Beyond the Needle: Understanding Parental Refusal and Pathways to Childhood Vaccine Equity in Akara IDPs, Hargeisa, Somaliland— Advancing SDGs 3, 4, 5, 10 & 16 in Humanitarian Settings

Background Childhood vaccination coverage in Somaliland is one of the lowest in the world, according to the Somaliland Health and Demographic Survey 2020. Only 13% of children aged 12–23 months were fully vaccinated, with 68% having received no immunizations. Despite the availability of routine immunizations, parental refusal and vaccination reluctance continue to impede uptake. To yet, no qualitative studies have addressed the underlying causes for vaccine refusal among parents in Hargeisa. The purpose of this study is to better understand these characteristics and propose context-specific solutions for increasing immunization rates. Methods A qualitative study was conducted using five face-to-face focus group discussions with 31 parents living in the Akara IDP settlement, Ahmed Dhagah District, Hargeisa. Thematic analysis was used to extract essential patterns and insights from participant responses. Results Parental refusal was affected by a variety of factors, including fear of side effects, a lack of awareness of vaccine benefits, previous unfavorable encounters with health personnel, and strong community attitudes and social norms. Physical availability to vaccines was not a big barrier. Participants emphasized the need of culturally relevant communication, regular outreach activities, and the involvement of trusted community figures in addressing vaccine concerns and building confidence. Conclusion Vaccine refusal in IDP camp is driven by fear, misinformation, and social influence rather than a lack of access. Customized public health methods centered on education, trust-building, and respectful participation are critical for increasing childhood immunization coverage in such contexts.