COVID-19 community measures

Without a doubt, the physical toll of a COVID-19 infection and the subsequent isolation has a tremendous impact on individual mental health, with an abundance of research dedicated to the effects of individual infection (National Institute of Health, 2023). In a broader scope, COVID-19 has led to adverse outcomes for both refugee and IDP communities, stressors reported in relation to COVID-19 rules and regulations, sickness vulnerability and COVID-related healthcare and information access.

In addition to the highly infectious nature of COVID-19, studies from South Asia and the Middle East have shown the role of living conditions for sickness vulnerability of refugees and IDPs. For example, general living conditions in Palestine facilitated COVID transmission (Jamal et al., Reference Jamal, ElKhatib, AlBaik, Horino, Waleed, Fawaz, Loffreda, Seita, Witter and Diaconu2022). In response to the accelerating spread of COVID-19 infections, countries all over the world implemented public safety measures, including lockdowns within the community, limiting transportation of materials and services, and pressures to vaccinate. One example is Canada’s implementation of various legal structures to ensure cooperation with screening officers for travel (Government of Canada, 2020). Despite the intentions of protecting public health, these protocols were additional stressors in an already-hectic, displaced life in countries such as Kenya (Oyekale, Reference Oyekale2022), Rwanda (Manirambona et al., Reference Manirambona, Uwizeyimana, Uwiringiyimana and Reddy2021), Somalia (Mumin et al., Reference Mumin, Wesonga, Handuleh, White and Mor2022), Bangladesh (Palit et al., Reference Palit, Yang, Li, Khan and Hasan2022), Jordan (Bernardi et al., Reference Bernardi, Gotlib and Zihnioğlu2021; El-Khatib et al., Reference El-Khatib, Al Nsour, Khader and Abu Khudair2020; Jones et al., Reference Jones, Baird, Abu Hamad, Bhutta, Oakley, Shah, Sajdi and Yount2022), Columbia (Espinel et al., Reference Espinel, Chaskel, Berg, Florez, Gaviria, Bernal, Berg, Muñoz, Larkin and Shultz2020), Mexico (Piñeiro & Ibarra, Reference Piñeiro and Ibarra2022) and Iran (Mahmoodi et al., Reference Mahmoodi, Bahrami, Ghavidel and Seddighi2023; Khozaie et al., 2024). In some notable cases, the lack of access to COVID-19 information leads to increased distress, such as in Tunisia (Ben Abid et al., Reference Ben Abid, Ouali and Ben Abdelhafidh2023) and Turkey (Atak et al., Reference Atak, Sezerol, Koçak, Değer and Kurubal2023a).

Social structures involving the community

Vulnerable populations also reported psychological stressors related to community structures during the COVID-19 crisis period. The pandemic crisis transformed the ways people interacted and influenced the environments of their host countries. Social events with great reach were exacerbated within the refugee and IDP communities in some countries. These include social fallout in Nigeria (Ekoh et al., Reference Ekoh, George and Ezulike2021), national economic hardships in Lebanon (Hajjar & Abu-Sittah, Reference Hajjar and Abu-Sittah2021), political stagnation and economic collapse in Lebanon (Fouad et al., Reference Fouad, Barkil-Oteo and Diab2020), and environments of violence in Mexico (Piñeiro & Ibarra, Reference Piñeiro and Ibarra2022) and Myanmar (Khai, Reference Khai2023). A report from Mercy Corps (2021a) reported that the breakdown in social cohesion and increasingly divergent public health knowledge of COVID-19 were associated with conflict-related mental health problems (Mercy Corps, 2021a). Outside of their settlements waited a world that stigmatized these refugees, who often came from other countries and were believed to be carriers of COVID-19 in countries such as South Africa and Uganda, (Bukuluki et al., Reference Bukuluki, Mwenyango, Katongole, Sidhva and Palattiyil2020; Mukumbang et al., Reference Mukumbang, Ambe and Adebiyi2020). For example, refugees in Uganda reported stigma and isolation from the host community because they were labeled as potential importers of COVID-19 (Bukuluki et al., Reference Bukuluki, Mwenyango, Katongole, Sidhva and Palattiyil2020). On a global scale, it has been reported that COVID-19 has aggravated ethno-racial tensions and stigmatization of all migrants (Aghajafari et al., Reference Aghajafari, Bailey, Chowdhury, Lorenzetti and Coakley2023) because both the disease and people were perceived by their similarity: their foreign status. Moreover, the unequal distribution of COVID-19 information and testing services was also identified along ethnic and racial lines, demonstrating systemic unevenness in access to health services (Centers for Disease Control and Prevention [CDC], 2021). Building on preexisting social discrimination, structures of stigma prevailed throughout the pandemic, such as ageism in IDP camps in Nigeria (Ekoh et al., Reference Ekoh, George and Ezulike2021) and Bangladesh (Anwar et al., Reference Anwar, Yadav, Huda, Ghimire, Rahman, Ali, Mahumud, Shuvo, Nowar, Mondal, Rizwan and Mistry2023a), and overall discrimination in Turkey (Kurt et al., Reference Kurt, Ilkkursun, Javanbakht, Uygun, Karaoglan-Kahilogullari and Acarturk2021) and Iran (Mohammadsadeghi et al., Reference Mohammadsadeghi, Bazrafshan, Seify-Moghadam, Mazaheri Nejad Fard, Rasoulian and Eftekhar Ardebili2022).

Government programs and international aid

Prior to the onset of the pandemic, there would be limited access to governmental and international aid programs. However, the regulations caused by COVID-19 further impeded financial assistance access in Burkina Faso (Ozer et al., Reference Ozer, Dembele, Yameogo and Elodie2022). It is also not difficult to imagine the hindrance of government processing of refugee and IDP status, as was the case for Uganda (Bukuluki et al., Reference Bukuluki, Mwenyango, Katongole, Sidhva and Palattiyil2020). Specific resources were greatly reduced throughout the pandemic, with reductions in food aid programs and inefficient cash transfer compromises in Rwanda (Manirambona et al., Reference Manirambona, Uwizeyimana, Uwiringiyimana and Reddy2021), aid programs being ineffective in improving living conditions in Burkina Faso (Ozer et al., Reference Ozer, Dembele, Yameogo and Elodie2022), and hindrances in identification processing leading to limited food program access in Uganda (Bukuluki et al., Reference Bukuluki, Mwenyango, Katongole, Sidhva and Palattiyil2020). The lack of aid also occurred on a global scale, as humanitarian aid supplies from agencies like the World Food Programme were adversely affected by the economic state of the U.S. and other wealthier donor countries as affected by the pandemic (UNHCR, 2020b; World Food Programme, 2023). The pandemic’s threat to aid workers’ health security also deterred development work in poorer countries (Manirambona et al., Reference Manirambona, Uwizeyimana, Uwiringiyimana and Reddy2021). Despite their importance, health workers’ mental well-being in crisis circumstances also calls for consideration as this can impact their capacity to provide care to those most vulnerable. A review of 16 studies on pandemic workplace interventions for health workers dealing with disease outbreaks in past pandemics showed that many settings lack the facilities, time and skills to incorporate mental health programs for health workers needing mental health support (Pollock et al., Reference Pollock, Campbell, Cheyne, Cowie, Davis, McCallum and Maxwell2020). As expected, war-torn countries such as Libya were worst hit by COVID-19 restrictions in terms of health systems capacity as conflict and war concurrently occurring with the disease outbreak overburdened health workers. This reportedly led to burnout, verbal abuse and anxiety symptoms among health workers (Elhadi et al., Reference Elhadi, Msherghi, Elgzairi, Alhashimi, Bouhuwaish, Biala and Albakoush2020).

Economic capabilities

COVID-19 is associated with financial- and resource-related stressors for refugees and IDPs, further correlated with mental health declines for refugees and IDP populations. Financial insecurities, such as limited money and lower income, were reported for both groups, in countries such as Burkina Faso (Ozer et al., Reference Ozer, Dembele, Yameogo and Elodie2022), Nigeria (Ekoh et al., Reference Ekoh, George and Ezulike2021), Uganda (Bukuluki et al., Reference Bukuluki, Mwenyango, Katongole, Sidhva and Palattiyil2020), Indonesia (Hajjar & Abu-Sittah, Reference Hajjar and Abu-Sittah2021), Jordan (Akhtar et al., Reference Akhtar, Bawaneh, Awwad, Al-Hayek, Sijbrandij, Cuijpers and Bryant2021), Turkey (Atak et al., Reference Atak, Sezerol, Değer and Kurubal2023b; İkiışık et al., Reference İkiışık, Surmeli, Sever and Maral2022), Mexico (Piñeiro & Ibarra, Reference Piñeiro and Ibarra2022), Turkey (Atak et al., Reference Atak, Sezerol, Değer and Kurubal2023b; Budak et al., Reference Budak, Özer and Özkan2021), and Lebanon (Alnaji et al., Reference Alnaji, Akesson and Bagenda2024; Fouad et al., Reference Fouad, Barkil-Oteo and Diab2020; Hoffman et al., Reference Hoffman, Liddell, Keegan, Kashyap, Tricesaria, Pestalozzi, Argadianti, Nadyatama, Khakbaz, Nilasari and Nickerson2023). Difficulties in employment felt in South Africa (Mukumbang et al., Reference Mukumbang, Ambe and Adebiyi2020), Somalia (Mumin et al., Reference Mumin, Wesonga, Handuleh, White and Mor2022), Turkey (İkiışık et al., Reference İkiışık, Surmeli, Sever and Maral2022), Jordan (Bellizzi et al., Reference Bellizzi, Alsawalha, Samawi, Al-Shaikh, Alfar, Muthu and Profili2021), Columbia (Espinel et al., Reference Espinel, Chaskel, Berg, Florez, Gaviria, Bernal, Berg, Muñoz, Larkin and Shultz2020), and India (Singh, Reference Singh2021) deepened this insecurity, though a report by Boiko et al. (Reference Boiko, Shyrai, Mats, Karpik, Rahman, Khan, Alanazi and Skrypnikov2024) alludes to the presence of this insecurity in a variety of countries. In a report by Badrfam and Zandifar (Reference Badrfam and Zandifar2021), these working conditions could also be stressful, as was the case for Iran. These economic hardships could be a factor in the poverty and homelessness faced in South Africa (Mukumbang et al., Reference Mukumbang, Ambe and Adebiyi2020) and Bangladesh (Hossain et al., Reference Hossain, Huda, Ullah and Renzaho2022). In the suburbs of Kampala city and other towns, the government-imposed lockdown compromised livelihoods and income security for many forcibly displaced communities. The lack of access to food and other basic necessities of life predisposed refugees to malnutrition, anxiety, stress, and psychosocial problems (Hossain et al., Reference Hossain, Huda, Ullah and Renzaho2022).

Resource access

Even after the limitations of resource aid programs, general scarcity of resources has been reported in Burkina Faso (Ozer et al., Reference Ozer, Dembele, Yameogo and Elodie2022), Bangladesh (Palit et al., Reference Palit, Yang, Li, Khan and Hasan2022), Jordan (Akhtar et al., Reference Akhtar, Bawaneh, Awwad, Al-Hayek, Sijbrandij, Cuijpers and Bryant2021), Lebanon (Fouad et al., Reference Fouad, Barkil-Oteo and Diab2020), India (Ozer et al., Reference Ozer, Dembele, Yameogo and Elodie2022), and Turkey (Kurt et al., Reference Kurt, Ilkkursun, Javanbakht, Uygun, Karaoglan-Kahilogullari and Acarturk2021). This is further specified as food scarcity in Rwanda (Manirambona et al., Reference Manirambona, Uwizeyimana, Uwiringiyimana and Reddy2021), South Africa (Mukumbang et al., Reference Mukumbang, Ambe and Adebiyi2020), Somalia (Mumin et al., Reference Mumin, Wesonga, Handuleh, White and Mor2022), Burkina Faso (Ozer et al., Reference Ozer, Dembele, Yameogo and Elodie2022), Venezuela (Espinel et al., Reference Espinel, Chaskel, Berg, Florez, Gaviria, Bernal, Berg, Muñoz, Larkin and Shultz2020), Lebanon (Zeid et al., Reference Zeid, Farouki, El Khoury, Sibai, Mendes de Leon, Alaweigh, Ramadan, Abdulrahim, Ghattas and McCall2023), and Bangladesh (Hossain et al., Reference Hossain, Huda, Ullah and Renzaho2022; Anwar et al., Reference Anwar, Yadav and Huda2023b). In some cases, post-traumatic stress settled as the shock brought back sour memories of their experiences and ordeals of the life during the conflict in their countries of origin. This finding is consistent with the findings of a previous study by Maharaj et al. (Reference Maharaj, Tomita, Thela, Mhlongo and Burns2017), who studied self-reported food insecurity and the risk of depression among refugees and immigrants in South Africa among 335 adults in Durban, South Africa. They found that food insecurity was associated with poverty and mental illness, and micronutrient deficiencies in vitamin B12 and iron were implicated in the etiology of depression among the sampled refugees (Maharaj et al., Reference Maharaj, Tomita, Thela, Mhlongo and Burns2017). General poor living conditions have been reported as a stressor for vulnerable populations in Lebanon (Alnaji et al., Reference Alnaji, Akesson and Bagenda2024), Jordan (Jones et al., Reference Jones, Baird, Abu Hamad, Bhutta, Oakley, Shah, Sajdi and Yount2022), and other countries as alluded to by Boiko et al. (Reference Boiko, Shyrai, Mats, Karpik, Rahman, Khan, Alanazi and Skrypnikov2024). This is also taken further, with overall quality of life being a factor in depressive symptoms for refugees in Turkey (Erol & Batgi, Reference Erol, Koyuncu and Batgı2023).

Indeed, the weight of these intersecting factors has been highlighted in some literature on refugee and IDP experiences in Bangladesh (Palit et al., Reference Palit, Yang, Li, Khan and Hasan2022) and Iran (Mahmoodi et al., Reference Mahmoodi, Bahrami, Ghavidel and Seddighi2023). Financial hardship and resource access are prominently reported for refugees and IDPs in many LMICs in Asia and the Middle East, but especially in African countries such as South Africa, Uganda, and Burkina Faso.

Demographic correlates

Thus far, the aforementioned stressors and adverse health outcomes could be applied with a focus on immigrant status and therefore any person living within the refugee or IDP settlements in their relevant countries. Specific health determinants have been covered throughout the paper thus far, such as immigrant status, resource access and financial aid. Other elements are also correlated with detrimental mental health in these contexts, though to a smaller extent. These included education for vulnerable migrants in Turkey (Atak et al., Reference Atak, Sezerol, Değer and Kurubal2023b; Budak et al., Reference Budak, Özer and Özkan2021), smoker status in Turkey (Atak et al., Reference Atak, Sezerol, Koçak, Değer and Kurubal2023a), pregnancy in Turkey (Atak et al., 2023), targeted parental support in North Lebanon (Miller et al., Reference Miller, Arnous, Saade, Tossyeh and Jordans2022), marital status in Turkey (Budak et al., Reference Budak, Özer and Özkan2021) and Ghana (Sakyi & Amoako Johnson, Reference Sakyi and Amoako Johnson2022), as well as age in Ghana (Sakyi & Amoako Johnson, Reference Sakyi and Amoako Johnson2022).

Gender is an interesting health determinant, as it affects refugees, IDPs and migrants in three ways: gender disparities in mental health experiences, gender discrimination and gender violence. Disparities in mental health were found in Uganda (Seruwagi et al., Reference Seruwagi, Nakidde, Lugada, Ssematiko, Ddamulira, Masaba, Luswata, Ochen, Okot, Muhangi and Lawoko2022), Bangladesh (Palit et al., Reference Palit, Yang, Li, Khan and Hasan2022), and Lebanon (Hajjar & Abu-Sittah, Reference Hajjar and Abu-Sittah2021). Existing literature supports that violence against women is a pervasive practice in contexts of displacement and is associated with poverty and inequitable gender norms (Amodu et al., 2020). Other issues that resulted from economic insecurity during COVID-19 among the displaced included early marriage, transactional sex, dysfunctional family dynamics, and intramarital violence. These themes of gender-based violence were present in Myanmar (Khai, Reference Khai2023) and Palestine (Jamal et al., Reference Jamal, ElKhatib, AlBaik, Horino, Waleed, Fawaz, Loffreda, Seita, Witter and Diaconu2022). Children were also a vulnerable demographic within refugees and IDPs in LMIC, such as in Jordan (Bellizzi et al., Reference Bellizzi, Alsawalha, Samawi, Al-Shaikh, Alfar, Muthu and Profili2021), Tanzania (Shayo et al., Reference Shayo, Mubyazi, Barongo, Bakari, Kiwale, Fabbri, Turner, Rodrigues and Devries2024), and Lebanon (Hajjar & Abu-Sittah, Reference Hajjar and Abu-Sittah2021). In some cases, youths had specific troubles adjusting to their host country during this period, such as limited access to education in Lebanon (Hajjar & Abu-Sittah, Reference Hajjar and Abu-Sittah2021) and Tanzania (Shayo et al., Reference Shayo, Mubyazi, Barongo, Bakari, Kiwale, Fabbri, Turner, Rodrigues and Devries2024) as well as increased experiences of violence in Palestine (Jamal et al., Reference Jamal, ElKhatib, AlBaik, Horino, Waleed, Fawaz, Loffreda, Seita, Witter and Diaconu2022), Tanzania (Shayo et al., Reference Shayo, Mubyazi, Barongo, Bakari, Kiwale, Fabbri, Turner, Rodrigues and Devries2024), and Myanmar (Khai, Reference Khai2023).

Physical health correlates

Changes brought on by COVID-19 were correlated with adverse physical health outcomes for refugees and IDPs. Physical health also plays a unique role in failing mental health, playing as both a cause and consequence of it. This was certainly the cause in South Africa, where secondary health concerns were linked to negative coping mechanisms such as substance abuse (Mukumbang et al., Reference Mukumbang, Ambe and Adebiyi2020) or the simultaneous link of psychological distress and poor physical health, as was the case for refugees in Uganda (Seruwagi et al., Reference Seruwagi, Nakidde, Lugada, Ssematiko, Ddamulira, Masaba, Luswata, Ochen, Okot, Muhangi and Lawoko2022). This issue is not limited to physical ailments that were caught during the pandemic’s height, such as COVID-19 infections or other sicknesses. Preexisting health issues were reported to be a hindrance in already-fragile mental health, in countries such as Ghana (Sakyi & Amoako Johnson, Reference Sakyi and Amoako Johnson2022). The issue of physical health is then worsened by the limited access to healthcare, as experienced by vulnerable groups in South Africa (Mukumbang et al., Reference Mukumbang, Ambe and Adebiyi2020), Somalia (Mumin et al., Reference Mumin, Wesonga, Handuleh, White and Mor2022), Burkina Faso (Ozer et al., Reference Ozer, Dembele, Yameogo and Elodie2022), Lebanon (Hajar & Abu-Sittah, 2021; Alnaji et al., Reference Alnaji, Akesson and Bagenda2024), Iran (Badrfam & Zandifar, Reference Badrfam and Zandifar2021), Jordan (El-Khatib et al., Reference El-Khatib, Al Nsour, Khader and Abu Khudair2020), Turkey (İkiışık et al., Reference İkiışık, Surmeli, Sever and Maral2022), and Bangladesh (Hossain et al., Reference Hossain, Huda, Ullah and Renzaho2022; Anwar et al., Reference Anwar, Yadav and Huda2023b).

Mental health and psychological correlates

COVID-19 was reported as the cause of a wide variety of adverse mental health outcomes. Common mental health issues, such as anxiety and depression, were often reported: anxiety was reported in Bangladesh (Hossain et al., Reference Hossain, Huda, Ullah and Renzaho2022), India (Singh, Reference Singh2021), Syria (Kira et al., Reference Kira, Shuwiekh, Ashby, Elwakeel, Alhuwailah, Sous, Baali, Azdaou, Oliemat and Jamil2023), Somalia (Mumin et al., Reference Mumin, Wesonga, Handuleh, White and Mor2022), Kenya (Oyekale, Reference Oyekale2022), Ghana (Sakyi & Amoako Johnson, Reference Sakyi and Amoako Johnson2022), Turkey (İkiışık et al., Reference İkiışık, Surmeli, Sever and Maral2022; Yalcin et al., Reference Yalcin, Bashan and Arpacioglu2021), and Uganda (Seruwagi et al., Reference Seruwagi, Nakidde, Lugada, Ssematiko, Ddamulira, Masaba, Luswata, Ochen, Okot, Muhangi and Lawoko2022), as well as depression in Turkey (Sevinc et al., Reference Sevinc, Hasbal, Sakaci, Basturk, Ahbap, Ortaboz, Mazi, Pirdogan, Ling and Unsal2021), or both anxiety and depression, such as in Turkey (Kurt et al., Reference Kurt, Ilkkursun, Javanbakht, Uygun, Karaoglan-Kahilogullari and Acarturk2021), or in various countries (Lushchak et al., Reference Lushchak, Velykodna, Bolman, Strilbytska, Berezovskyi and Storey2024). However, a few studies did find a little decrease in anxiety and depression rates or no change altogether, such as in Jordan (Akhtar et al., Reference Akhtar, Bawaneh, Awwad, Al-Hayek, Sijbrandij, Cuijpers and Bryant2021) and Turkey (Atak et al., Reference Atak, Sezerol, Koçak, Değer and Kurubal2023a; Atak et al., Reference Atak, Sezerol, Değer and Kurubal2023b; Ünver & Perdahlı Fiş, Reference Ünver and Perdahlı Fiş2022; Yalcin et al., Reference Yalcin, Bashan and Arpacioglu2021), though these are rare within the literature. Many studies often report general terms for mental health, such as psychological or mental distress, that may not be specific in diagnosis or perceived psychological effects. General mental health decline, stress or psychological distress was reported in Iran (Khozaei et al., Reference Khozaei, Carbon and Razak2022; Khozaei et al., Reference Khozaei, Islam, Ramayah, Ayub and Carbon2024), Palestine (Jamal et al., Reference Jamal, ElKhatib, AlBaik, Horino, Waleed, Fawaz, Loffreda, Seita, Witter and Diaconu2022), Rwanda (Manirambona et al., Reference Manirambona, Uwizeyimana, Uwiringiyimana and Reddy2021), South Africa (Mukumbang et al., Reference Mukumbang, Ambe and Adebiyi2020), Bangladesh (Palit et al., Reference Palit, Yang, Li, Khan and Hasan2022) and China (Hall et al., Reference Hall, Zhao, Xiong, Latkin, Yang and Wang2021). Other articles also reported intense psychological issues, such as PTSD in Bangladesh (Hossain et al., Reference Hossain, Huda, Ullah and Renzaho2022), Uganda (Baluku et al., Reference Baluku, Nansubuga, Kibanja, Ouma, Balikoowa, Nansamba, Ruto, Kawooya and Musanje2023a), Iraq (Kizilhan & Noll-Hussong, Reference Kizilhan and Noll-Hussong2020), Turkey (Seçinti et al., Reference Seçinti, Şen and McCarthy2023; Yalcin et al., Reference Yalcin, Bashan and Arpacioglu2021) and various other countries (Lushchak et al., Reference Lushchak, Velykodna, Bolman, Strilbytska, Berezovskyi and Storey2024); type III trauma in Syria (Kira et al., Reference Kira, Shuwiekh, Ashby, Elwakeel, Alhuwailah, Sous, Baali, Azdaou, Oliemat and Jamil2023); obsessive-compulsive symptoms in various countries (Boiko et al., Reference Boiko, Shyrai, Mats, Karpik, Rahman, Khan, Alanazi and Skrypnikov2024); and substance abuse disorders and elevated substance use in India (Singh, Reference Singh2021) and Turkey (Atak et al., 2023a). One notable inclusion is Ünver and Perdahlı Fiş, Reference Ünver and Perdahlı Fiş2022, as they note the increase of multiple behavioral disorders such as ADHD, ODD and conduct disorder in Turkey. Isolation, found in Uganda (Bukuluki et al., Reference Bukuluki, Mwenyango, Katongole, Sidhva and Palattiyil2020), Nigeria (Ekoh et al., Reference Ekoh, George and Ezulike2021) and Lebanon (Hajjar & Abu-Sittah, Reference Hajjar and Abu-Sittah2021; Alnaji et al., Reference Alnaji, Akesson and Bagenda2024), was also reported as an experience resulting from stressors. A few studies approached mental health through the changes in the brain.

Research suggests that the perceived risk of exposure to COVID-19 impacts mental health. For example, Kim et al. (Reference Kim, Nyengerai and Mendenhall2020) conducted a mixed methods survey to evaluate the mental health impacts of the COVID-19 pandemic in an urban setting in Soweto, South Africa. In the general population surveyed, a higher perceived risk of COVID-19 infection was associated with greater depressive symptoms during the first six weeks of quarantine. In fact, in examining COVID-19 perceptions, multiple academics report an increase in anxiety directly related to the pandemic and infection in articles from Jordan (Akhtar et al., Reference Akhtar, Bawaneh, Awwad, Al-Hayek, Sijbrandij, Cuijpers and Bryant2021), Bangladesh (Anwar et al., Reference Anwar, Yadav and Huda2023b), Turkey (Budak et al., Reference Budak, Özer and Özkan2021), and Tanzania (Shayo et al., Reference Shayo, Mubyazi, Barongo, Bakari, Kiwale, Fabbri, Turner, Rodrigues and Devries2024).

Certain psychological effects are the result of both COVID-19-related issues and the underlying social structures that refugees and IDPs previously listed. A unique mental health outcome of COVID-19 was the social isolation for refugees in LMICs. Whether this was the result of COVID-19’s restrictions or the social exclusion of their host country, the weight of isolation was observed to be influential in the decreasing quality of mental health for these vulnerable groups in Uganda (Bukukluki et al., Reference Bukuluki, Mwenyango, Katongole, Sidhva and Palattiyil2020), Nigeria (Ekoh et al., Reference Ekoh, George and Ezulike2021) and Lebanon (Hajjar & Abu-Sittah, Reference Hajjar and Abu-Sittah2021).

Effects of detrimental mental health

The consequences of detrimental mental health can be cyclical in nature and have dire implications within crisis contexts. Two studies, both conducted in Turkey by Alpay et al (Reference Alpay, Kira, Shuwiekh, Ashby, Turkeli and Alhuwailah2021) and Kira et al. (Reference Kira, Alpay, Turkeli, Shuwiekh, Ashby and Alhuwailah2021), found that PTSD and depression associated with COVID-19 traumas, stresses and fears have affected deficits in working memory and inhibitory control. In another report from Uganda, Baluku et al. (Reference Baluku2023) found that psychological inflexibility correlated with poorer adherence to COVID-19 health measures. This implies that the relationship between COVID-19 and mental health is bidirectional, as a report by Hall et al. (Reference Hall, Zhao, Xiong, Latkin, Yang and Wang2021) finds that poor confidence in the protective abilities of COVID-19 measures was linked to higher depression.