Currently, the district planning is based on the host population figures disregarding the refugees.
PIC: Refugees in one of the camps in Uganda
ADJUMANI- For a 100-bed hospital, 300 patients are a tad too high. Since the refugee influx that started in 2016, three major disease outbreaks have hit the district. This is Adjumani, one of the 12 refugee hosting districts with the highest numbers in the country.
This year’s World Refugee Day, under the theme: ‘Standing for Refugees’, has a number of stakeholders questioning the country’s ability to contain the growing number of refugees.
As of February 2018, Adjumani was home to 239,443 refugees from South Sudan, but also as explained by the Assistant district health officer, Godfrey Emanga, many of the refugees though registered in other districts, prefer to live in Adjumani. “The refugees keep going back home and Adjumani gives them an easy access. You don’t have to cross a river (White Nile) as is the case with the other hosting districts in this area.”
The 2014 National Population Census put the population of the district at 225,251.
Adjumani according to the DHO has as expected been challenged in terms of delivering health services given the influx. He argues that currently, the district planning is based on the host population figures disregarding the refugees.
Due to the numbers and congestion especially in the camps, the district suffered a measles outbreak in January 2014. A month later there was a meningitis outbreak with 86 persons affected. The district registered four fatalities (all refugees). Two years later, the district was hit by a cholera outbreak that stretched for three months(August-October).
The district had to decongest the camp (which one) leading to the creation of a new camp in Moyo. Lucky enough, according to Emanga, there were no fatalities of the 101 cases that were registered.
“The medicine and supplies we receive from National Medical Stores run out in two weeks leaving us to struggle through the rest of the two month until the next supply,” he says adding that the over 400,000 people (refugees and hosts combined) have to rely on medicines meant for 225,000 hosts.
Ideally, NMS supplies as per the demands at the health facilities. However, as explained by the officer, the push (HC111 and 11) and pull (HC4 and district hospitals) systems under which the supplies are made already have restrictions.
“The requests made to NMS are as per the budget ceiling of each district and unfortunately, Adjumani is still being served as per the population of the host community,” he explained.
Adjumani, according to Emanga, who is also the focal person health integration in the refugee hosting communities, is still battling with two of the Neglected Tropical Diseases (NTDs) namely onchocerciasis (river blindness) and bilharzia. However, when the drugs for these conditions are distributed, they are only available to the host population.
Unfortunately, he argues, the refugee camps are in some of the five endemic sub-counties.
The medicines for NTDs according to Emanga, are funded by partners and therefore restricted to host population. But this cannot help us in our elimination agenda.
Emanga was speaking during the launch of a poverty assessment report between refugees and host communities that was carried out by Makerere University’s Economic Policy Research Centre and Cardiff University with funding from UNICEF.
The study titled ‘Child Poverty and Deprivation in Refugee-Hosting Areas: evidence from Uganda’ put water-borne diseases such as typhoid and diarrhea as the most common diseases in the refugee hosting communities. These were followed by cough, flu, pneumonia, asthma, tuberculosis.
According to the report, although government and partners have adopted a non-discriminatory model which allows both refugees and nationals to seek health services in the same facilities, ‘the capacity of the health sector to respond to emergencies like epidemic diseases and severe illnesses is still weak’.
Despite the fact that the district has a total of 41 health centres offering easy access for the communities, these have been found lacking on service delivery.
“You leave home at 6am and go to the health centre. Due to long waiting hours, you return at 7:00pm without even paracetamol. The health centre has only two nurses and it receives many patients daily. They are also human beings. They get tired and chase away patients without treatment” a participant from one of the camps is quoted saying in the report.
Uganda is host to over 1.4 million refugees making it the largest refugee hosting country in Africa and among the third in the world. Throughout 2017, Uganda responded to three concurrent emergency influxes; South Sudan, DRC and Burundi.