When Belonging Heals: Study Maps How Structural Inequality Shapes Afghan Refugee Children’s Health in Pakistan

Afghan refugee children growing up in Pakistan are not simply unlucky in their health; according to a new mixed-methods study published in BMC Pediatrics, their physical and psychological well-being is being systematically produced by the social and legal structures around them. The research, conducted by Muhammad Asad Latif of Islamia University of Bahawalpur, examined how displacement, poverty, legal insecurity, and discrimination converge to shape both health outcomes and children’s sense of belonging in three Pakistani cities. The findings suggest that the single strongest predictor of whether a refugee child feels well is not a biological factor at all, but whether that child experiences social support and whether that child is treated with dignity by the society around them.

The study employed a convergent mixed-methods design carried out between January and April 2026 in Peshawar, Quetta, and Islamabad, cities that host substantial Afghan refugee populations. Quantitative data came from 150 Afghan refugee children aged 10 to 17 years, who completed structured questionnaires. This numerical backbone was complemented by qualitative depth: 35 semi-structured interviews were conducted with refugee children, their caregivers, and community representatives. Quantitative analyses were performed in IBM SPSS Statistics and R, encompassing descriptive statistics, reliability analysis, Pearson correlations, bivariate comparisons, and multiple linear regression, while the interview material was analyzed using reflexive thematic analysis. The design allowed the researcher to test statistical relationships and then check whether the lived experiences described in interviews told the same story.

The descriptive results paint a picture of moderate but fragile well-being resting on weak structural foundations. Mean scores indicated moderate physical health (M = 3.48, SD = 0.71), moderate psychological well-being (M = 3.21, SD = 0.76), and a moderate sense of belonging (M = 3.05, SD = 0.81). Beneath those middling averages, however, sat the structural deficits: healthcare accessibility scored lowest among the moderate measures (M = 2.94, SD = 0.82), housing quality fell further (M = 2.81, SD = 0.79), and food security was the weakest domain of all (M = 2.73, SD = 0.88). In other words, the children surveyed were neither in crisis nor thriving; they were surviving in conditions where the basic infrastructure of a healthy childhood, from reliable food to adequate shelter to reachable medical care, was consistently the weakest link.

The correlational analysis revealed how tightly these threads are woven together. Sense of belonging was strongly positively correlated with social support (r = .73), psychological well-being (r = .71), and physical health (r = .65), and strongly negatively correlated with perceived discrimination (r = −.69), with all of these associations reaching statistical significance at p < .001. These effect sizes are unusually large for social science research, indicating that the children who felt connected to others were also, in large measure, the children who felt healthier and happier, while those who perceived discrimination were markedly less likely to feel they belonged anywhere at all.

Multiple linear regression pushed the analysis further, testing which factors independently predicted children’s sense of belonging when all others were held constant. The overall model was highly significant, F(12,137) = 24.51, p < .001, and explained 68.2 percent of the variance in belonging (R² = 0.682; adjusted R² = 0.654), a remarkably high proportion for research on human social outcomes. Within that model, social support emerged as the strongest positive correlate (β = 0.301), followed by psychological well-being (β = 0.245), healthcare accessibility (β = 0.238), and educational access (β = 0.201). Perceived discrimination stood out as the most powerful negative correlate (β = −0.347), outweighing even the strongest positive factor. All reported coefficients were statistically significant at p ≤ .002.

The pattern of these coefficients carries a technical implication worth pausing on. Discrimination’s beta weight exceeding every positive predictor means that the corrosive effect of being treated as an outsider is not merely one disadvantage among many; it is, in this dataset, the dominant force suppressing children’s sense of belonging. Meanwhile, the independent contributions of healthcare accessibility and educational access demonstrate that belonging is not purely an emotional or interpersonal phenomenon. Children who could reach a clinic and attend school felt that they belonged more fully, suggesting that material inclusion, the practical ability to use the institutions of the society one lives in, is itself a psychological resource.

The qualitative interviews converged on the same conclusions from a different direction. Thematic analysis of the 35 interviews with children, caregivers, and community representatives highlighted structural barriers, social exclusion, and the importance of supportive relationships for children’s belonging. Where the regression quantified discrimination’s statistical weight, the interviews gave that weight texture: the experience of exclusion, the difficulty of navigating services designed for others, and the protective role of families and communities who stood between children and a hostile environment. The convergence of the two strands of evidence strengthens the study’s central claim, because the numbers and the narratives point in the same direction independently.

The study’s conclusion reframes the problem in a way that challenges common intuitions about refugee health. Afghan refugee children’s health and belonging, the author argues, are socially produced through intersecting structural inequalities rather than arising from individual vulnerability alone. This distinction matters for policy. If poor health among refugee children were primarily a matter of individual vulnerability, interventions would focus narrowly on treating sick children one by one. But if health is manufactured by legal insecurity, discriminatory treatment, inaccessible clinics, inadequate housing, and unreliable food supplies, then the effective levers are structural: the rules, institutions, and social attitudes that determine what kind of childhood a displaced child is permitted to have.

The author’s stated conclusions point toward rights-based policies as the necessary response: strengthening legal protection, ensuring equitable healthcare, building inclusive education systems, and fostering community support while actively reducing discrimination. Each of these policy domains maps directly onto a significant predictor in the regression model. Legal protection addresses the legal insecurity that underlies displacement-related disadvantage; equitable healthcare and inclusive education correspond to the healthcare accessibility and educational access coefficients; and community support corresponds to the social support variable, which carried the largest positive beta weight in the model. Reducing discrimination, meanwhile, addresses the single strongest negative correlate of belonging identified in the analysis.

For the millions of children living in protracted displacement worldwide, this study offers both a warning and a measure of hope. The warning is that discrimination is not a soft issue to be addressed after material needs are met; in this data it was the heaviest single burden pressing down on children’s sense of belonging. The hope is that the same analysis shows belonging to be highly responsive to changeable conditions: where social support, healthcare, and education reach refugee children, their well-being and their sense of connection rise together. The research was reviewed and approved by the Advanced Board of Studies and Research at The Islamia University of Bahawalpur, with informed consent obtained from parents or guardians alongside children’s assent, and it is published open access, making the full evidence base available to the policymakers, clinicians, and communities whose decisions will determine whether these children are treated as guests to be tolerated or as children to be included.

Subject of Research: Health, belonging, and structural inequality among Afghan refugee children in Pakistan

Article Title: Health, belonging, and structural inequality: Afghan refugee children’s experiences in Pakistan

Article References: Health, belonging, and structural inequality: Afghan refugee children’s experiences in Pakistan. (n.d.). https://doi.org/10.1186/s12887-026-07754-x

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07754-x

Keywords: Afghan refugee children, health inequalities, structural inequality, sense of belonging, social determinants of health, Pakistan, mixed methods, perceived discrimination, healthcare accessibility, inclusive education, refugee health, child well-being