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Uganda: A country pushed to its limits
“They just slaughter you, whether you're a man, woman, or child. I lost all my brothers and my relatives. Life here is very difficult. With no man, nobody helps you.”
Maria* (not her real name), is just one of thousands of refugees who have fled to northern Uganda since July 2016, following renewed violence in South Sudan.
Over 630,000 refugees have arrived in the country since last July, and thousands more continue to arrive every week. The total number of South Sudanese refugees and asylum-seekers now stands at over 900,000.
Uganda now hosts more refugees than anywhere else in Africa, accepting more refugees than the whole of Europe granted asylum to in 2016.
While those arriving are in relatively good health, many share stories of horrific violence in their place of origin or on their journey.
Insufficient emergency response
The scale of the refugee influx has also pushed Uganda’s progressive refugee policies to their limits, overwhelming reception conditions and the government’s ability to respond.
"Despite the large-scale humanitarian mobilisation, the emergency response is still far from being sufficient, and many people have been left with insufficient water, food and shelter,” says Jean-Luc Anglade, Médecins Sans Frontières/Doctors Without Borders (MSF) head of mission in Uganda.
Many newly arrived refugees lack shelter are forced to sleep under trees. Delays in food distributions and a lack of drinkable water have even prompted some refugees to return to South Sudan.
MSF in South Sudan and Uganda
Despite over 85 percent of new arrivals being women and children, and widespread reports of sexual violence in South Sudan, there are very few organisations responding to their specific protection needs.
“As the flow of refugees shows no sign of abating, a sustained and long-term effort will be needed to assist these people over the coming months, if not years,” says Anglade.
In addition to our operations in South Sudan, MSF has been responding to the humanitarian crisis in Uganda since July 2016, with medical and water and sanitation activities.
We are currently working in four refugee settlements in the north-west: Bidi Bidi, Imvepi, Palorinya and Rhino.
Here we provide inpatient and outpatient medical care, maternity care, nutrition, community health surveillance, and water and sanitation.
We also responded to an influx into Lamwo, on the border with South Sudan after an attack in Pajok, Eastern Equatoria, but have since handed over these activities to other organisations.
Access to water
Access to water is one of the biggest challenges in the refugee settlements, and MSF has been scaling-up operations in water support in response to this.
In Palorinya, we treat an average of two million litres per day drawn from the River Nile, supporting over 100,000 people. We provided a staggering 52.5 million litres of clean water to refugee settlements in Palorinya in April this year alone.
“There is a never-ending cascade of challenges,” says Casey O’Connor, MSF project coordinator in Palorinya. “We can treat millions liters of water a day but it all needs to be trucked to water tanks in refugee settlements that are 150-250 square kilometres.
"After heavy rains, many roads become impassable. This leaves tens of thousands of people without water for days.
"And in the rainy season, if people can’t get clean water, they will resort to using dirty, disease-ridden standing water.
"This can turn the health status of a population on its head – from relatively healthy to disease outbreak in a matter of days.”
In addition to responding to the refugee influx, MSF runs regular programmes in Uganda. These include sexual reproductive health services for adolescents in Kasese, HIV/AIDS care for the fishing communities on Lake George and Lake Edward, and HIV blood tests in Arua regional hospital.