Re-thinking epidemic preparedness in refugee settings: An ethnographic exploration in Palabek Refugee Settlement, northern Uganda, during COVID-19

Current framings of epidemic preparedness in refugee settings foreground biomedical and techno-scientific approaches. However, a growing body of critical social science literature highlights the need to pay much greater attention to the perspectives of those experiencing epidemics, and the socio-political dynamics shaping policies and practices on the ground. Despite this, there is a lack of ethnographic research foregrounding refugees’ perspectives of epidemic preparedness.

This PhD explores how epidemic preparedness principles and practices intersect with the unique historical, socio-economic, spiritual and political challenges facing South Sudanese Acholi refugees. Fourteen months of ethnographic fieldwork was carried out in Palabek Refugee Settlement, northern Uganda, between April 2021 and June 2022, during the COVID-19 pandemic. In addition to living with a South Sudanese family, 158 semi-structured interviews were carried out with refugees, Ugandans living near the settlement, and humanitarian and government actors. The research also followed individuals and ideas from the settlement to district, regional and national meetings.

Four elements of epidemic preparedness are critically explored. First, COVID-19 containment policies, which were framed as a form of humanitarian ‘protection’, are juxtaposed with mobility-orientated forms of ‘self-protection’ amongst refugees. Second, COVID-19 vaccination is analysed as a ‘suspicious business’, problematising dichotomised debates in public health discourse regarding vaccine supply and vaccine hesitancy. Third, COVID-19 screening is explored by following the performance of counting COVID-19 in different contexts, demonstrating that seemingly ‘objective’ counting practices are entangled in complex social, economic and political dynamics. Lastly, the linear temporality central to public health approaches to preparedness is problematised through an exploration of the relational nature of time amongst refugees.

Overall, the PhD demonstrates how historical, spiritual, socio-economic and political dynamics are inextricable from the way in which epidemic preparedness is conceptualised, delivered and responded to. Current mainstream frameworks for preparedness ignore important perspectives from refugees that could usefully inform a re-thinking of preparedness, while also obfuscating the everyday suffering of refugees, and the (geo)political dynamics that perpetuate it.