Evidence on the long-term health consequences of forced displacement remains limited, particularly for refugees who permanently settle within host communities. This thesis examined changes in mortality, morbidity and chronic disease care among Mozambican self-settled refugees in rural South Africa, compared with the South African host population, Mozambican migrant workers, and residents of the Manhiça district in Mozambique. Longitudinal data from the Agincourt Health and Demographic Surveillance System (HDSS) (1994-2018), the Manhiça HDSS (1999-2018), and the Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI, 2014-2019) are analysed.

Refugees experienced an initial survival advantage following settlement, which reversed during the HIV epidemic before narrowing after the scale-up of antiretroviral therapy, resulting in convergence with the South African host population by 2014-2018. This long-term trajectory demonstrates that the health consequences of forced displacement are dynamic and evolve across successive stages of the epidemiological transition. Comparisons with Manhiça further showed that refugee mortality increasingly resembled that of the South African host population. HIV/AIDS and other infectious diseases drove mortality inequalities during the epidemic, whereas non-communicable diseases became increasingly important in later years. Despite convergence in survival, inequalities in chronic disease prevention and management persisted. HIV care outcomes were similar between refugees and hosts, but hypertension care remained suboptimal, with diagnosis representing the greatest point of loss. 

The health consequences of forced migration evolve across successive stages of the epidemiological transition. Although mortality differentials narrowed over time, important health inequalities persisted. These findings advance understanding of the long-term health consequences of forced displacement and provide evidence to inform refugee health policy, chronic disease management, and universal health coverage in protracted displacement settings.

Wonder Agbemavi is a PhD candidate in the School of Demography at the Australian National University. He holds a Bachelor of Arts and an MPhil in Population and Health from the University of Cape Coast, Ghana. His research focuses on migration, mortality, chronic disease, and health inequalities in sub-Saharan Africa, with a particular interest in using longitudinal population data to generate evidence that informs health policy and strengthens equitable health systems.

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