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Principal Investigators: Dr Gloria Seruwagi, PI (Makerere University) and Prof. Stephen Lawoko, Co-PI (Gulu University)

Research Snapshot: Exploring refugee compliance to COVID-19 guidelines in Uganda

The Refugee Lived Experiences, Compliance and Thinking (REFLECT) study assessed community knowledge, attitudes and practices (KAP) and implementation of Uganda’s national response to COVID-19 among refugee communities.

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What did the study set out to achieve?

This study sought to understand the extent to which refugee communities were aware of COVID-19 and compliant with related measures and guidelines. It prioritised the lived experience of refugees, while also analysing the processes and outcomes of COVID-19 policy and guidelines in Uganda. Critical issues, actions, intentions and experiences were explored at the individual, community and national levels.

The study assessed awareness and behavioural shifts in Uganda’s diverse refugee settings, with more than five different nationalities participating. It looked to establish whether contextual specificities of urban and rural-based refugees have a bearing on awareness, feasibility, enforcement and compliance to policy and guidelines from Uganda’s national response to COVID-19. Embedded in this research was a policy analysis strand – assessing policy formulation, feasibility, implementation and outcome.

Dr Gloria Seruwagi, Principal Investigator

Makerere University

A plethora of etic perspectives on the refugee experience largely drives programming, policy and research. A glaring gap is the insider (emic) perspective. This research positions refugees at the centre, highlighting issues most meaningful and positively transformative for them. We need to listen, learn and then act - acknowledging their agency and “nothing about us without us” message.

What were the key findings?

  • Refugees were generally knowledgeable about COVID-19, although up to 40% exhibited knowledge gaps and plenty of myths existed.
  • There was non-adherence to most guidelines, and between 25% – 70% had adopted risky behaviour likely to lead to transmission of COVID-19.
  • Reasons include mixed messages from multiple information centres; socioeconomic, cultural and structural barriers (such as food insecurity, or politics); and the ‘infodemic’; fuelled by social media or refugee links with the diaspora.
  • Variations exist in knowledge and compliance behaviours across different sociodemographic characteristics:
    • gender: Men more knowledgeable about COVID, but less compliant than women
    • location (urban vs rural): Urban refugees more knowledgeable but less compliant than their rural counterparts
    • religion: Muslims more knowledgeable and compliant than Christians
  • Several local community resources, systems and structures existed: including community champions, livelihoods or savings support groups and community faith coalitions. These informally supported the COVID-19 response, including helping to reach vulnerable or excluded community members.

What does this mean for policymakers and practitioners?

The study recommended that the government of Uganda review not only its approach but also related outcomes in addressing COVID-19 in humanitarian settings, considering what is feasible for refugees. For example, focusing more on water, sanitation and hygiene (WASH) preventive measures, instead of social distancing may be better for refugees in crowded settlements or homes. The team also suggested that the Government and partners address the barriers of non-compliance and consider implementing a robust socioeconomic response interlinked with other key sectors and actors. They noted that active community involvement and engagement would foster an acceptable, effective, inclusive and sustainable approach.

Humanitarian actors focused on health (including WASH), protection, livelihoods and other sectors could use the findings of this research to improve interventions, or design more responsive interventions that are guided by local partnerships.

A series of resources are available on the Chase-I REFLECT website page that share the team’s experience of conducting this research. The resources include blogs that reflect on the perspectives of all the partners in the study; policy briefs, such as guidance on how communities can be empowered to steer sustained COVID-19 compliance measures; and community engagement activities.

Related Resources

Impact Case Study COVID-19, Research Uptake

Impact Case Study: Exploring refugee knowledge and compliance to COVID-19 guidelines in Uganda

Article, Peer Reviewed COVID-19

Healthworker preparedness for COVID‑19 management and implementation experiences

Article, Peer Reviewed COVID-19, Mental Health and Psychosocial Support

Psychological distress and social support among conflict-affected refugees in Uganda

Briefing Note COVID-19

The A – Z of COVID-19 in Uganda

Policy Brief COVID-19

Compliance to COVID-19 Guidelines in Uganda: Insights from a Multi-site Study in 13 Refugee Settlements

Research Snapshot COVID-19

Research Snapshot: Exploring refugee compliance to COVID-19 guidelines in Uganda

Latest Updates

Research Impact Case Study Published

Jul 2023

This study was selected by the R2HC for our Impact Case Study series. The case study is now available to view online.


Website Live

Feb 2021

The team created a website to share the work of the REFLECT project. Here you can find blogs from the field, lessons learned, policy briefs and all the other resources developed as a result of the project to understand COVID-19 in Uganda's refugee camps.


Is Uganda’s CES the new face of resilient health systems in COVID?

Jan 2021

Gloria Seruwagi, co-principal investigator for the REFLECT study, shares her thoughts on the resilience of Uganda's health system amid COVID-19.


A policy-makers pespective on the REFLECT study

Dec 2020

An interview with Brian Luswata from the Ugandan Ministry of Health on his experience working with the REFLECT study.

REFLECT Research Assistants preparing to embark on data collection in Kyaka II refugee settlement.
Hand washing with soap demonstration. Photo credit: ACORD.
Refugee settlement in Adjumani. Photo credit: LWF.
Handwashing in settlements during COVID-19. Photo credit: ACORD.
One of the boreholes in Adjumani refugee settlement. Photo credit: LWF.
A young refugee mother helping her child to wash hands. Photo credit: ACORD.
South Sudanese children at a refugee settlement in Adjumani. Photo credit: LWF.
A home visit by ACORD staff in Kyaaka II Refugee Settlement. Photo credit: ACORD
Anne and LWF staff preparing for a distribution. Photo credit: LWF.
Sensitising Congolese refugees on aspects of COVID-19 transmission and how to prevent it
Refugees struggle to fetch water, one of the most essential commodity needed to fight COVID-19
Loading handwashing facilities destined for Kyaka and Kyangwali refugee settlements
Dr. Gloria training REFLECT Research Assistants in Kyaka Refugee settlement
Dr. Eric Lugada training Research Assistants in Kyaka II refugee settlement
Distributing bar soap, liquid soap and masks to Congolese refugees to enable them practice effective hand washing thereby fighting COVID-19
A Congolese refugee practicing hand washing to prevent COVID-19
Community Rides to sensitise Congolese refugees in Kyaka settlement on COVID-19
ACORD Community facilitator sensitising Congolese refugees on COVID-19 during one of the home to home outreaches
A Congolese refugee with a disability demonstrating hand washing after receiving training soap and a hand washing facility from ACORD to fight COVID-19

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