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

Afghan refugee children living in Pakistan experience multiple health and social inequalities arising from displacement, poverty, legal insecurity, and discrimination. However, limited empirical evidence has examined how these structural conditions collectively influence children’s health and sense of belonging. This study investigated the relationships between health, belonging, and structural inequality among Afghan refugee children in Pakistan. A convergent mixed-methods design was employed between January and April 2026 in Peshawar, Quetta, and Islamabad. Quantitative data were collected from 150 Afghan refugee children aged 10–17 years using structured questionnaires, while qualitative data were obtained through 35 semi-structured interviews with refugee children, caregivers, and community representatives. Quantitative analyses were conducted using IBM SPSS Statistics and R software, including descriptive statistics, reliability analysis, Pearson correlations, bivariate comparisons, and multiple linear regression. Qualitative interviews were analysed using reflexive thematic analysis. Among 150 Afghan refugee children, mean scores indicated moderate physical health (M = 3.48, SD = 0.71), psychological well-being (M = 3.21, SD = 0.76), and sense of belonging (M = 3.05, SD = 0.81), with lower healthcare accessibility (M = 2.94, SD = 0.82), housing quality (M = 2.81, SD = 0.79), and food security (M = 2.73, SD = 0.88). Sense of belonging was strongly positively correlated with social support ( r = .73), psychological well-being ( r = .71), and physical health ( r = .65), and negatively correlated with perceived discrimination ( r = − .69; all p < .001). Multiple regression was significant, F (12,137) = 24.51, p < .001, explaining 68.2% of variance (R² = 0.682; adjusted R² = 0.654). Social support (β = 0.301), psychological well-being (β = 0.245), healthcare accessibility (β = 0.238), and educational access (β = 0.201) were significant positive correlates, whereas discrimination was negative (β = −0.347; all p ≤ .002). Qualitative findings converged, highlighting structural barriers, social exclusion, and the importance of supportive relationships for children’s belonging. Afghan refugee children’s health and belonging are socially produced through intersecting structural inequalities rather than individual vulnerability alone. Rights-based policies that strengthen legal protection, equitable healthcare, inclusive education, and community support while reducing discrimination are essential for improving health outcomes and fostering long-term social integration among refugee children in Pakistan.