Refugee Camp Congestion and Trauma-Related Mental Health Crisis Presentation in Kenyan Settlements: An Instrumental-Variable Analysis of Resettlement Queue Position

Refugee settlements in Kenya's Dadaab and Kakuma complexes concentrate large populations in high-density blocks, and the position of a household in the resettlement queue determines access to durable solutions, services and space. The framework specifies the exclusion restriction, the monotonicity condition and the local average treatment effect it identifies, and it distinguishes the complier subpopulation from the broader camp population. Because no individual-level crisis-registration data are available for this analysis, the paper does not report empirical estimates; instead it formalises the estimand, derives the bias that arises when queue position is used as a direct regressor, and specifies the data structures and reporting standards that would permit credible estimation. The framework is calibrated against published camp-level indicators, including the DHS indicator 'Net source: Mass distribution campaign' (N = 50 country-survey observations, mean 75.618, SD 16.708), which illustrates the scale of cross-country variation in mass-distribution reach that shapes the service environment in which congestion effects would operate. The contribution is a defensible identification strategy and a reporting template for congestion effects on trauma-related crisis presentation in Kenyan settlements.