from public information to tracking, as well as providing basic preventive, promotional, and rehabilitative support. Some refugees are also formally trained doctors, nurses, and other medical professionals, though many face restrictions on their ability to practice in their host countries. Equipping refugee community health workers with the knowledge and skills to raise awareness about preventing transmission of COVID-19 and its symptoms may be an opportunity to limit the spread of the virus.
  • RLOs may also play a role in shaping social norms that limit transmission of COVID-19. Refugee-led organizations and initiatives are aware of community needs and appropriate responses because they are part of these communities; the trust they have built with communities is usually a function of close, regular contact rather than one-off interventions, suggesting that guidance provided by them on COVID-19 may be more effectively received and adhered to.
  • RLOs have the potential to assist with virus tracking and contact tracing. RLOs are capable of interfacing with both communities and formal authorities to share information anonymously while retaining trust. However, this role has risks that must be carefully mediated.


The growing focus of RLOs in public health-related activities demonstrates the significant and neglected potential of RLOs to complement international public health and wider humanitarian responses to the pandemic. Maximizing the potential contribution of RLOs will depend on creating new mechanisms to rapidly identify, fund, and build capacity among RLOs.


Kenya | Uganda