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MSF in Uganda, 2006
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For nearly 20 years, people in northern Uganda have suffered from brutal conflict between government forces and rebel groups including the Lord’s Resistance Army (LRA).
Large-scale displacements mandated by the government have added to the misery. By mid-2006, almost two million people — nearly 90 per cent of the population of the north — had been uprooted to 200 camps. Unable to work or farm, these people are completely reliant on external assistance.
“It is no exaggeration to say that over the past two decades, the fabric of society has been torn apart. The effect of living in the camps has crushed the life out of many people.
Alcoholism is rife and violence, especially domestic violence, is common. What we treat is only the tip of the iceberg … people are not living in the camps, they are surviving. Nothing more.”
MSF staff Amaia Esparza
Whilst direct violence began to subside in 2005/2006, many people continued to die from preventable diseases including malaria, respiratory tract infections and diarrhoea. Most of the displaced living in the northern districts of Gulu, Lira, Pader and Kitgum barely manage to survive their deplorable living conditions.
Providing basic healthcare in the camps
In Lira district, MSF provides healthcare in six camps and runs a therapeutic feeding center in Lira town with a capacity for 360 children. The feeding center also offers tuberculosis (TB) treatment and in January 2006, MSF started counselling and testing children suspected to have HIV/AIDS. In February, 78 of 158 children tested were found to be HIV-positive. The team treats the children’s opportunistic infections and is exploring ways to set up antiretroviral (ARV) treatment.
In Kitgum district, MSF offers basic healthcare in five camps. The team also provides mental health support, care for survivors of sexual violence and makes referrals to secondary facilities. In Kitgum town, MSF has established a clinic for children under the age of five, where up to 1500 patients were treated in one month of 2006 alone, 356 with malaria.
MSF cooperated with the NGO Interplast Holland in December 2005 and April 2006 to provide reconstructive surgery in Kitgum town for civilians mutilated during the conflict. Six patients with war-related injuries were treated as well as 18 with cleft lip and palate conditions or burns.
In neighbouring Pader district, MSF works in the Atanga and Pader Town Council camps. In the village of Patongo, where a single camp houses close to 40,000 people, MSF provides up to 1000 weekly medical consultations at a health center managed in tandem with Uganda’s Ministry of Health. Malaria, respiratory infections and diarrhoea are the most common ailments treated. MSF has built an 8-bed structure — including an isolation ward for patients suffering from bloody diarrhoea, meningitis and measles — to complement the existing 15-bed inpatient ward, which was insufficient to meet the area’s needs.
In camps in Gulu, MSF offers basic healthcare, giving special attention to young children and pregnant women and those suffering from malaria. The team carries out water and sanitation work and health and hygiene promotion among the local population.
Over the years, the LRA is reputed to have kidnapped more than 20,000 children to fill its fighting ranks, although it is thought to have only one-tenth that number of soldiers today. Every night as many as 4000 children stream into shelters including the Lacor shelter, near Gulu town. Walking as far as 10 kilometres, these “night commuters” are a vivid symbol of the violence in the region. MSF provides basic healthcare and mental health counselling for many of these children.
Focusing on HIV/AIDS
In the northwestern Arua district, MSF provides comprehensive HIV/AIDS care to thousands of people, with 2500 receiving ARVs. Between 100 and 150 new patients are admitted to the program every month, including patients from neighbouring Sudan and the Democratic Republic of Congo (DRC). TB is the most common killer of persons living with HIV/AIDS, and MSF Is working to integrate care for persons with both diseases, completing construction of a 40-bed isolation ward in Arua in 2005/2006.
Malaria and meningitis
In Nakapiripirit, along the border with Kenya, MSF sees increasing numbers of patients suffering from kala azar and malaria at Amudat Hospital and three peripheral health centers. In July 2006, 300 malaria patients and 60 patients with kala azar were receiving treatment. An outbreak of meningitis at the end of 2005 caused MSF to launch a mass vaccination campaign that reached 40,000 children.
Improving water supply and sanitation
The growing population in rural camps has stretched the water supply, such that people began collecting contaminated rainwater from the street or from surrounding rivers and springs, leading to an increase in water-related illnesses. MSF has started improving the water supply and sanitation facilities in a number of locations.
Almost a quarter of the population has no access to latrines and those who do must share one with at least 60 other people. Waste management is virtually nonexistent and the burning of waste poses fire hazards to grass-roofed huts during the region’s dry season. MSF is drilling boreholes, repairing hand pumps, rehabilitating springs, constructing waste pumps and building latrines to increase the availability of safe drinking water and sanitation facilities.
Increased insecurity Violent ambushes against civilian and humanitarian vehicles in the final months of 2005 led to the suspension of MSF international staff travelling to the camps in northern Uganda for almost three months. Killings of aid workers and civilians compelled MSF in November to call on all armed groups to respect the safety of civilians and their freedom of movement, as well as the independence and safety of humanitarian aid workers. Throughout the north, MSF continued to provide emergency medical relief through the efforts of national staff, and by February 2006, with improvements in the security situation, most international staff had returned.
Helping refugees from DRC
In February 2006, MSF in Kisoro district distributed blankets, soap and fresh water amongst 10,000 refugees who had fled an attack on Rutshuru, DRC. Shortly thereafter, half the refugees were moved to the Naki Valley camp under pressure from national authorities. The rest returned to DRC.
MSF has worked in Uganda since 1980.