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Insights on Alzheimer’s From the Long-running Nun Study

By Alia Hoyt originally posted Oct 3, 2019 

Sister Nicolette, 94, (center) and fellow elderly nun subjects at the School Sisters of Notre Dame convent in 2001 where a long-term study of Alzheimer’s disease has been conducted since 1986 and still goes on today. Photo credit Steve Liss/The LIFE Images Collection via Getty Images

Speaking an extra language or two is more than just a cool party trick. It turns out that multilingualism may have a protective effect against dementia, according to data from a recent study out of The University of Waterloo in Canada. It was published in the Journal of Alzheimer’s Disease in September 2019.

This effort looked at data from 325 Roman Catholic nuns who were members of the School Sisters of Notre Dame order in the U.S. The study found that 31 percent of nuns who spoke only one language developed dementia, compared with only 6 percent of nuns who spoke four or more languages (proficiently, but not necessarily on a daily basis). This lends further credence to the belief that extra brain use can somehow ward off dementia.

“Language is a complex ability of the human brain and switching between different languages takes cognitive flexibility. So, it makes sense that the extra mental exercise multilinguals would get from speaking multiple languages might help their brains be in better shape than those who speak only one language,” says study co-author and University of Waterloo associate professor Dr. Suzanne Tyas in an email. “This is consistent with recommendations to remain cognitively active as a strategy to prevent dementia: it’s well established that when it comes to the brain, it’s ‘use it or lose it.'”

Although it might seem random to look at nun data, rather than that of the general population, it’s actually the unique situation of sisterhood that makes their data extra useful. The Waterloo study is but one prong of the internationally acclaimed “Nun Study,” which started in 1986 with a small group of sisters, but has since expanded to cover nearly 700 Catholic nuns across the country. So far, the Nun Study has helped scientists better predict how cognitive and linguistic abilities factor into Alzheimer’s and other types of dementia risk. In addition, scientists are gaining a better understanding of how incidence of neuronal hypertrophy (increase in certain nerve cells in the brain) factors into Alzheimer’s disease development and progression.

“What makes them [nuns] such a valuable group to research is that they share very similar adult lives, including factors such as income, social support, marital status, reproductive history, alcohol and tobacco use, and access to health services,” says Tygas. “So, in the Nun Study, we have a greater ability to focus on multilingualism without it being influenced by all these other factors that usually vary from person to person during adulthood and that can weaken other studies.”

These similarities made the nuns perfect for the study of how multilingualism affects dementia. “People who speak multiple languages differ from those who speak only one language in many characteristics, and it’s important to be sure we are truly looking at the effect of multilingualism and not the effects of those other characteristics,” Tyas says.

But it is also possible that the brains of multilingual people are structured to fight back against dementia, and that’s why they enjoy lower risk. “This is similar to interpreting the established protective impact of higher levels of education on dementia: We cannot say whether it is the education itself or the fact that people who attain higher levels of education may be different, and it is those differences that explain the reduced risk of dementia,” Tyas explains. However, a study to definitively determine this (where one group learns a new language and another does not and the researchers follow up later) would be extremely difficult to pull off.

Don’t fret too much if multilingualism isn’t your bag, however. “Multilingualism is only one of a growing list of strategies that people can use. Dementia is more preventable than people realize,” Tyas says, noting that certain health choices provide protection, including lots of physical and mental activity; a good social network; eating well and controlling health conditions such as high blood pressure.

A bonus finding of the study is that other forms of linguistic ability, such as writing, could actually be more important than speaking several languages. The researchers discovered this by looking at the autobiographical essays the nuns wrote as young adults before taking vows, which were decades old. Each essay was analyzed in regard to the structure of the writing, idea density, grammatical complexity and general content.

“We found that when we looked at these measures together, written language ability had a stronger protective effect on dementia than multilingualism,” Tyas says. “Previous studies have not looked at multilingualism in the context of other measures of language ability, and this looks like a promising direction for future work. And, for those not interested in speaking more than one language, exercising language abilities in other ways may also be helpful in reducing the risk of dementia.”

(Sources: Dementia Training for NH Home Care & Hospice)

  

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Leaving Home: She left after the fire; a Chilean community’s struggle to stay

Some have migrated from the Valparaíso region, but others have organised to remain in the face of advancing forest fires. 

El Olivar neighbourhood in Viña del Mar, scorched by the fires that hit the Valparaíso region of Chile in February 2024 (Image: Cristobal Basaure Araya / SOPA Images / ZUMA Press / Alamy)

Carmen Mardones first began to call Canal Chacao home when she was 29. Set among the hills of Quilpué, the neighbourhood offered a life closer to the forest with their two young children: Kattya, four, and Jorge, two. Catalina, their third, was born after they had made the move, in 1997, from the nearby coastal city of Viña del Mar.

At first, she rented. Over time, she bought a house and spent years fixing it up. She continued to work in Viña del Mar, selling automobile parts in a business she had inherited from her father. She built a life.

Then came the great fire of 2-3 February 2024 – the deadliest in Chile’s recent history, killing 138 people and affecting more than 21,000, according to government figures. She remembers the day. She remembers how a black cloud settled over their homes. Sirens wailed, gas pipes exploded, and smoke filled every space. The water was cut off.

She evacuated with her husband and youngest daughter, damp towels pressed to their faces because the air was unbreathable and the flames were everywhere. They got into the car, and for a while, left the fire behind. Still, she did not leave.

Mardones left two weeks later – after days of clearing away earth and burnt debris, and listening to the sound of the neighbour across the street crying. “I just wanted to stop seeing everything destroyed every day,” she said. What hurt the most, was “losing the history of each family”. “It does you a world of harm. It gives you no hope.”

She isn’t alone. Mardones’ decision is part of an issue drawing increased attention. Between 2016 and 2022, nearly 39,000 people were forced to leave their homes due to a weather event or to avoid its effects. Earthquakes accounted for 41% of these displacements, followed by forest fires (30.8%), floods (17.4%), extreme temperatures (6.4%) and landslides (3.3%). More recently, nearly 50,000 people were evacuated in a matter of hours after wildfires stuck southern Chile in January 2026, shows data from the National Service for Disaster Prevention and Response (Senapred).

Homes in Canal Chacao, central Chile, where Carmen Maldones used to live. Given their location by the forest, fires are common in the summer (Image: Muriel Alarcón)

In Canal Chacao, that vulnerability was part of the everyday. The neighbourhood sits on a strip of land where the town meets the forest. Summer fires, Mardones said, “were relatively normal”. They would last an hour, and residents knew what to do: Mardones would run hoses and soak her roof till they subsided.

Until February 2024, normal had not meant this. It had not meant a fire driven by fierce winds that refused to subside. And it had not meant the heartbreaking question: should they stay or should they go?

Preparing for disaster

One year before the February 2024 fire, some residents began to organise themselves to prepare for disaster. The Canal Chacao area comprises around 1,400 homes, spread across the neighbourhoods of Canal Chacao itself, Villa Botania, Cumbres de Quilpué and Bello Horizonte, where some 12,600 people live. In 2023, they founded the Canal Chacao Association, with 12 people on its board.

The urgency had been building for years. In 2014, the Great Valparaíso Fire had destroyed 2,900 homes and affected 12,500 people. Across the region, increasing heatwaves and strong winds renewed the pressure every summer. And there was no faith in the state’s early warning systems, explains Estrella Barrios, a member of the association’s board. “There was a lack of trust in the authorities, who are supposed to protect us, but don’t arrive on time,” she says.

Estrella Barrios (right) and Brenda Rodríguez (left), members of the Canal Chacao Association’s board, at the organisation’s command centre (Image: Muriel Alarcón)

Latin America has become one of the epicentres of the global climate crisis. UN climate science body the IPCC says the region is experiencing warming, and an increased frequency of droughts and other extreme weather events. “Central and South America are highly exposed, vulnerable and strongly impacted by climate change”, it states. The situation is “amplified by inequality, poverty, population growth and high population density, land use change particularly deforestation with the consequent biodiversity loss, soil degradation, and high dependence of national and local economies on natural resources for the production of commodities”.

The members of the Canal Chacao Association knew they had to act. In 2023, they began participating in training sessions organised by Caritas Chile, a Catholic aid organisation, in partnership with the National Forestry Corporation (Conaf) and the Quilpué municipal government. The five-month programme focused on understanding the local environment – its strengths, risks and vulnerabilities – as well as the resources available within the community. Conaf provided the more technical information: regulations, what can or cannot be pruned, and protected species. They even set up a command centre, complete with a computer and printer for administrative work, as well as tools like brush cutters, wheelbarrows, rakes, radio equipment and a camera to document their activities.

“Communities that feel frightened and abandoned by the state often want to go and tackle the fire themselves,” says Andalucía Corvalán, a specialist in community disaster risk management at Caritas Chile. “Part of the project’s transformation process was to explain that the community’s role is prevention too.”

In the months that followed, the group put that training into practice. By January 2024, they had cleared areas with dense vegetation, built firebreaks by removing vegetation from residential zones, pressured the local council to install water tanks to dampen areas exposed to high temperatures, and planted doca (Carpobrotus chilensis), a succulent that acts as a natural defence against fires. They designed a community risk map identifying, among others, older people and those with reduced mobility who would need help evacuating.

Bush removal in Canal Chacao in December 2025. Along with the planting of succulents, these actions help to impede the spread of fire and keep roads open in case of an outbreak (Image: Agrupación Canal Chacao)

When the fire came, it was these actions that helped save lives. The clearing and brush removal helped keep roads open and access routes unobstructed. Barrios said that the community knew not to head towards the fire, so as not to hinder the work of firefighters. 

In nearby Villa Independencia, the destruction was far greater and the death toll significantly higher. Estimates suggest that around 60 people died there. In Canal Chacao, the death toll was seven. “Chile has a serious shortage of resilient infrastructure. So when the great fire came, the population had no defined excavation routes. In Canal Chacao, people knew the area and how it worked,” says Sofía Jacob, a researcher on disaster displacement at the Latin American Faculty of Social Sciences (Flacso).

One of those who lost their life was a voice that had been warning of the risks. Months earlier, the Canal Chacao Association had hit a wall during their training: public land could be cleared of weeds, but adjacent private land was beyond their remit. Carmen Mardones’ home bordered a privately owned forest, and her neighbour, Delia Uribe, an octogenarian who was a member of the Canal Chacao Association, had warned of the need to clear it, Barrios said. “She told us literally: ‘If the forest catches fire, I’m going to burn to death’”.

When the fire came, and raged through the weeds, Uribe refused to evacuate, choosing to stay with her husband who had previously suffered a stroke. Today, the Canal Chacao Association meets at a command centre named after her: Delia Uribe.

Living with the fire

Though she was aware of the association’s resilience work, Mardones did not take part in their training sessions in 2023. Her job made it impossible. “Retail hours are quite demanding,” she says.

And yet, she has never doubted that leaving was the right decision. Staying was taking a psychological toll. In the days after the fire, her husband refused to leave the ruins of their home. He slept inside the car, in the garage, and watered the remains every day. “I was afraid he would be left with trauma. That is why I decided to leave, and go far away,” she says about the decision to move to Limache, another inland city in the region.

For Jacob, community preparedness efforts like those in Canal Chacao can help reduce distrust and, in turn, displacement. The decision to leave is rarely triggered by a specific moment, she says, but by a continuum of factors which build up in the months or years before. “Without environmental education, there is no resilience,” she says.

In Canal Chacao, residents now have portable radios connected to Senapred and the Fire Service. They watch weather data closely and analyse it to anticipate the behaviour of fires. Given the uncertainty about authorities issuing timely alerts, they can initiate an evacuation themselves. “If we see the situation is unfavourable, we issue the first warning through a WhatsApp group made up of community members and managed by the Canal Chacao Association,” explains Barrios. They now hope to implement a third lever of alert using an emergency siren. “That’s what we still have pending,” Barrios adds.

Much of the challenge ahead is financial: USAID funding that enabled them to acquire basic equipment is now gone. “It stopped providing funding,” Barrios says. The group now applies to different funding sources, with some limited success – they recently bought some chainsaws, and a drone is next on the agenda.

Mardones, on her part, still visits Canal Chacao where her former neighbours still live. The house she left behind was demolished and later rebuilt with support from the social organisation Desafío Levantemos. It is now home for her son Jorge, 31, his partner, and her daughter Catalina, now 23.

Carmen Mardones on the site where her house stood before it was destroyed by fire in 2024. Following a reconstruction, her son and daughter now live there (Image: Muriel Alarcón)

“It’s beautiful now,” she says.

And yet, she still feels afraid for her children. She knows they live with the burden that they must always be prepared, and always at the ready; caught between leaving and staying. “Before, it never even crossed our minds that Canal Chacao could burn. Now, I think it could happen again.”

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Leaving Home: They returned to Afghanistan, but not to stability

Millions of Afghans forced back across the border are returning to a country where conflict, climate and hardship make rebuilding fragile from the start. 

An Afghan refugee rests in the desert beside a camp near the Pakistan-Afghanistan border in Torkham, Afghanistan in November 2023. Many Afghans arrived at the Torkham crossing shortly before the expiration of a Pakistani government deadline for mass repatriation (Image: Ebrahim Noroozi / AP / Alamy)

In Pakistan, Khoja Gul was a businessman. He is Afghan, but like many around him, he moved across the border as a young man. There, he dealt in plastic scrap and owned a warehouse. He has a wife and eight children, and in his own words, they were “doing well in life.” Then, as the relationship between Pakistan and Afghanistan soured, the precarious life they had built collapsed around them.

They came home. Except the word home can mean many things, and for Gul it brings no comfort. Home means all ten of them squeezed together in a shanty in Kabul. “I have no job. No money. I barely manage to pay rent for my family. I have nothing.”

More than five million Afghans have returned to Afghanistan since the end of 2023, around 10% of the country’s population. Nearly three million came back in 2025 alone, two-thirds from Iran and one-third from Pakistan, said Charlie Goodlake, head of external relations for the UN refugee agency UNHCR. “For many Afghans, there are no good options – not in Iran, not in Pakistan, and not upon return,” he added.

The circumstances of their move are often difficult to discuss openly, when their legal status, family security and future mobility remain uncertain. Pakistan’s government has given several reasons for the mass repatriation of Afghans under its Illegal Foreigners Repatriation Plan – national security, economic stability and legal regulation. From Iran, Afghans have fled in search of safety from escalating hostilities.

For Gul and his family, the question is not just leaving or arriving. It is what they are returning to. When they came back, they found themselves in the throes of a winter so severe it left 61 people dead in three days. “We suffered in the rains. We did not even have bedding or blankets. It was only our gawandi (neighbour) who gave us some out of kindness,” he said.

Afghanistan has seen four decades of armed conflict, and it is also one of the world’s most vulnerable countries to climate change. For displaced people on both sides of the Durand Line that means the violence of conflict is compounded by climatic extremes, said Hafiz Abdul Qadeem Abrar, spokesperson for the International Rescue Committee (IRC) Afghanistan. “Frost waves, floods, and now the expected heatwaves in the summer,” he added.

At the Torkham border, in April 2025, Afghan refugees board a truck to be sent back to Afghanistan, following their arrest by the police in Pakistan (Image: Hussain Ali / ZUMA Press Wire / Alamy)

When returnees first make their way across a volatile border, they are brought to camps, where they receive an initial medical assessment and treatment, some food, shelter and necessities. But the influx is incessant, and they are soon encouraged to go to their native areas. “IRC in collaboration with the government is giving both awareness and aid to refugees, especially about how to survive in a harsh climate. But no matter how much is done, it is never enough. Women and children suffer the most; they are lost without a home,” Abrar said.

What they return to is not stability. It is a country ravaged by conflict and natural disasters – floods, prolonged drought, repeated crop losses. Destruction so profound, that there is mass internal displacement.

Maisam Shafiey, advocacy manager for the Norwegian Refugee Council (NRC) Afghanistan, said: “Many families in Badghis [province] have been forced to leave their homes due to drought and the loss of their livelihoods, relocating to Herat. On the other hand, the devastating earthquake in eastern Afghanistan [last year] displaced thousands of people, forcing many to live in informal settlements and leaving them in urgent need of humanitarian assistance.”

The earthquake affected areas hosting many recent returnees, said Charlie Goodlake. “Many had only just returned and were trying to rebuild their lives. Some families have now experienced triple displacement – first to Pakistan or Iran, then back to Afghanistan, and then displaced again within the country.”

Afghan refugees at a camp near the Torkham border in Afghanistan, in November 2023 (Image: Ebrahim Noroozi / AP / Alamy)

“It is not that civil society isn’t helping. But barely a quarter will be able to get the full support they need. The people (who need assistance) are simply too many.”

Coming home as a stranger

Shahtaj (name changed) is still getting used to Kabul. He didn’t grow up in Kabul. He wasn’t even born in Kabul.

His parents moved from Afghanistan to Pakistan in the late 1970s, where he was born some years later. He grew up with the many stories about the difficulties they faced; with a tangled sense of identity – never knowing what he could really call home. “Growing up outside one’s homeland affects the way one sees identity, belonging and security. No matter what you do, and no matter how long you live in another country, you are still seen as an alien, a foreigner. That feeling stays with you,” Shahtaj said.

That feeling, that uncertainty in the pit of the stomach, did not leave when he and his family took the decision to return to Afghanistan. Here too, he felt like an outsider. “Coming to a country where I had never lived before, everything seemed new and different. Although Afghanistan was my homeland by origin, in practical terms, it was still unfamiliar to me. That made the process of settling back difficult,” Shahtaj said.

“When we speak to people at the border, the challenges they describe are layered and complex,” Goodlake said. “Some were not even born in Afghanistan. Others, returning after decades, face deep social and cultural readjustments.”

And yet, estrangement doesn’t come only from violence or the feeling of not belonging. It is sharpened by the real, visceral, tangible effects of climate extremes that make difficult lives harder still. When Maria Patel, for instance, founder of TheDisplacement.com, visited the oldest Afghan camp in Karachi in May 2025, she discovered that refugees had been asked to evacuate the area in a matter of months. By September, they were all gone. “When I asked them how the climate has impacted their lives in Pakistan, they said that since they live in temporary settlements, they face long hours of load-shedding which becomes unbearable during heatwaves. The drainage is improper which means flooding during the rain, and children fall in them when they are playing,” Patel shared.

The settlements were temporary, and often, roofs would collapse or walls would be torn down in the torrential rain. “On top of all this, they feared that upon their return to Afghanistan, they will have to live in camps, in unknown terrain, and wondered how they would navigate such climatic conditions,” Patel said.

Some refuse to return. When Dr Maryam (name changed) left Afghanistan as the Taliban regained control of the country a few years ago, she was in her 50s, a respected gynaecologist with an illustrious career and a comfortable life. She left everything behind except her family, and some valuables worth USD 100. “For a woman, her home is everything. But I am happy in Pakistan. At least I am safe here,” she said.

Women wait at the Torkham border in November 2023, among thousands of Afghans returning from Pakistan amid mass repatriations and growing humanitarian uncertainty (Image: Ebrahim Noroozi / AP / Alamy)

But as a woman and a doctor, Maryam worries for those making arduous journeys across international boundaries. “Private hospitals don’t admit refugees unless we have proper documents which in most cases we don’t,” she said. “And in camps and shelters, severe winters or floods take their toll on pregnant women and children.”

In Patel’s experience during her research on refugees, she found that women were fighting acute mental health challenges, often helpless in the face of harassment but unable to file complaints. “Advocate Umer Gilani stepped in to help them by setting up a hotline. But still there was a lot of work which needed to be done and that’s when I set up TheDisplacement.com where I also penned down a policy brief catering for people displaced by climate and conflict,” said Patel.

The next displacement

It is clear Afghanistan needs help, relief workers on the ground say.

The need for humanitarian assistance in the country was already projected to reach around 22 million people in 2026, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA). But Shafiey, of NRC Afghanistan, believes the situation is deteriorating even further with the return of millions of Afghans from neighbouring countries, the displacement of thousands, and the natural disasters that force families to live in the open or informal settings.

“These overlapping crises are significantly increasing needs and require urgent international attention and scaled up funding,” Shafiey said. “We call on the international community to honour and fully deliver on their pledges to Afghanistan, particularly in support of the Humanitarian Needs and Response Plan (HNRP). In 2025, only 41.7% of the pledged funding was met, leaving critical gaps in life-saving assistance for millions in need.”

Imran Khan, former country director of the US Institute of Peace, said attention has been drawn away from the situation in Afghanistan by burgeoning conflict elsewhere – such as the humanitarian crisis in Gaza or the Iran-US-Israel war. “In Washington DC or London or Geneva, policymakers must not have the time to come up with ideas for Afghan refugees. And under the global leadership of President Trump, the climate change agenda has suffered irreparable damage,” he said.

Given this context, Khan said there was little hope that the “world elites” would come to the rescue of Afghan refugees. “Even Pakistan has changed its policy of being a refuge. It’s calculus primarily shifted after 2023 when the Afghan Taliban came to power. Pakistani policymakers accuse the government in Kabul of taking actions against Pakistani security forces and civilians in the last two years,” he said.

But while he understood why Islamabad felt compelled to act, Khan said the move had forsaken Afghan refugees who had lived in Pakistan for decades. “Afghanistan is still far from stable and safe, and many regions have been deeply impacted by the effects of climate change. I think the UN and international community hasn’t been proactive on this issue. Pakistan has little support or incentive to keep hosting millions of Afghans, other than a moral imperative.”

For Charlie Goodlake, the case for support is simple: to ensure return is a “moment of hope, not the start of another cycle of displacement.”

Because there are occasions when Shahtaj in Kabul feels like he is teetering on the brink of another tectonic decision: to become a climate and conflict migrant for the third time. He often sits and weighs the costs; costs he knows well. “Migration will lead to our cultural erosion. Second or third generation migrants grow up with a weaker connection to our customs, our ways of life, our languages,” Shahtaj worries.

And yet, it is a decision he is forced to consider. “It is an unfortunate thought, but it is a real one. Migration has affected more than one generation in my family. I had hoped that this cycle would end with us,” Shahtaj said.

“But there are times when it feels inevitable, because Afghanistan’s trials are not over yet.”

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Leaving Home: They fled war; in Kakuma, refuge is fragile too

Refugees in Kenya’s Kakuma camp have fled war, raids and persecution. But even in a place of safety, life must be rebuilt again and again. 

A refugee transports firewood home at the Kakuma camp in north-western Kenya. The camp hosts over 300,000 refugees, many of whom fled conflict in neighbouring countries like South Sudan (Image: Joerg Boethling / Alamy)

He almost whispers into the phone: “Jambo la kwanza ni uhai” – the first thing is life.

It was March 2018 in Oronyo, a village in South Sudan. Thomas Kisario Mariano was 18 years old. As was routine, his family – his parents, his four brothers and three sisters – had spent the day out in the fields farming. They came back home and found that all their cows were gone. “For us, cattle were everything.”

Everyone in the house was crying. It was far from safe. His father calmed the family down, and in the morning, they left for Torit, the closest town in Eastern Equatoria state. A week later, his father told them that without the cattle, there was no way he could keep taking care of them.

For Mariano, the theft was when home stopped feeling secure. He had to leave. “Some steal. Some raid,” he said. “There were cattle raiders, and there was civil war. The country was just not peaceful.”

His siblings were taken to Uganda. As a young man, Mariano made his own way, following the path of an older relative who had made a similar journey towards Kenya. Eventually he arrived at the border near Nadapal. And with a group, he waited until the UN refugee agency came to get him.

They took him to Kakuma, one of the world’s largest refugee camps.

Less a single camp than an aggregation of settlements, Kakuma was established in 1992 after civil war drove thousands of young boys from their families and villages in southern Sudan. Most still under 10, some fled to Ethiopia to escape death or induction into guerilla armies; others walked more than a thousand miles to reach Kakuma. Some died on the way. Those that lived came to be known as the Lost Boys of Sudan.

Today, Kakuma has expanded into multiple zones, including the newer Kalobeyei settlement. Together, as of 31 March 2026, Kakuma and Kalobeyei host 313,247 refugees and asylum seekers, according to the UN refugee agency. Most come from South Sudan, Somalia, the Democratic Republic of Congo, Burundi, Ethiopia and Sudan.

The Kakuma refugee camp was established in 1992 and has since expanded into multiple zones. The newer Kalobeyei settlement, pictured here, was set up with the aim of reducing over-dependence on aid and promoting self-reliance (Image © UNHCR / Samuel Otieno)

The numbers tell only part of the story.

In East Africa, displacement is increasingly shaped not by a single emergency but by several layered on top of one another. War and political instability. But also, extreme weather made worse by climate change. In Somalia for instance, an estimated 211,000 people were displaced in the three months from October to December 2025. The causes were drought (52%), conflict (44%) and flooding (4%). Across sub-Saharan Africa, internal displacement had reached a record 38.8 million people by the end of 2024.

The Kakuma settlement is often described as a place of asylum. But for many families who flee war and conflict, refuge does not mean the end of instability. They find themselves at risk of being displaced again by flood, heat or the collapse of basic support. Safety can mean learning to endure a different set of pressures.

For Mariano, it is still worth the cost. Because “safety comes before everything”, he said. “Before cattle. Before land. Before food. Before all plans. You can make plans. You can work. But someone can come and take over everything.”

“The first thing is life.”

When safety is not stability

Mwanaidi Nerima is a protection assistant with Kenya’s Department of Refugee Services in Kakuma. She works on the front lines of asylum reception, among the officials who first meet people like Mariano when they arrive. The pressure is not only the number of people coming in, but their condition.

“Yesterday, we received someone with a gunshot wound. He was shot in Jonglei state. While receiving him, we notified Kenya Red Cross and International Red Cross that we have a gunshot-wound refugee. He was attended to at the hospital,” she said.

The tide of people ebbs and flows, but it never stops. “From November to early January, we were receiving an influx from Sudan and South Sudan. Maybe close to 200 per day. Yesterday [22 April 2026] we had 14 – five families from South Sudan and one family from Congo.” Is there ever a day no one arrives? Nerima almost laughs in response. “No, no, no.”

The Kalobeyei reception camp, where new arrivals are looked after until they can be allocated more permanent accommodation (Image: Joerg Boethling / Alamy)

Once they are past Nerima, refugees must begin to reckon with a new set of challenges.

“While conflict was the main reason for my displacement, environmental challenges and climate change have continued to shape my experience in Kakuma,” Manahil Musa, a Sudanese refugee, told Dialogue Earth. Now an educator and social entrepreneur who co-founded the Blossoms of Hope initiative, Musa has spent 18 years of her life navigating Kakuma’s unpaved bylanes. “Life in Kakuma is not easy,” she said.

Access to quality education, healthcare and employment opportunities is not always guaranteed, she said, and many people live with the weight of displacement and trauma. When it rains, the flooding contaminates drinking water, and electricity becomes unreliable.

During teaching sessions, heavy rains cause the streams near her educational centre to overflow. Some students come late, others leave early, and some don’t come at all. “Even for those present, it is hard to concentrate because of the conditions. It impacts attendance, participation and the overall learning experience,” she said.

What Musa is describing is not an anomaly but a clear pattern. The camp sits in a landscape defined by extremes; long stretches of heat and dust, interrupted by sudden, often overwhelming rain. In recent years, those swings have sharpened. Dry seasons linger. Then, when the rains come, they arrive with force. The result is what development experts and meteorologists are calling “drought-to-deluge”.

Between the two, life becomes a matter of constant recalibration for refugees.

A refugee from Uganda inspects the remains of his home in the Kakuma camp after it was destroyed by heavy rain (Image: Sally Hayden / SOPA Images/ Alamy)

Shadrack Kiprono, a project advisor on humanitarian energy access at SNV, the Dutch development organisation, said: “Drought increases the need for irrigation, water pumping, cooling systems and refrigeration, all of which depend on energy. Water pumping is expensive. Small shops need refrigeration. Medicines need cooling. Vegetables sourced from far away need preserving. For people trying to diversify their livelihoods, everything becomes more difficult.”

When Thomas Kisorio Mariano first arrived in Kakuma, he was registered as size one – alone. “A single person could not be given a household, so they paired two people together. I was housed with a woman from Toposa,” he said. Then, in 2022, the floods came. “There is a small river called Tarach. When rain comes, it carries away entire houses. It carried away ours,” he said.

A house he had called home for four years, swept away by the raging river. “Sometimes there is drought. Sometimes there are floods. There is not much help. We were relocated to Kalobeyei and given a tent. We had to rebuild with the pieces we salvaged.”

Self-reliance without the means

Avril Ndambwe Shabani’s working life is organised around bees. For the past seven years, he has run Kakuma Bee Social Enterprise Limited, a refugee-led business that produces and sells honey and other bee products while supporting local beekeepers and farmers in Kakuma. “I fled ethnic and tribal conflict in my country, Democratic Republic of the Congo, in 2013. I had just completed my university studies then. It has taken me seven years to build my business,” Shabani said.

Shabani’s entrepreneurial spirit leans into what authorities in Kakuma are now increasingly encouraging: self-reliance and integration. Kiprono, for instance, says SNV’s work aims to support both refugees and host communities as users and suppliers of clean-energy technologies. Refugees manufacture improved cookstoves and briquettes, sell solar products and use solar panels in restaurants, shops and other businesses. Some 500 people, he says, have found work along these supply chains.

A small array of solar panels set up in the Kakuma camp by refugee entrepreneur Vasco Hamisi to supply electricity to nearby homes and businesses (Image © UNHCR / Samuel Otieno) )

None of this comes without challenges and entrepreneurs like Shabani encounter structural exclusion often. “As a refugee, accessing loans from banks is challenging even when you have a good banking record. Travel outside the camp requires official documents that are hard to obtain, and these barriers limit both business growth and economic opportunities,” Shabani said.

And then there is climate. The impact on beekeeping, he says, is direct. “During drought, there are fewer flowering plants, so bees struggle to find nectar and pollen. This leads to reduced honey production, weaker colonies, and sometimes even the loss or migration of bees. During periods of heavy rain or flooding, vegetation can be destroyed, hives damaged, and activity disrupted,” Shabani said.

The national policy direction, meanwhile, is also towards self-reliance and integration. Kenya’s Shirika plan, launched in 2025, aims to turn camps such as Kakuma and Dadaab into integrated settlements linked to county systems and national services. Nerima said this government plan deals “mainly with socio-economic inclusion for refugees and the host community. It shifts the mindset from humanitarian assistance to socio-economic empowerment for sustainable development.”

The full plan shows that climate is not only one of its action areas, but part of the pressure the plan is trying to respond to. It states that Kenya’s “severe climatic changes” have increased in frequency and intensity. Shrinking grazing areas, drought and ecological decline have escalated land degradation, it says.

“Recognising the increasing pressures that climate change places on natural resources, the plan emphasises environmentally sustainable practices to mitigate environmental degradation and build long-term resilience,” the text reads.

It mentions initiatives to restore degraded land through tree planting and improve agricultural productivity via water conservation techniques, as well as “the adoption of climate-smart farming practices to enhance food security for refugees and host communities.”

A worker measures out cooking oil for refugees queuing at a World Food Programme (WFP) distribution centre in Kakuma. With the withdrawal of USAID support in May 2025, the WFP warned it would need to make drastic cuts to the food aid it supplies (Image: Trappe / Agencja Fotograficzna Caro / Alamy)

A worker grazes goats at the Choro farm in Kakuma. Set up by the UN refugee agency in 2017, the farm aims to boost food security in the camp in the face of the increasing extremes of climate change (Image: Wang Guansen / Xinhua / Alamy)

The move towards integration is taking place in a world where humanitarian support is shrinking, with Kakuma exposed to shocks far beyond East Africa. The World Food Programme (WFP) said in May 2025 that around 720,000 refugees in Kenya would receive only 28% of their food ration from June unless new funding arrived. The situation had not improved by August, when WFP cut aid by 80% for those with income and by 60% for vulnerable groups, including pregnant women and disabled people, Al Jazeera reported.

And now, with the Iran war disrupting food and medicine supply chains to sub-Saharan Africa, aid organisations have called for a humanitarian corridor through the Strait of Hormuz.

For Shabani, while the transition towards self-reliance is important, many still lack support systems to sustain themselves. “There are still clear gaps, especially for those expected to be self-reliant without sufficient resources,” Shabani said.

And yet, for Thomas Kisario Mariano, even this precarity is preferable to return. He refuses to think of South Sudan as home anymore. “People do not always understand what trauma stays with you. Even remembering brings pain,” he said.

He has visited because his parents still live there. But it is in Kakuma that he has built a life, however fragile, that is his own. That tension, between a deep and troubled attachment to home and the hard reality that makes permanent return impossible, is one many refugees live with. Fellow refugee Musa, who is from Sudan, says: “While hope may remain in the heart, there is also a need to build a life where one is.”

Mariano’s life in Kakuma now includes four children – three daughters and a son. “And honestly, I don’t hope for them to grow up back home. Because there, people lose too much. You can lose your life,” he said.

Jambo la kwanza ni uhai – the first thing is life.

Note: The UNHCR images featured above may be republished as part of this article, following the terms of Dialogue Earth’s Creative Commons licence.

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