Sheltering Hope: Navigating the Nexus of Refugee Housing Conditions and Well-Being

Abstract

Housing a crucial social determinant of health and well-being is a fundamental right under the United Nations Universal Declaration of Human Rights. This chapter provides an overview of literature focusing on the impact of housing on the health and well-being of refugee populations, during post-resettlement. Housing is a basic human right, and refugees often face significant challenges in accessing safe and adequate housing, experiencing substandard living conditions in both camp and resettlement settings. Existing research emphasizes the factors influencing refugee housing quality, affordability, and stability, highlighting the need for tailored support services and policy interventions in resettlement countries. Beyond mere shelter, “healthy housing” encompasses safety, privacy, psychological, and physical well-being, fostering development and social integration. Community integration and empowerment emerge as critical factors in fostering positive housing outcomes, with inclusive housing policies and placemaking efforts playing essential roles in promoting a sense of belonging and identity among refugee communities. This chapter stresses the impact of housing conditions on refugee health and well-being, advocating for inclusive policies and community integration efforts to foster a sense of belonging and identity among refugee populations. Recommendations include enhancing housing affordability, improving access to resources and support services, and fostering transparent communication and accountability within housing systems.

1. Introduction

Housing stands as a crucial social determinant of health and well-being, as highlighted by various studies [1, 2, 3]. It is also recognized as a fundamental right under the United Nations Universal Declaration of Human Rights, article 25 [4]. Beyond mere shelter, ‘healthy housing’ encompasses safety, privacy, psychological, and physical well-being, fostering development and social integration, as emphasized by the World Health Organization [3]. Additionally, housing contributes to ontological security, representing a sense of identity, consistency, agency, and control, particularly for those in unstable living conditions [5]. This connection between home security, health, and well-being has been extensively documented [6]. Despite being a fundamental right, refugees often lack access to safe and clean housing with adequate facilities [7]. Instead, they are frequently accommodated in various types of shelters, including camps and informal settlements, characterized by poor living conditions across rural and urban settings [8].

A review of the past literature reveals a lack of studies focusing on the quality of refugee housing. Ziersch and Due [9] conducted a literature review study on refugee housing, where they identified 30s that focused on refugee camps or post-resettlement housing and their impact on physical and/or mental health. Several studies have identified that housing quality, affordability, mobility, discrimination, and overcrowding affect the health of refugees in resettlement countries [10, 11, 12]. It has been suggested by multiple researchers that unstable housing, overcrowding, and discrimination lead to increased stress and worsened mental health [13, 14], alongside exacerbating physical health issues like asthma and infectious diseases [15]. Thus, access to stable housing is crucial for effective mental health treatment. Furthermore, the study also states that there is an urgent need for research in this field to guide policymakers in resettling countries regarding providing support services tailored to different categories of refugees, addressing housing influencing their health and well-being.

In this chapter, the authors provide an overview of the effect of housing on the health and well-being of occupants as identified in previous literature along with the current condition of housing for refugees around the globe as they resettle. A systematic search across various databases was conducted, and relevant journals were consulted to identify literature on refugee housing. Key search terms such as ‘refugee housing’, ‘forced migration’, ‘refugee integration’, and ‘shelter challenges’ were utilized to ensure comprehensive coverage. Additionally, the reference lists of identified articles were reviewed to enhance the scope of their search. Eligible studies were then reviewed for inclusion, and pertinent details such as study name, authors, journal, research design, and findings were extracted by two researchers. These details were synthesized to inform the analysis, focusing on key aspects of each study including its purpose, methodology, and conclusions.

2. Understanding refugee housing pre- and post-resettlement and well-being

Currently, there are 110 million forcibly displaced people worldwide, including 36 million refugees enduring vulnerability and uncertainty in their living environments [16]. Inadequate living conditions significantly impact physical and mental health, often resulting in mortality, contradicting the World Health Organization’s ‘everyone healthy’ concept and Sustainable Development Goals 6 and 11, which aim for universal access to water and sanitation by 2030 [17]. Refugees face precarious housing crises living in temporary shelters or even after being repatriated to the resettlement countries.

Refugees living in temporary shelters including camps whether it is located in urban or rural areas, the housing crises are enormous including insufficient water, sanitation, and hygiene facilities (WASH), and overcrowding caters to their psycho-physical ill-being. Currently, over 6.6 million refugees and individuals in similar circumstances reside in camps; of these, 4.6 million are in planned or supervised camps and over 2 million are in self-settled camps [18]. In urban areas, refugees accommodation live in non-functional public buildings, collective centers, slums, or even in informal settlements with poor living conditions. UNHCR and the wider humanitarian communities construct shelters or communal centers in urban areas, while in rural areas, refugee camps serve as critical components of the humanitarian response, especially during crises [19]. These camps are typically managed by national host governments and humanitarian organizations led by the UNHCR, ensuring aid delivery [20]. However, despite their intended purpose of aiding and protecting those fleeing persecution, refugee camps can have negative impacts on inhabitants. Humanitarian aid within these camps may diminish refugees’ independence and worsen the trauma of displacement [21].

The security and stability of refugee camps depend largely on their location [22], management [23], and population demographics [24]. Often situated in poor areas away from major cities, these camps lack proper security measures and are prone to armed attacks. While a higher male ratio may reduce the risk of assault, internal criminality, particularly gender-based violence against women and girls, poses significant threats to stability found among Somali Women Refugees In Dadaab Refugee Camp [25]. Refugees face immense challenges in accessing adequate sanitation and housing, essential for their health and dignity [18]. Due to their temporary nature and focus on short-term solutions, refugee camps frequently lack sufficient infrastructure and water supplies [26]. Furthermore, access to education is another obstacle in refugee camps, where children’s educational programs are typically provided at no cost, though financial barriers may still arise for supplies, transportation, and other necessities [27]. Limited employment opportunities exacerbate psychological issues, social isolation, and the cycle of poverty among refugees [28]. Restrictions on formal employment and access to financial services hinder refugees’ ability to contribute to the economy has been evident in the European countries [29]. Additionally, refugees often face restrictions on their rights and liberties within camp settings, including limitations on movement, access to services, and employment opportunities. Four key aspects—security and stability, housing and hygiene, employment and education, and health—define the quality of living conditions in refugee camps across the globe [9]. However, a large amount of research conducted in low- and middle-income nations revealed that low living conditions in refugee camps are strongly associated with poor physical and mental well-being (Figure 1) [17].

Figure 1.

Rohingya refugee camp, Cox’s Bazar, Bangladesh [17].

Post-resettlement is the final destination of the refugees after residing for a long period in temporary shelters/houses in different neighboring countries as undocumented immigrants or refugees. Housing plays an important role in the successful integration of refugee immigrants into society [30]. UNHCR’s role in migration is unique and actively plays a role in nominating refugee titles and resettling refugees in different high-income countries including the USA, Germany, Australia, and Canada [31]. However, past literature found that refugees often face post-resettlement stresses—housing is one of them [32].

Post-resettlement living conditions for refugees present various challenges across resettlement nations like Australia, Canada, the UK, Germany, and New Zealand. These include discrimination, high rental prices, uncertain tenancy, restricted access to public housing, and language barriers. To go in-depth, asylum seekers may also lack the necessary documentation and eligibility for welfare and fear repercussions on their visa applications when raising housing concerns [9]. Past research also found that limited government support and work restrictions further increase the risk of homelessness for asylum seekers, underscoring the need for improved housing regulations and support services [33]. Moreover, past studies also claimed that cultural barriers, geographic constraints, and rising costs further hinder access to affordable housing during resettlement, as evidenced in various studies [34]. Furthermore, as noted in a study conducted by Bhattacharjee and Noyori-Corbett [35], inadequate and substandard housing among refugee immigrants post-resettlement has remained a significant public concern, as highlighted by existing literature emphasizing the role of housing in influencing the health and well-being of residents. Moreover, Oudshoorn, Benbow, and Meyer [36] noted in their study that in Canada, while Syrian refugees can find affordable housing, securing units in desirable locations proves challenging. Asian refugees in Australia contend with significant ventilation issues in their resettled housing [37], while in Germany, refugee children lack access to adequate play facilities in their new homes [38], which impacts their well-being (Figure 2).

Figure 2.

Overcrowded living conditions, refugee family apartment, Dallas TX [35].

Well-being refers to being physically and mentally comfortable, healthy, happy, and prosperous. It encompasses a holistic sense of contentment, satisfaction, and fulfillment in various aspects of life, including physical health, mental and emotional well-being, social connections, and a sense of purpose or meaning. Subjective well-being (SWB) comprises life satisfaction (i.e., contentment with life overall), emotional well-being (also known as affect or hedonic well-being), and eudaimonia (i.e., self-actualization and finding meaning in life) [39]. It also reflects how individuals perceive their overall well-being within their social circumstances across different domains including housing [40].

Housing conditions including home ownership and community environment significantly influence health consequences, and the well-being of residents is broadly acknowledged in the existing literature [41, 42, 43, 44]. There has been a compelling amount of evidence showing the detrimental effects of indoor air toxins [45, 46], dampness [47], mold [48, 49], cold interior temperatures [50], overcrowding [51], and safety hazards on the physical health of the residents also reflected the refugee studies [52] as well (Figure 3).

Figure 3.

Indoor environmental health and safety issues, refugee family apartment, Dallas, TX [35].

Given the complexity of the issues encountered by displaced populations, it is concerning that refugee issues receive little attention in the debate surrounding research [53, 54]. Refugees frequently endure trauma, are uprooted, and have trouble getting basic services. Their integration is further hampered by marginalization and discrimination. Refugee studies are neglected due to a lack of cooperation, financing, and global priorities that conflict with one another. To give refugee issues top priority and facilitate efficient responses to refugee crises, more advocacy work and public awareness are required [55].

3. Factors influencing refugee housing conditions

Globally, numerous studies have addressed housing for voluntary immigrants; however, research focusing solely on refugee immigrants is limited [56].

Several researches indicated that refugee immigrants encounter numerous barriers to accessing suitable housing or accommodation upon arrival in resettlement countries [12, 57, 58, 59]. The quality of housing among refugee immigrants is influenced by a multitude of factors, including government policies, humanitarian aid efforts, and host community attitudes [60]. Literature indicates that government policies play a pivotal role in shaping the quality of refugee housing through regulations, standards, and funding mechanisms [61, 62, 63]. Additionally, government policies impact the availability of suitable housing options and the integration of refugees into existing communities.

Studies conducted in Australia and the UK have identified challenges in securing private rental accommodation due to various factors, such as availability, lack of references, and affordability, making alternative accommodation options difficult to attain [7, 9, 10, 12, 57, 58, 64]. Multiple studies in suburban and urban areas of Canada have identified challenges faced by refugee immigrants in obtaining secure and well-paid employment, which impacts their integration and housing conditions [65, 66]. Lack of knowledge about available and affordable housing, along with insufficient housing services and programs, forces them to rely on their social networks rather than resettlement agencies for housing location decisions [66, 67, 68]. Studies in the USA have examined various aspects, including homeownership rates among refugee populations in specific regions [56], housing pathways for immigrants [69, 70], and challenges faced by particular immigrant groups in finding affordable housing [71, 72].

Further, attitudes of the host community toward refugees have a significant influence on the quality of housing available to them. Positive attitudes and welcoming environments facilitate the integration of refugees into local communities and promote inclusive housing policies. Conversely, negative attitudes and discrimination may lead to limited access to housing resources, unsuitable living conditions, and social exclusion for refugees. Discrimination against refugees in countries like Australia and the UK further highlights the housing access issues [12].

Based on the data from the existing literature discussed above, the primary factors influencing the desirability and affordability of refugee housing are related to limited economic stability, availability of housing, poor housing conditions, and cultural and social considerations. Many refugees face economic challenges that limit their ability to afford suitable housing options. Limited access to employment opportunities and financial resources can worsen housing affordability issues. The availability of affordable and suitable housing options is critical in determining housing desirability for refugees. Limited housing supply, competition for rental properties, and restrictive zoning regulations may pose barriers to accessing adequate housing. The quality of housing, including factors such as safety, cleanliness, and accessibility, significantly impacts its desirability. Refugees often face challenges due to substandard housing conditions, overcrowding, and insufficient infrastructure. As cultural preferences, family size, and social networks influence refugees’ housing preferences and choices, access to culturally appropriate housing options and support services can enhance housing desirability and result in successful resettlement. Difficulties in securing housing are also linked to other aspects of refugee integration or resettlement, such as education and social connections [11].

4. Impact of housing conditions on well-being

Researchers worldwide have highlighted housing as a key determinant of health and well-being for refugee immigrants during resettlement [9, 58, 73, 74, 75, 76]. A healthy living environment should offer safety and privacy and be in proximity to places of employment and essential amenities. However, for refugee immigrants, housing is often situated in stigmatized areas that are in deteriorating conditions [77].

Over the last two decades, research related to housing has been focused on three key aspects, i.e., quality, affordability, and stability. Studies have examined the impact of housing conditions on health outcomes, emphasizing factors such as structural integrity, indoor air quality, and sanitation [78, 79, 80]. The affordability of housing is directly related to its quality and accessibility. Research has explored the connection between housing affordability and health, highlighting the financial strain that inadequate housing places on individuals and families [81, 82, 83, 84]. Housing stability, which encompasses factors such as tenure security and eviction risk, is equally important for maintaining health and well-being. Several studies have shown the detrimental effects of housing instability on mental health, stress levels, and overall quality of life of the residents [10, 85, 86, 87, 88].

Apart from physical health, numerous studies have highlighted the relationship between housing conditions and mental health. Substandard housing conditions, marked by overcrowding, insufficient ventilation, and safety hazards, have consistently been linked to negative mental health consequences. Singh, Danielle, and Bentley [89] conducted a study examining longitudinal data on the effects of housing disadvantage on mental health. Their findings suggest that previous exposure to housing disadvantage related to tenure, instability, and physical attributes could have lasting effects on mental well-being later in life.

Individuals living in substandard housing often experience increased levels of stress, anxiety, and depression. Previous studies concluded that housing insecurity along with food insecurity was linked to insufficient sleep among adults, while stress from housing or food insecurity may contribute to prolonged psychological distress or depressive symptoms [90, 91, 92]. Studies also highlighted the adverse effects of housing insecurity, such as crowding and frequent relocations, on children’s psychological well-being, and health [91, 92]. Poor housing conditions, such as lack of safety, high noise levels, and inadequate heating or cooling, may further disrupt sleep patterns that affect both the psychological and physical well-being of occupants [78, 93].

Further, the financial implication of maintaining inadequate housing or struggling with housing affordability can lead to chronic stress and mental health challenges [81]. When individuals are forced to prioritize housing expenses over other essential needs, such as health care or education, the strain on mental health can be particularly acute [94, 95]. Conversely, improvements in housing conditions have been shown to have positive effects on mental health outcomes. Access to safe, stable, and suitable housing can provide individuals with a sense of security, control, and belonging, thereby promoting overall well-being [96, 97]. Recognizing how housing conditions and mental health are closely related is crucial for developing effective interventions and policies for improving both aspects of the residents’ lives.

In conclusion, access to quality housing emerges as a major influential factor affecting both the physical and mental health of refugee immigrants [98]. A photovoice study by Fozdar and Hartley [15] among refugees in Western Australia revealed that homes provided a significant source of ontological security, regardless of whether they were rented or owned, despite challenges in the housing market. An analysis of housing pathways in rural Germany by Weidinger and Kordel [99] found that refugees often relocate after being granted refugee status due to the low quality of housing.

5. Cultural adaptation and housing strategies

Refugee immigrants, when in a new environment, often find comfort in familiarity, connecting with elements that are reminiscent of their roots. This can involve resuming old habits, socializing with similar-minded individuals, or integrating tangible symbols of their heritage or personal aspirations into the physical surroundings. The concept is referred to as placemaking, which plays a crucial role during the resettlement process, as it can either greatly facilitate or hinder the resettlement journey depending on its cultivation. This refers to adapting to the environment, both physically and emotionally, to align with the cultural pride and identity of its inhabitants. Placemaking involves transforming a generic space that is focused solely on functionality, into a meaningful place that reflects the individual’s concept of ‘home’.

Placemaking is particularly vital for refugees navigating displacement, providing a means for them to endure the challenges of living in camps, especially in larger ones like Azraq and Zataar in Jordan. In these camps, housing thousands of individuals seeking refuge, a distinct ecosystem has naturally evolved, gradually transforming them from temporary shelters into potential ‘cities of tomorrow’. Despite limited construction resources and knowledge, residents have taken it upon themselves to expand, construct, and enhance the camps, significantly improving safety, organization, and overall comfort for everyone involved.

In Canada, a study revealed that despite facing the crisis of adequate housing, poor neighborhood conditions, and procedural barriers preventing them from improving their housing conditions, refugee immigrants are making efforts to adjust their living environments at various levels including placemaking [100].

6. Community integration and empowerment

Integration of refugee and host communities has always been a concern among stakeholders and policymakers, especially in locales where many refugees resettle. Disapproval of refugee resettlement among host community members is usually high where images of immigrants are negative due to a prevailing anti-immigrant political climate. Some believe that the stability of their employment has been threatened by newcomers to their communities, while others believe that crime rates increase when a larger number of refugees are present [101]. Among the several indicators of obstructions to integration between merging communities, a history of systemic racial discrimination within the rental market in the USA, including redlining and steering techniques, presents integration challenges [102].

The divide between the two communities has its most negative impact on the refugee side. Most refugees came from a community where they felt everyone was connected and, in turn, that connectedness made the community strong. They now feel isolated and helpless, as they do not feel part of the society they live in [103]. However, refugees expressed the importance of balancing connections to host community members and privacy when they were asked about their living environment. Willems et al. [103] found this as the balance between the expansion of social capital in a newly resettled community and the preservation of a refugee’s particular identity. Refugees also confirmed that both connectedness to the host community and privacy help not only heal their traumas but also the better integration of the two communities. Housing designs and designing processes considering this balance will help create an inclusive and diverse built environment and society.

NGOs play a significant role in supporting refugee housing issues and thus help the process of integration of host and refugee communities. Typically, in the USA, NGOs prepare an apartment unit for a refugee family before their arrival. They also prepare basic furniture and other items such as kitchen utensils and dining sets. Preparation for their apartment after securing the unit for newly arrived refugees is only one of numerous numbers of services local NGOs provide to newly arrived refugees funded by the federal government [104]. Frontline staff are responsible for providing services, such as cultural orientation, youths’ enrollment in schools, job orientation, medical services, legal services, and case management.

In preparation for their housing, NGOs also help refugees with challenges refugees face, such as racist discriminatory practices by private owners or real estate/housing companies [105]. In addition, it depends on the role of an employee of the NGO, but an employee can perform a variety of roles, such as finding resources for counseling and support while their housing search continues, as there are many obstacles including discrimination, guarantee owners who are suspicious of foreigner’s accountability for payment. This support provided by local NGOs eventually helps communities to achieve integration. The challenges NGO workers face in securing housing for newly arriving refugees are intersectional, depending on the racial, ethnic, and gender background of refugees [106].

7. Policy implications and recommendations

As one of the authors once worked as a social worker serving refugees in a major Southern state, she acknowledges that the responsibilities of the case manager work are diverse. Securing housing is one of the numerous services a case manager needs to complete before the arrival of refugee individuals and families. There is no time for these frontline case workers to advocate for better programs, policies, and governance to help solve the local challenges of securing a place to live for refugees. The challenges refugees face when a case manager searches for new apartment units to rent for refugees speak more to macro issues in our society that individual workers or NGOs cannot solve by themselves.

Byrne et al. [102] conducted community participatory housing research in Utah, USA, and recommended certain tactics for refugees to reduce their mindset of uncertainty and powerlessness when going through their housing search: accessible opportunities and landlords, increased accountability, transparency, and communication. Not only the lack of trust for landlords but also the system itself make refugees feel excluded from their communities. Any newcomers from foreign countries are not used to the U.S. rental market regulations such as extra fees at the beginning and seemingly much larger monthly rates. Auslender [107] discussed the importance of having guidance through which housing policies and the rental market can play a big role in the smoother integration of refugees into host communities. To achieve this, each city resettling refugees should prepare for any future refugee arrival by considering multiple factors, such as population density, availability of housing, and geographic location.

Also recommended is the importance of developing a collaborative strategic plan for refugee accommodation between the city government and the resettlement NGOs [107]. Not only policy but the governance of a coalition of city government and NGOs should be analyzed for the success of refugee housing issues if there are any failures. Governance in this sense includes institutional psychology and practices that might be biased by the major party within it [108]. In the example of Sweden [107], researchers suggested that both housing and resettlement policies need to be considered as a package. Debate in terms of general housing policy and local market dynamics, instead of investigating ideographic cases of specific new refugee groups. If the city government develops a new policy only for a specific new refugee group by creating ‘refugee categories’ for their smooth resettlement, there will be an issue of integration, as this new refugee housing policy will result in the sacrifice of other vulnerable populations.

The major concern in terms of developing a better policy is the gap between federal policy for refugee resettlement and the capacity of local NGOs active in a community. As noted earlier, refugees face intersectional challenges when a frontline staff of a local NGO tries to secure housing for refugees without these concerns and obstacles not being discussed in resettlement policies. Specific programs need to be developed, along with a policy related to these specific needs [106].

8. Conclusion

As noted in this chapter, housing is a primary determinant of health and well-being acknowledged both internationally and also by the United Nations Universal Declaration of Human Rights [4]. Despite this acknowledgment, refugees in various resettling countries often face significant challenges accessing safe and adequate housing as noted by multiple authors. Current literature on the topic of refugee housing highlights various factors that influence refugee housing quality which includes but is not limited to affordability and stability, underscoring the need for tailored support services and policy interventions in resettlement countries.

Refugee housing conditions, whether in camps or post-resettlement settings, significantly impact physical and mental health outcomes. Several factors such as substandard housing quality, characterized by overcrowding, inadequate sanitation, safety hazards, and housing instability and affordability, contribute to a range of health issues and exacerbate pre-existing conditions including both physical well-being [35, 89] and psychological well-being [81].

It has also been recognized that community integration and empowerment are crucial for fostering positive housing outcomes for refugees, thus influencing well-being. These include but are not limited to positive host community attitudes, support from NGOs, and inclusive housing policies [107]. Furthermore, placemaking efforts and culturally sensitive housing strategies play essential roles in promoting a sense of belonging and identity among refugee communities [103].

Policy implications as described earlier emphasize the need for collaborative approaches between governments, NGOs, and local communities to address refugee housing challenges effectively [107]. Recommendations include enhancing housing affordability, improving access to resources and support services, and fostering transparent communication and accountability within housing systems. Additionally, policymakers should consider the challenges and the specific needs associated with diverse refugee populations when developing comprehensive and inclusive policies prioritizing refugee well-being and integration into host communities.

Conflict of interest

The authors declare no conflict of interest.