Despite the open policy of integration, refugees in South Africa have been experiencing increasing exclusion and discrimination in socio-economic development and from social services. State-sanctioned discrimination contributes to mistrust among marginalized groups toward the government and its institutions. However, public trust towards healthcare authorities and government institutions is critical during pandemic outbreaks to ensure the population’s willingness to follow public health initiatives and protocols to contain the spread of a pandemic. Eleven key informants, including refugee community leaders and refugee-serving NGOs, were virtually interviewed about refugees’ access to healthcare in South Africa during the COVID-19 pandemic and the consequences of inconsistent access and discrimination on their trust of public healthcare initiatives. Interviews were analyzed using critical thematic analysis. The results suggest that refugees’ access to public healthcare services were perceived as exclusionary and discriminatory. Furthermore, the growing mistrust in institutions and authorities, particularly the healthcare system, and misperceptions of COVID-19 compromised refugees’ trust and adherence to public health initiatives. This ultimately exacerbates the vulnerability of the refugee community, as well as the wellbeing of the overall population.
In this longitudinal study, we examine changes in psychological distress and multidimensional well-being from before to during the COVID-19 pandemic among South African adults. As a secondary purpose, we explore whether pre-pandemic flourishing is protective against subsequent psychological distress during the public health crisis. The analytic sample ( n = 293; Mage = 44.27, SD = 14.28; female = 65.19%) completed measures of anxiety symptoms, depression symptoms, and well-being shortly before the stringent nationwide lockdown started in South Africa (T1). A follow-up assessment was completed approximately 6 months later (T2). Paired samples t-tests supported very small improvements in anxiety ( d = −0.09) and depression symptoms ( d = −0.13). For domains of well-being, small increases were found in close social relationships ( d = 0.25) and financial and material stability ( d = 0.19). Positive changes in the domains of character and virtue ( d = 0.10) and meaning and purpose ( d = 0.07) were very small. Changes in physical and mental health ( d = −0.03) and life satisfaction and happiness ( d = 0.02) were more negligible. Results from the generalized linear models indicated that continuous scores of secure flourishing assessed before the COVID-19 pandemic were associated with lower subsequent psychological distress (particularly depression symptoms) during the public health crisis. We discuss the implications of the findings for the development and delivery of interventions to promote and sustain human flourishing during public health crises, especially in contexts of social-structural vulnerability.
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