Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed Safety, trust, and disclosure: A qualitative examination of violence against refugee adolescents in Kiziba Camp, Rwanda Laura Gauer Bermudez a , Lauren Parks b , Sarah R. Meyer b , Liberata Muhorakeye c , Lindsay Stark b,* a Columbia University School of Social Work, 1255 Amsterdam Ave., New York, NY 10027 USA b Columbia University Mailman School of Public Health, Department of Population and Family Health, 60 Haven Ave B-4 Suite 432, New York, NY 10032 USA c Plan International Rwanda, Plot Number 821 in Gasabo District, P.O. Box, Kigali, Rwanda ARTICLE INFO Keywords: Rwanda Refugees Violence Disclosure Adolescents Safety ABSTRACT Refugee adolescents face increased vulnerability to child protection risks including abuse, neglect, violence, and exploitation. The aim of this qualitative study was to examine the nature of violence against adolescents in Kiziba Camp, Rwanda, using an ecological framework to analyze the factors that influence protection risks and abuse disclosure across multiple system levels. In order to understand these issues more comprehensively, a transgenerational inquiry sought perceptions from both adolescents and their caregivers. In April 2016, as part of a larger, comprehensive study on adolescent protection, 19 focus group discussions were conducted with a total of 70 adolescents and 68 caregivers from the Democratic Republic of Congo. A qualitative content analysis identified three salient themes. First, structural protection risks exist for adolescents in Kiziba Camp, with economic insecurity and resource constraints resulting in specific risks such as overcrowded housing and ado- lescents traveling for firewood collection. Second, intergenerational conflict between caregivers and adolescents was perceived to negatively influence abuse disclosure. Lastly, protection mechanisms and reporting pathways were underutilized as caregivers and adolescents expressed concern over the shame, embarrassment, and social rejection that characterized formal disclosure in Kiziba, often rooted in restrictive and inequitable gender norms. These findings suggest that efforts at child protection should be multi-faceted and address structural aspects of risk; household levels of communication and trust; and societal norms that deter abuse reporting. The study also underscores the need for further research on risk and protective factors in camp settings to better tailor inter- ventions aiming to reduce violence against children. 1. Introduction Of the approximately 22.5 million refugees across the world today, over half are children and adolescents under the age of 18 (UNHCR, 2017c). Refugees face numerous hardships as they seek safe havens for themselves and their families, including but not limited to lack of fi- nancial resources, insecure shelter, and disruption of social networks prior to displacement, during flight, and in refugee camps (Miller and Rasco, 2004). Whether residing in urban or camp settings, refugees may experience decreased access to clean water, food insecurity, and limited healthcare and education, often compounded by a precarious legal status (Grafham et al., 2016; Murray, 2016). The stress of forced mi- gration, particularly for adolescents who have been exposed to conflict or violence, is occurring during an already challenging time of ma- turation and identity formation (Belfer, 2008; Fowler et al., 2009; Meeus, 2011). While reliable estimates of violence against children in humani- tarian settings are lacking (Stark and Landis, 2016), prior research has shown the issue to be of concern, even when active conflict has ceased (Saile et al., 2014; Stark et al., 2017b). Adolescents who have lived in conflict zones may suffer challenges to mental health, including an- xiety, depression, and aggression (Vossoughi et al., 2016) with such outcomes influenced by continued exposure to violence within their current communities (Mels et al., 2010; Reed et al., 2012). Adolescents who witness sustained interpersonal or community violence are more likely to suffer a range of negative psychological outcomes (Fazel et al., 2012) including depression (Kennedy et al., 2010) and social mal- adjustment (Schwartz and Proctor, 2000). Indeed, this cumulative ex- posure to violence, one that prolongs a compromised sense of safety even after fleeing conflict, can be detrimental to adolescent develop- ment and well-being (Garbarino, 2010). At the same time, in contexts where violence is chronic and enforcement systems inadequate, the https://doi.org/10.1016/j.socscimed.2018.01.018 Received 28 July 2017; Received in revised form 13 January 2018; Accepted 15 January 2018 * Corresponding author. E-mail addresses: lgb2123@columbia.edu (L.G. Bermudez), lauren.r.parks@gmail.com (L. Parks), sm3992@cumc.columbia.edu (S.R. Meyer), Muhorakeye.Liberata@plan-international.org (L. Muhorakeye), ls2302@cumc.columbia.edu (L. Stark). Social Science & Medicine 200 (2018) 83–91 0277-9536/ © 2018 Elsevier Ltd. All rights reserved. T