This study examined experiences of school and community violence exposure, perceptions of neighborhood, and socio-emotional health among refugee and nonrefugee youth in The Republic of The Gambia, West Africa. Participants included 943 10th and 11th grade students at 6 Gambian senior secondary schools. Participants completed a self-report survey (the Social and Health Assessment). Findings indicate that, although both refugee (n = 33) and nonrefugee (n = 910) youth reported frequent exposure to community and school violence, refugee youth report the highest levels. Refugee youth also reported significantly higher levels of post-traumatic stress reaction and delinquent behavior compared with their Gambian peers. Refugee youth were significantly more likely to report having been high from alcohol or marijuana at school, and having sold drugs to earn money within the past year compared to Gambian youth. Among Gambian youth, those living in neighborhoods with a refugee presence were more likely than those living in neighborhoods without refugees to report higher levels of community and school violence exposure. Perceptions of neighborhood emerged as a significant moderator in the link between refugee status and delinquent behavior and depression. Negative perceptions of neighborhood were related to increased levels of delinquent behavior among refugee youth, but not among Gambian youth. Neighborhood perceptions did not appear to influence post-traumatic stress reaction among refugee or Gambian youth. The research sheds light on the socio-emotional health of refugee youth who are in the resettlement stage of adjustment and their nonrefugee peers.