Kiryandongo battles measles, Mpox outbreaks amid health worker shortages

KIRYANDONGO - Kiryandongo district is facing a growing health crisis as disease outbreaks surge and the local health system struggles to cope.

As of March 17, the district had recorded 148 measles cases and 69 mpox cases, which has been around for two years since its outbreak in 2024, figures that health officials said are still rising. Kiryandongo, one of Uganda’s largest refugee-hosting districts, is often among the first to be hit whenever outbreaks occur in the country.

“We suffer a lot from epidemics. Almost every time there is an outbreak in the country, Kiryandongo is affected. Many of these start in the refugee settlements and then spread to host communities,” said Acting District Health Officer Dr. Irene Nabitaka.

The district’s vulnerability is closely linked to its population dynamics. Of the estimated 365,000 people living in Kiryandongo, about 165,000 are refugees from countries including South Sudan, the Democratic Republic of Congo, Sudan, Eritrea and Burundi, making up more than 45 percent of the population.

“This is a district under immense pressure,” Nabitaka said. “We are dealing with a high disease burden, a very young population, and limited human resources.”

She noted that the outbreaks are happening in a health system already battling Uganda’s leading causes of illness. Malaria remains the top cause of morbidity, followed by pneumonia and other infections.

Malnutrition is another major concern, with a Global Acute Malnutrition rate of 8 percent an alert level according to global standards.

Kiryandongo’s overall staffing level stands at just 38 percent, with nutrition staffing even lower at 30 percent. The district currently has only one nutritionist, despite the scale of malnutrition cases across its facilities.

“We need at least four nutritionists to manage both clinical and community interventions effectively. Right now, one person cannot handle the workload,” Nabitaka said.

Nabitaka pointed to additional challenges, including frequent stockouts of medicines, limited ambulance services, and rising mental health cases among refugees, many of whom are dealing with trauma, depression, and anxiety.

“We are seeing more mental health issues, especially in the settlements. These are linked to past experiences, but also to the current conditions people are living in,” she said.

At Kiryandongo General Hospital, a key referral facility along the busy Kampala–Gulu highway, staffing gaps are stark. In the emergency and trauma unit, only one nurse Florence Akello is responsible for handling all incoming cases.

The facility receives between 30 and 60 accident victims every month, many of them from road crashes along the highway.

“It is overwhelming. Sometimes you are alone, handling multiple critical patients at the same time. There is only so much we can do with the resources we have. We need more staff, more support, and better infrastructure,” Akello said from the emergency ward.

The general hospital also has only two general doctors, further stretching its ability to manage emergencies, outbreaks, and routine care and yet it serves a population of more than 500,000 people.

Despite these challenges, the hospital must remain operational around the clock. With unreliable electricity supply, it relies heavily on generators, spending more than Shs20 million every four months on fuel alone.

Hospital officials said such costs divert already limited resources away from essential services like medicines, staffing, and outreach programs.

The situation has been worsened by the withdrawal of several humanitarian partners who previously supported health services in the district. According to Chief Administrative Officer Anslem Kyaligonza, at least five implementing partners have scaled down or exited operations, leading to the loss of 146 health workers.

“These partners were not just supporting staff, they were also providing food and cash assistance to households,” Kyaligonza said. “Their departure has left a huge gap.”

The reduction in support from agencies such as the World Food Programme and UNHCR has also had a direct impact on nutrition, particularly among refugee families who rely on food rations and cash assistance.

“When households lose that support, it affects what they eat. And when nutrition declines, children become more vulnerable to diseases like measles and other infections,” he added.

Health experts warned that malnutrition and disease outbreaks are closely linked. Malnourished children have weaker immune systems, making them more susceptible to infections and more likely to develop severe complications.

This is one reason the government has launched the nationwide screening campaign, which will be rolled out across 13 refugee-hosting districts.

The exercise aims to identify malnourished children early through door-to-door visits by Village Health Teams (VHTs), who will use simple tools to assess children and refer those in need of treatment.

The campaign will also integrate other services, including immunisation, vitamin A supplementation, and deworming an approach health officials say is critical in districts like Kiryandongo that are facing multiple outbreaks.

Speaking at the launch, Director General of Health Services Dr. Charles Olaro, who represented the Health Minister, acknowledged the growing challenges but emphasised the importance of early intervention and prevention.

“Malnutrition has tripled in some areas, and children with severe wasting are at much higher risk of illness and death,” Olaro said. “We must identify cases early and ensure they receive treatment.”

He also highlighted the need for continuous screening beyond the campaign period and called for stronger integration of services at both community and facility levels.