Scabies, a neglected tropical disease affecting an estimated 200 million people globally, thrives in overcrowded, resource-limited environments and carries significant stigma. Refugee camps present conditions conducive to its spread, yet little is known about how scabies is experienced and understood in such settings. This study explores scabies as a manifestation of structural violence among Kinyarwanda speaking Congolese refugees in Kigeme camp, Rwanda. An ethnographic study was conducted from March to September 2022 using participant observation, 19 in-depth interviews with adults affected by scabies, 5 key informant interviews, 6 family interviews, and 2 focus group discussions with 12 unaffected adults. Transcripts were thematically analysed in NVivo, combining deductive and inductive coding to explore lived experiences, stigma, and coping strategies. Findings reveal that scabies was misinterpreted as an HIV/AIDS-related opportunistic infection, producing stigma, broken marriage negotiations, and social isolation. Participants also linked scabies to weakened immunity, poor nutrition, and poverty, describing it as symbolic of a deteriorated body and refugee deprivation. Stigma curtailed livelihoods and deepened psychological suffering. During outbreaks, perceptions shifted temporarily as the condition became widespread, reducing stigma but reinforcing the sense of collective vulnerability. Coping strategies included intensive hygiene, concealment of rashes, and self-isolation, though these often proved ineffective in crowded conditions. The neglect of scabies treatment—reliance on benzyl benzoate despite the availability of ivermectin—reflected structural inequities in global health policy and humanitarian support. This study is the first to use ethnographic methods to demonstrate the multifaceted structural violence underlying scabies in refugee contexts. Beyond a skin condition, scabies exposes systemic injustices, including exclusion from citizenship, inadequate humanitarian support, and the absence of clear integration or resettlement pathways. Addressing scabies requires both biomedical interventions and structural reforms that expand refugee rights, confront inequality, and integrate displaced populations into global strategies for neglected tropical disease elimination.
Bayisenge et al. (Fri,) studied this question.