Refugees are increasingly migrating to urban areas, but little research has been conducted to compare health and wellbeing outcomes of urban refugees with those based in camps. This analytic cross-sectional study investigated differences in health-related quality of life (QoL) for urban and camp-based refugees in sub-Saharan Africa, and assessed the influences of both the environment and the perceived environment on refugees’ health-related QoL using the WorldHealth Organization’s Quality of Life scale (WHOQOL-BREF.) Data for urban refugees were drawn from an administrative database used by an international agency that serves refugee populations in South Africa.

Data for camp-based refugees were collected via surveys conducted at two refugee camps in sub-Saharan Africa. Refugees in urban environments reported significantly higher satisfaction with overall health, physical health and environmental wellbeing than refugees placed in camps. In multivariate analyses, urban environments were associated with better physical health for refugees, compared to camp environments. In addition, refugees’ perceptions of their environment,particularly feeling safe in daily life and in the home environment, as well as being satisfied with living conditions, were more strongly associated with physical health than the environment itself, whether urban or camp-based.