Refugee camps are some of the most densely populated and resource-constrained living environments on earth, housing millions of displaced people in settings originally designed to last weeks or months but often persisting for decades. While the public image of a refugee camp tends to be rows of white tents in a dusty landscape, the reality has grown far more complex. Camps evolve into something closer to unplanned cities, with informal markets, governance structures, chronic disease clinics, and energy grids, all shaped by the tension between their intended temporary status and their practical permanence.
The Mental Health Burden
The psychological toll of conflict, flight, and prolonged displacement concentrates inside camp walls. A study of Syrian refugees in a camp setting found that roughly four in five met criteria for probable post-traumatic stress disorder, and more than a third showed probable depression. Women faced especially steep odds: the likelihood of PTSD was about four times higher for women than for men, and the likelihood of depression was about five times higher. Having had previous mental health problems, experiencing a direct threat to one’s life, or having a loved one injured during the conflict all significantly increased the risk of PTSD.1The Journal of Nervous and Mental Disease. Prevalence and Predictors of Posttraumatic Stress and Depression Symptoms Among Syrian Refugees in a Refugee Camp
Those rates are not unique to one camp or one conflict. A separate study of Syrian refugees in the Kurdistan region of Iraq found that about 60 percent had probable PTSD, and a nearly identical share experienced probable depression. The length of time a person had spent in the camp and the number of different types of traumatic events they had endured were both significant predictors.2PubMed Central. Post-traumatic stress disorder and depression among Syrian refugees residing in the Kurdistan region of Iraq In Nakivale camp in southwestern Uganda, researchers documented even broader psychiatric distress: generalized anxiety disorders affected about 73 percent of residents, PTSD about 67 percent, major depression about 58 percent, and substance use disorders about 30 percent.3PubMed Central. Post-traumatic stress disorder, psychiatric comorbidities and associated factors among refugees in Nakivale camp in southwestern Uganda
These numbers are striking in any context, but especially so given how little mental health infrastructure exists in most camps. The handful of counselors, peer support programs, or mobile therapy initiatives that do operate are vastly outnumbered by the need. Many residents go years without any formal mental health contact, and the stressors that sustain psychological distress, overcrowding, lack of autonomy, uncertainty about the future, do not ease with time.
Water, Sanitation, and Infectious Disease
Population density in camps can be extraordinary. A camp studied in Thailand, for example, packed about 11,500 people into each square kilometer, and the sanitation infrastructure lagged far behind what that density requires, in large part because the camp was never planned to become a long-term settlement.4PLOS Neglected Tropical Diseases. Use of Oral Cholera Vaccine and Knowledge, Attitudes, and Practices Regarding Safe Water, Sanitation and Hygiene in a Long-Standing Refugee Camp, Thailand, 2012-2014 Drinking water stored in households was frequently contaminated: in follow-up surveys, between roughly a third and half of all tested households had stored water positive for E. coli. The contamination was linked to a lack of safe water containers, a deceptively simple problem with real consequences when clean containers are not available or affordable.5PLOS Neglected Tropical Diseases. Use of Oral Cholera Vaccine and Knowledge, Attitudes, and Practices Regarding Safe Water, Sanitation and Hygiene in a Long-Standing Refugee Camp, Thailand, 2012-2014
Cholera, hepatitis, typhoid, and diarrheal diseases thrive in these conditions. Humanitarian agencies typically prioritize water, sanitation, and hygiene programs early in a camp’s life, but the gap between “improved” infrastructure and genuinely safe infrastructure is wide. Even when latrines and water points exist, they can be poorly maintained, too distant from shelters for safe nighttime access, or overwhelmed by the population they serve. When a camp doubles or triples in size faster than planned, the infrastructure meant for 10,000 people ends up serving 40,000.
Chronic Illness Behind Camp Walls
Infectious disease gets the lion’s share of attention in emergency settings, but chronic conditions like diabetes and hypertension are increasingly common among camp populations, especially among refugees from middle-income countries where these diseases were already prevalent before displacement. In Shatila refugee camp in Lebanon, Médecins Sans Frontières ran a structured care program for Syrian refugees with diabetes and high blood pressure. At intake, only about 29 percent of diabetes patients had their blood sugar adequately controlled, and just 32 percent of hypertension patients had their blood pressure under control. After six months of consistent care, those figures rose to 61 percent and 50 percent respectively.6PubMed Central. Treating Syrian refugees with diabetes and hypertension in Shatila refugee camp, Lebanon: Médecins Sans Frontières model of care and treatment outcomes
Those results demonstrate that chronic disease management in camps is possible, but they also reveal how far from controlled most patients are when they first arrive at a clinic. Many have gone months or years without medication. Getting treatment to patients also required intensifying care: the share of hypertension patients needing three or more medications climbed from 23 to 38 percent, and the share of diabetes patients requiring insulin went from 21 to 29 percent, reflecting how undermedicated people had been before enrollment.7PubMed Central. Treating Syrian refugees with diabetes and hypertension in Shatila refugee camp, Lebanon: Médecins Sans Frontières model of care and treatment outcomes Loss to follow-up was 16 percent, a reminder that even when a clinic exists, people leave, move, or fall out of the system.
How Camp Living Shapes Long-Term Health
It is one thing to live in a camp during the acute phase of an emergency and quite another to spend years there. A cross-sectional analysis of the U.S. Annual Survey of Refugees found that, after adjusting for socio-demographic characteristics, refugees who had lived in camps for a year or more had about 27 percent greater odds of reporting poor physical health than those who had never lived in a camp. The association between camp living and poor mental health, though present in raw numbers, lost statistical significance once the researchers accounted for demographic differences, suggesting that some of the mental health burden attributed to camps may overlap with factors like education, income, and family structure.8PubMed Central. Associations between refugee camp living and duration lived in refugee camps with health outcomes: A cross-sectional analysis of the Annual Survey of Refugees, 2021–2022
That finding is worth sitting with. It implies that the physical health costs of extended camp residence persist even after resettlement in a high-income country, likely because years of inadequate nutrition, delayed care, and chronic stress leave marks on the body that do not resolve simply by changing location. For policymakers debating how long to keep camps open versus investing in earlier resettlement or integration, this is a tangible argument that time in a camp is not neutral.
Informal Economies and Self-Organization
Camps are not passive spaces where people sit and wait for aid. One of the most studied examples is Za’atari camp in Jordan, which at its peak was home to tens of thousands of people and developed a bustling commercial district dubbed the “Champs-Élysées” by residents. Researchers studying the camp found that refugee-led informal supply networks emerged organically, driven by channels that were technically illicit under camp regulations but broadly seen as legitimate by both residents and many camp staff. These networks supported economic exchange between refugees, between refugees and aid organizations, and between the camp and the surrounding Jordanian community.9Journal of Operations Management. Towards a theory of informal supply networks: An exploratory case study of the Za’atari refugee camp
Cultural conventions and behavioral codes governed how these networks operated, including norms about trust, credit, and dispute resolution that had nothing to do with formal camp rules. The researchers argued that these informal economic activities actually benefit the host community and improve quality of life inside the camp, and that camp authorities and host governments should factor informal economic activity into their planning rather than suppressing it.10Journal of Operations Management. Towards a theory of informal supply networks: An exploratory case study of the Za’atari refugee camp This is an area where policy often lags behind reality: by the time regulators notice the informal economy, it has already become the backbone of daily life.
Self-governance goes beyond commerce. In Al Nasr refugee camp in Amman, Jordan, residents created their own local governing structures, including youth nonprofits that organized civic education, theater, and community action. The camp also hosts a government-recognized body called the Camp Rehabilitation Committee, which functions as a focal point for negotiation with Jordanian authorities. Residents actively resist the presence of additional government officials inside the camp, viewing such incursions as threats to their autonomy. The camp’s physical layout reinforces this: exceptionally narrow streets, some as tight as 60 to 80 centimeters across, create an urban fabric that is difficult for outside authorities to navigate, and residents intentionally maintain this informality as a spatial tool for self-determination.11Urban Governance. Refugee camps enacting agency: The case of Al Nasr refugee camp, Amman, Jordan
What Camps Mean for Host Communities
The arrival of a large refugee camp reshapes the surrounding area in ways that are neither purely positive nor purely negative. Research on host communities near Rohingya camps in Bangladesh found that areas closer to the camps experienced higher economic growth after the refugees arrived. The likely mechanism was humanitarian aid: host households near camps showed higher rates of formal employment, greater access to aid services, and improved food consumption.12World Development. Refugees, camps, and host communities: Evidence from Bangladesh’s humanitarian hosting system
But those gains came with real costs. Proximity to camps was also associated with increased safety concerns among host residents and a higher prevalence of communicable diseases, consistent with epidemiological spillovers from overcrowded camp conditions and added pressure on local health infrastructure and roads.13World Development. Refugees, camps, and host communities: Evidence from Bangladesh’s humanitarian hosting system The takeaway is that host communities are not simply bystanders. Their experience of a nearby camp depends heavily on whether the international community invests in shared infrastructure or treats the camp and the host area as separate problems.
Environmental Vulnerability and Climate Exposure
Camps are frequently sited on marginal land, the kind of terrain that was unoccupied for good reason. The Dadaab complex in Kenya, one of the world’s largest and longest-running refugee settlements, faces drought, deforestation, and flooding as its primary environmental threats. The region around these camps is among the most consistently disaster-prone in Africa.14Oxford Open Climate Change. Nexus dynamics: the impact of environmental vulnerabilities and climate change on refugee camps
A broader analysis indexing climatic exposure across East African camps found that seven out of seventeen camps studied fell in the upper two quartiles of environmental exposure relative to a simulated general population. That means more than 600,000 refugees in those camps face elevated exposure to climate hazards compared to what they would experience in other potential locations. Kakuma camp in Kenya stood out as the only camp near the top quartile of national exposure while also being home to one of the largest encamped populations globally. Six other camps, including sites in South Sudan and Tanzania, clustered in the second-highest quartile.15Scientific Reports. Indexing climatic and environmental exposure of refugee camps with a case study in East Africa
A scoping review of climate risks for displaced populations confirmed the broader pattern: displaced people are disproportionately at risk of being harmed by climate hazards because of their high sensitivity to environmental shocks, their limited ability to adapt, and, in many cases, the heightened exposure that comes with being placed on marginal land to begin with.16Journal of Refugee Studies. Climate risks for displaced populations: a scoping review and research agenda Climate change does not affect all people equally, and camp residents sit at the sharp end of that inequality.
Energy Access and the Diesel Trap
Electricity in most refugee camps has historically been limited to the operations of humanitarian agencies themselves, with power coming from diesel generators. Residents, by contrast, often rely on candles, kerosene, or small batteries. This “diesel trap” is both expensive and dirty. A study of Nyabiheke camp in Rwanda found that hybrid solar-diesel mini-grids could cut total energy costs by up to 32 percent and reduce carbon emissions by as much as 83 percent compared to running diesel generators alone. Payback times ranged from under one year to about six years depending on the level of solar integration, and even partial hybridization delivered meaningful savings.17Sustainable Energy Technologies and Assessments. The potential for solar-diesel hybrid mini-grids in refugee camps: A case study of Nyabiheke camp, Rwanda
Designing microgrid systems specifically for camp settings introduces its own complexity. A techno-economic analysis of a camp microgrid found that the proposed solutions were highly sensitive to capital costs, but that allowing a small capacity shortage, accepting brief periods without full power, significantly reduced the upfront investment needed while barely affecting day-to-day energy access.18Renewable Energy. Techno-economic microgrid design methodology for off-grid refugee camps: Kobe camp case study The engineering is increasingly well understood. The bottleneck is funding and political will: installing solar panels or wind turbines implies the camp will be around long enough to pay back the investment, which conflicts with the fiction that camps are temporary.
Gendered Spaces and Women’s Experience
The daily experience of living in a camp diverges sharply along gender lines. Women and girls face heightened risks tied to the physical design of camps themselves: shared latrines, poorly lit pathways, and overcrowded communal shelters all increase vulnerability to harassment and violence. Research on Afghan women in German refugee accommodation documented how women navigated spatial inequalities, gendered vulnerabilities, and the feeling of being stuck in an indefinite limbo. Women responded with forms of agency that included creative use of space, resilient navigation of institutional constraints, and building solidarity through faith and sisterhood.19Population, Space and Place. Refugee Camps as Contested Gendered Spaces: Afghan Women’s Liminality, Inequality, and Agency in Germany
The mental health data already mentioned underscore this divide. The disproportionate odds of PTSD and depression among women in camp settings are not just artifacts of pre-flight trauma. They reflect ongoing exposure to insecurity, loss of privacy, and constrained autonomy within the camp itself. Designing camps with sex-segregated sanitation, adequate lighting, women-only safe spaces, and female community health workers can mitigate some of these risks, but such design principles are often treated as optional rather than essential.
The Permanence Paradox
Refugee camps are, by definition, supposed to be temporary. That temporariness shapes every decision: governments resist investing in permanent infrastructure, donors fund short-term cycles, and legal frameworks treat camps as transitional. Yet the average duration of a major refugee situation now stretches well beyond a decade, and some camps, like those housing Palestinian refugees, have existed for more than 70 years. Researchers have described the permanent possibility of closure as a defining feature of camp life, one that keeps residents in a state of uncertainty regardless of how long the camp has actually existed.20Progress in Human Geography. Closing camps
When camps do close, the process is rarely straightforward. Closures are expressions of state power, and they take place within the same exclusionary landscapes that created the camps in the first place. Residents may be relocated to other camps, repatriated to countries that remain unsafe, or simply scattered without formal support. What happens after closure, the “afterlife” of a camp, receives far less attention than the camp’s active years, even though the social and spatial imprint of a former camp endures in the host community, in the displaced population’s ongoing health needs, and in the informal infrastructure left behind.21Progress in Human Geography. Closing camps
This paradox creates a policy trap. Investing in durable infrastructure, energy systems, schools, and clinics would improve life enormously, but it also signals permanence that host governments and donor countries are reluctant to acknowledge. The result is a middle ground that satisfies no one: structures that are too flimsy for the long term but too entrenched to dismantle, populations that are neither fully aided nor free to build, and host communities that absorb costs without the shared planning that could turn a camp into a functioning neighborhood. The fiction of temporariness, in other words, is not just a bureaucratic label. It is a policy choice with consequences that compound every year a camp remains open.