Infection and social dislocation: policy and practitioner accounts of COVID-19’s impacts on children and adolescents in Rwanda during a public health emergency

COVID-19 profoundly disrupted children’s lives, with severe impacts in low-income settings. School closures, economic shocks, service disruption and social isolation undermined wellbeing. This study examines how the pandemic and its control measures affected child and adolescent wellbeing in Rwanda, explaining how structural and institutional conditions shaped these effects. Durkheim’s anomie helps explain moral dislocation. We draw on anomie alongside Archer’s morphogenetic approach to examine how structural inequalities and wider political economic dependencies mediated the pandemic’s effects and how reflexive agency shaped adaptations to the crises and its consequences. We conducted 25 interviews with national and local policy actors and practitioners (November 2020 to January 2021). Thematic analysis combined with retroduction was used to identify interacting structural, institutional and agentic mechanisms. Four inter-linked themes illustrated how COVID-19 generated processes of social dislocation undermining and reconfiguring children’s wellbeing: (1) loss of school routines; (2) household strain and mental distress; (3) gendered and socioeconomic inequalities; and (4) adaptive agency through new coping and learning routines. COVID-19 revealed structural weaknesses in the health system, education, social and child protection, employment, family and financial systems. Critical realism offers a framework for enriching explanations of health crises that link global inequalities, institutional fragilities, and health outcomes.