Uganda: A neglected emergency

"Sick one day, and dead the next. It is scary, if this person can die, what about me?"
- Mother of nine, living in Aloi camp

Those who stay at home risk kidnapping or worse at the hands of brutal members of the Lord's Resistance Army, the rebel force controlling much of this region. Despite the level of suffering facing civilians, assistance to the population remains grossly inadequate.

Hundreds of thousands of people have sought refuge in camps near the town of Lira. Hunger, disease and terror have combined to weaken the area's residents. Surveys conducted by MSF in October 2004 in five of these camps found staggering death rates, mostly caused by malaria and diarrhea.

MSF runs a 350-bed therapeutic feeding center that cared for 320 severely malnourished children in August 2005. It also operates clinics and provides water and sanitation facilities in six area camps.

Forced displacements mandated by the government have brought almost the entire population of Pader district (290,000 people) into displacement camps. Because the local health center cannot meet the enormous needs, MSF is providing medical care and water-and-sanitation support to those living in the camps around the town of Pader. MSF staff also provide basic health care for young children, mental health counseling and water and sanitation support in the town of Atanga.

Starting in October 2004, in Kitgum district, MSF opened clinics in Orom, Agoro, Lokung, Mucwini and most recently Potika to help those most vulnerable to malaria - mainly children under five and pregnant women. In the district's southern area of Patango, MSF is providing medical assistance and water to 35,000 displaced people. The team is now planning to introduce tuberculosis (TB) care in Lira, Kitgum and Pader camps.

Mental health surveys conducted in the towns of Lira and Pader revealed that many respondents had been exposed to serious traumatic events since 2002 including the abductions of family members, torture and killings. A survey also found that five percent of the respondents had been forced to physically harm someone. In all of its clinics in Lira, Kitgum and Pader, MSF has treated patients for trauma and the consequences of failed suicide attempts. The survey revealed that 63 percent of the women interviewed thought about committing suicide.

In Gulu district, forced displacements have resulted in the creation of about 50 camps holding approximately 90 percent of the population. MSF runs a night shelter on the grounds of Lacor Hospital for up to 4,000 children who seek a safe place to sleep each night.

Most are sent by their parents to avoid their children being abducted by rebels and forced into combat or life as a sexual slave. MSF supports a clinic in Pabbo camp, the district's largest, hosting 60,000 people; another clinic in Awere camp (22,000 displaced people); and one in Amuru camp (33,000 displaced people). Overcrowding and a lack of sanitation sparked a cholera epidemic in Pabbo, in October 2004.

Medical teams set up cholera treatment centers for patients, caring for hundreds. Since then, MSF has responded to cholera in five different camps where sporadic cases are reported on a weekly basis. By July 2005, 550 cases had been treated.

In June 2005, MSF opened a new project focusing on maternal and child health in the displacement camps in the Omoro county area of Gulu district providing medical care and setting up a referral system. Activities include specialized treatment for those with malaria or TB, prevention of mother-to-child transmission of HIV/AIDS, and mental health support for victims of sexual violence. MSF is also working to improve the quantity and quality of water and sanitation facilities within the camps.

The more than 100,000 people who sought safety in and around the town of Soroti in Teso region in 2003-4 are now returning home. Today, approximately 17,000 displaced people continue to live in small camps near the town. As a result of improving security, MSF progressively transferred its activities in one of the outpatient departments in Soroti and closed a clinic in Abalang.

MSF carried out a measles-vaccination campaign in September 2004 covering 20,000 children under the age of five. The organization transferred responsibility for its feeding center to the ministry of health in late 2004. A team refurbished Amuria's 24-bed health center, supported the inpatient and outpatient departments and provided water and sanitation for many months before transferring these activities to local authorities in January 2005.

Facing AIDS, malaria and kala azar

HIV prevalence is growing in Uganda with an estimated seven percent or 800,000 people, living with the virus. In Arua, MSF now provides medical care for nearly 3,000 HIV-positive people. As of July 2005, 1,916 were receiving antiretroviral (ARV) therapy. The program has been extended to reach people living in the city of Koboko, located north of Arua on the border with Sudan and the Democratic Republic of the Congo (DRC). This program supports the local health clinic offering ARV treatment as well as care of opportunistic infections.

In Uganda, kala azar (visceral leishmaniasis) is endemic in parts of the country. In June 2005, MSF was treating 87 patients for this deadly parasitic disease spread by sand flies at Amudat Hospital located in the remote eastern Karamoja region. Approximately 600 patients will receive treatment before the end of 2005. To speed up implementation of highly effective artemisinin-based combination therapy (ACT) for those with malaria, MSF started introducing ACT in a pilot project in the health structures of Pokot subcounty.

Aiding refugees

MSF responded to an influx of refugees from the DRC who fled into Uganda's western districts in January 2005. Teams vaccinated the refugees against measles and polio. In the resettlement area in Kyaka, MSF conducted health screenings for newcomers. An MSF team working at the landing site of Nkondo assisted Congolese refugees crossing Lake Albert. The team vaccinated more than 3,000 people, set up a mobile clinic and provided water and sanitation facilities.

MSF has worked in Uganda since 1980.