Security improves but fears remain - MSF maintains health care for displaced in Pader District, Uganda

Doctors, nurses, clinical officers and nurse assistants provide up to 1,000 medical consultations every week at a health center, managed in tandem with Uganda's Ministry of Health, mainly treating patients for malaria, respiratory infections, and diarrhea. The rainy season has recently started, which means there will likely be a large increase of patients with malaria.

After nearly two decades of conflict between the government and the Lord's Resistance Army (LRA), an estimated 90-95 per cent of the population in northern Uganda now lives in overcrowded camps for displaced people, some within a kilometer of their homes. Many in the three most affected districts of Kitgum, Gulu, and Pader are completely dependent on outside assistance for health care, water and sanitation services, and food.

"We should not assume that humanitarian assistance is the only option in northern Uganda," said Francois Delfosse, head of mission for Médecins Sans Fronetières (MSF) programs in Pader District's village of Patongo. "People rely on outside assistance because the government has not entirely met its responsibilities."

Security has improved slightly in the past few months, so some people are moving from larger camps in Kitgum, Gulu, and Pader to smaller, satellite camps. While ongoing fear prevents them from going directly to their homes, people have moved to these smaller camps in the hopes of cultivating their nearby fields.

The village of Patongo was originally a trading center of several thousand people. Today, a camp houses an additional 35,000 to 40,000 people, many of them displaced in 2001 after attacks by the Karamajong, a group of semi-nomadic herders in northeastern Uganda who have been in the middle of various conflicts, involving cattle raids. Most of the displaced people subsequently remained in the camp out of fear of attacks by the LRA.

Doctors, nurses, clinical officers and nurse assistants provide up to 1,000 medical consultations every week at a health center, managed in tandem with Uganda's Ministry of Health, mainly treating patients for malaria, respiratory infections, and diarrhea. The rainy season has recently started, which means there will likely be a large increase of patients with malaria.

Because the 15 bed in-patient ward did not meet the area's needs, the team built an additional eight bed structure, including a four bed isolation ward for patients suffering from bloody diarrhea, meningitis or measles.

When the team first arrived in December 2004, many of the wells were contaminated and there was an insufficient number of hand pumps for water, and most were broken. MSF first built an emergency water system, and has drilled another ten wells with pumps that provide up to 600,000 liters of water each day.

"Today, we can provide 17 liters of water per person per day," said Delfosse. "But our objective is to increase that to 20."

Most of the team evacuated Patongo in November 2005 because of increasing insecurity, characterized by violent ambushes on civilians and humanitarian vehicles. The full team could not return until early January 2006, but medicines and supplies were provided to the staff members living in Patongo who kept the program running.

"When we returned in January 2006, the clinic was open and full of patients," said Delfosse. "The level of consultations dropped drastically for the first five days after the evacuation, but then steadily increased up to a normal level of activity. It was not sustainable over the long run, but it was great to see the level of commitment and involvement from the staff to keep the clinic open."