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Examination Number: Y0600476 Department of Politics University of York Electronic Essay Submission Cover Sheet This cover sheet should be the first page of your essay. Examination Number: Y0600476 Module: 5 Essay Deadline: 11/8/2014 I confirm that I have - checked that I am submitting the correct and final version of my essay - formatted my essay in line with departmental guidelines - conformed with University regulations on academic integrity - included an accurate word count - put my examinations number on every page of the essay - not written my name anywhere in the essay - saved my essay in pdf format PLEASE TICK BOX TO CONFIRM

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Page 1: MIHA Module 5 Assignment

Examination Number: Y0600476

Department of Politics

University of York

Electronic Essay Submission Cover Sheet

This cover sheet should be the first page of your essay.

Examination Number: Y0600476

Module: 5

Essay Deadline: 11/8/2014

I confirm that I have

- checked that I am submitting the correct and final version of my essay

- formatted my essay in line with departmental guidelines

- conformed with University regulations on academic integrity

- included an accurate word count

- put my examinations number on every page of the essay

- not written my name anywhere in the essay

- saved my essay in pdf format

PLEASE TICK BOX TO CONFIRM √

Page 2: MIHA Module 5 Assignment

Examination Number: Y0600476

Refugee Health Risks in Northern Uganda: A Case Study Project of Kiryangdongo

Refugee Settlement, Bweyale Sub County, Kibanda County, Kiryangdongo District.

Acknowledgements

Special acknowledgements to:

The Office of the Prime Minister of the Republic of Uganda.

All the local and international NGOs working at Kiryangdongo Refugee Settlement

Camp.

All the NGO health workers who took the time to meet with the researcher.

All government health extension workers for the precious time given to answer

questionnaires.

All the refugees that agreed to participate to the Focus Group Discussions.

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LIST OF ACRONYMS

AIDS - Acquired Immunodeficiency Syndrome

EEQ - Eastern Equatorial

FGDs - Focus Group Discussions

GoU - Government of Uganda

HIV - Human Immune Virus

IDPs - Internal Displaced Persons

IHAs - International Humanitarian Agencies

INGOs - International Non-Governmental Organizations

LRA - Lord’s Resistance Army

OPM - Office of the Prime Minister

RMF - Real Medicine Foundation

SCU - Save the Children Uganda

SP - Samaritan Purse

SPLM/A - Sudan People’s Liberation Movement/Army

STIs - Sexually Transmitted Infections

UNICEF - United Nations International Children Emergency Fund

UNHCR - United Nations High Commissioner for Refugees

WASH - Water, Sanitation and Hygiene

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List of Contents

Acknowledgements……………………………………………………………….. 1

Executive Summary……………………………………………………………… 4

Background……………………………………………………………………….. 6

I. Situation in Kiryangdongo Refugee Camp…………………………….. 6

II. Objectives…………………………………………………………………. 7

III. Methodology………………………………………………………………. 8

IV. Results……………………………………………………………………… 10

a) Results of 4Ws………………………………………………………………… 13

b) Results of Field Work………………………………………………………… 14

V. Discussions and Recommendations……………………………………. 22

VI. Conclusion………………………………………………………………... 30

VII. Reference………………………………………………………………….. 31

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Executive Summary The Kiryandongo refugee settlement in Uganda has been one of biggest camps that was

created to resettle Sudanese refugees as a result of war, established in 1991 for the

group of Eastern Equatorial (EEQ) refugees who had fled fighting between Sudan

People’s Liberation Movement/ Army (SPLM/A) and Sudanese government forces.

Their exile had begun in Kitgum district but Lord Resistance Army (LRA) attacks led to

their transfer to Masindi by the government of Uganda and the United Nations High

Commissioner for Refugees (UNHCR).

The field study was carried out to establish information on health risks faced by the

South Sudanese refugees currently settling at Kiryangdongo refugee camp as a result of

the massive displacement of over 1,300,000 people out of South Sudan due to the

fighting that happened between the government troops and the rebels of South Sudan

since December, 2013. This study report is presented based on the prevailing health

conditions of the refugees relocated and living in Kiryangdongo refugee settlement

camp which presentations covers:-

a) The situation of the refugees in Kiryangdongo refugee settlement camp which

comprised of Uganda IDPs and refugees from Kenya, Congo, Rwanda and South

Sudan, with the majority being refugees from South Sudan.

b) The objectives which aimed to identify the health problems affecting the refugees

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relocated and living at Kiryangdongo settlement camp to determine the connections

between current health needs being addressed by existing health service providers

and un met health needs which calls for health support, and as well as conduct

research on the health facilities in place and how they are governed that would

provide effective health services for South Sudan refugees in the Kiryangdongo

refugee resettlement area by identifying gaps and opportunities for future

intervention.

c) The methodology used has employed two study approaches of i) A mapping

exercise according to the 4Ws of Who was Where, When, doing What to get the

required quantitative data on impact of existing health service providers. ii)

Fieldwork consisting of interviews with international NGO workers, focus group

discussions with refugees, camp commanders, local leaders and site visits to get

qualitative data on health needs of the refugees at Kiryangdongo settlement camp.

d) The results were based on the two study approaches above used as study guidelines

to enable the researcher arrived at meaningful, informative and insightful decisions.

e) The report ended with discussions which provided considerable recommended

intended to influence policy decisions on refugee settlement and treatment in

gazatted refugee camps.

f) Conclusion has been drawn from diversified perspectives provided by key study

findings which gave the summary on lesson learning areas for future interventions.

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Background

I. Situation in Kiryangdongo Refugee Camp

Kiryangdongo refugee settlement in Bweyale, Kiryangdongo district, Uganda has been

UNHCR managed refugee settlement mandated at providing shelter, land and support

to more than 25,000 refugees comprising of Uganda IDPs and refugees from Kenya,

Congo, Rwanda and South Sudan.

Many people have been forced out of South Sudan into Northern Uganda with good

number of refugees being relocated to Kiryangdongo settlement camp while it is

believed more refugees were transferred from West Nile to Bweyale, Kiryangdongo

district factoring high risks of the current health needs of the camp dwellers. The

reported health problems has been wide spread of diarrheal diseases, malaria,

pneumonia and skin rashes due to congestion in the settlement camp making it prone

to poor hygiene and sanitation thus breeding environment for communicable diseases

in and around the refugee settlement areas.

Other international non-governmental organizations (INGOs) found operating within

the resettlement in partnership with the Office of the Prime Minister (OPM) of the

government of Uganda are Samaritan Purse (SP), Real Medicine Foundation (RMF) and

Save the Children (SCU) who provide support to refugees within Kiryangdongo

settlement camp and the greater surrounding communities of Bweyale through:-

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a) Health care support to existing health units & centres by supplying drugs, bringing

in visiting medical teams who come to work alongside resident health workers and

renovation of weathering buildings to strengthen as well improve on health service

delivery to the refugees within the camps and surrounding communities.

b) Education by construction of new classrooms, paying tuition/training fees and

provision of scholastic materials such as exercise books, pens, pencils, rulers, and

uniforms to pupils/students including sanitary wears/pads to grown up girls to

help out during menstrual periods.

c) Vocational skills training support programs to out of school youth and children by

construction of training workshops, paying instructors and providing starter trade

tools at the end of the trainings such as tailoring machines, hand tools for carpentry

and wood works, building and concrete works, hairdressing and saloon as economic

boost to their newly acquired entrepreneurship skills to increase on local income

towards improved economic opportunities.

II. Objectives

This research study was a follow up the media report on the challenges and gaps

brought by the influx of migration by Southern Sudanese refugees into Northern

Uganda prompting the government of Uganda (GoU) and International Humanitarian

Agencies (IHAs) involved in their resettlement.

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The overall aim of the study is expected to answer the two research questions:-

a) What is the critical health issues affecting the refugees at Kiryangdongo settlement

camps?

b) What can be done to reduce health risks brought by the refugee influx at the

settlement camps located at Bweyale Sub County, Kibanda County, Kiryangdongo

district?

The specific objectives were:

1. To identify the health issues affecting the refugees at Kiryangdongo settlement camp

in order to determine the connections between current health needs being addressed

by existing health service providers and unmet health needs calling for health

support.

2. To conduct research on the health facilities in place and how they are governed that

would provide effective health services for South Sudan refugees in the

Kiryangdongo refugee resettlement area.

III. Methodology

The study of Kiryangdongo refugee settlement camp which took place from 5th July

and ended on 8th August 2014 focused on assessment of the current health conditions of

the refugees and the communities surrounding the settlement areas. The assessment

employed two study approaches:-

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1. The quantitative study A mapping exercise according to the 4Ws (Who is Where,

When, doing What?). Input from 4 participating International nongovernmental

organizations that were providing and operating health support services in

Kiryangdongo refugee settlement camp were met through physical contacts whose

views was collected and analyzed to determine the impact of their services on the

refugees living in the settlement camp which results hereto shared to inform the case

study report findings.

2. The qualitative study: Fieldwork consisting of interviews with international NGO

workers, focus group discussions with refugees, camp commanders, local leaders

and site visits. To compliment the “4Ws” additional qualitative fieldwork was

conducted, divided in three parts:-

a) Interviews with nongovernmental organizations and government health workers

to have a better view of the services provided, the challenges faced and the

recommendations.

b) FGDs was organized to help collect data from both refugee household leaders

and the organizations working in Kiryangdongo refugee settlement camps.

FGDs took place with mothers with babies and children and youth. The aim of

the study was explained to participants’ prior conducting the FGDs. The

participants were informed that participation is voluntarily. Further they were

assured that the information given will remain confidential and anonymous.

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c) Site visits to health centres providing the services for refuges aimed at observing

the sites, the organization of work, talking with the health workers and when

possible conducting FGDs with Sudanese refugees.

The researcher used semi-structured interviews to conduct with NGO field health

workers and local leaders, FGDs questionnaires was used while conducting FGDs with

refugee household leaders and field observations from site visits.

IV. Results

Sudanese refugees receive relief goods at Kiryangdongo

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Facts: At the Kiryangdongo refugee settlements the South Sudanese refuges have been

arriving by their own means since the beginning of the recent influx. In some cases the

refugees, mostly of Dinka ethnic group, have been rejoining family members as the

majority interviewed by the researcher stated they wish to be at a distance from the

border fearing of being marginalized against or falling in the hands of ruthless armed

militias from South Sudan. Many South Sudanese met have become familiar with

Uganda’ settlements and are living in host communities of Bweyale Sub County in

Kiryangdongo district.

Sudanese Refugees line up for medical checkup at Kiryangdongo settlement

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Many of these refugees were well off before they had to flee South Sudan. They were

business owners; they worked in offices. These Sudanese refugees suffered a lot of

conflict while majority of their women and girls have suffered rape. Some of them have

witnessed the killing of their own loved ones. Some of them have never witnessed

peace in their lifetimes.

Health/Nutrition: In Kiryangdongo refugee settlements, the local government is

providing health services including immunization, nutrition screening and curative

services. A 13 member medical team operating mobile clinics supported by Action

African Help Uganda as motorized medical equipment to provide on spot treatment to

refugees with serious cases being referred to Panyandoli Health Centre III located at

Bweyale Sub County for management. Also at Kiryangdongo, donation of vaccines and

de-wormers was received from Real Medicine Foundation by district health teams and

children ages 0-14 are being vaccinated against polio and measles at the reception

centres established within the settlements. UNICEF and Samaritan Purse provide also

support immunization with HIV/AIDS voluntary test and counseling is done in all

these centres as well as awareness and community outreach services. The health teams

posted at the reception centre continued to carry out routine medical checkups,

malnutrition screenings and immunizations. The leading common conditions remain

malaria, upper respiratory tract infections followed by watery diarrhea calling for

corporate health education on diarrhea diseases prevention through WASH campaigns.

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Vaccination of children against polio and measles continued as did the provision of

doses for vitamin A and de-worming of children.

1. Results of 4Ws

The data was collected from the following organizations:-

a) Samaritan Purse was handling construction of 8 classrooms where vocational

skills training were conducted to empower 876 youth refugees with market trade

vocational skills in tailoring and weaving, carpentry and wood works, building

and concrete works, hairdressing and saloon. The trainees are given starter tools

in form of tailoring machines, hand tools for carpentry and wood works,

building and concrete works and hairdressing and saloon to improve as well

provide income opportunity and livelihood status. The organization also

provides voluntary counseling and testing support services on HIV/AIDS to let

the refugees know their Sero status to enabling the victims to access anti-

retroviral medication at early stage as possible.

b) Real Medicine Foundation handled rehabilitation of emergency health units that

had been shut down before arrival of Sudanese refugees, bringing in visiting

medical teams who come to work alongside government health workers as well

providing medical supplies such as drugs of malaria, diarrhea, typhoid, syringes

and vaccines of polio and measles. The organization operated health education

through village teams through sensitization and awareness on cholera.

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c) UNICEF was responsible for providing medical supplies such as vaccines for

polio, measles, Diphtheria, Hepatitis B, meningitis and tetanus including

supplying scholastic materials such as books, pens, pencils, rulers and uniforms

as well paying of instructor’s salaries on 3 year contract term.

d) Action Africa Help Uganda responsible for operation of a 13 member mobile

health unit as emergency medical support to reinforce the existing health

facilities and their workers to address cases of disease outbreaks of contagious

diseases as well providing referral support system by carrying most affected

patients to Panyandoli Health Centre III located at Bweyale Sub County for

further management.

2. Results of Field Work

This section takes into account information gathered from the following activities:-

a) Interviews with key stakeholders involved in provision of health services in

Kiryangdongo refugee settlement camp.

b) Focus Group Discussions with Sudanese refugees.

c) Site visits to health centres providing the health services for Sudanese refugees.

Focus 1: Considerations of basic health needs and services

a) Concerning operational health facilities and infrastructures

The report shows response from health workers interviewed from:-

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Samaritan Purse: Out of the 7 staff contacted, 3 being female and 4 male are

serving on village health teams drawn from community within Bweyale that

work in temporary tents providing emergency health support services to back

up the 4 government supported health units which were overwhelmed by the

influx of refugees transferred from Arua, Moyo and Adjumani districts.

The 2 female health workers from government aided health units supported

reported lack of adequate anti-retroviral supplies by government as the major

factor hindering effective treatment and management of HIV/AIDS prevalence

including STI related cases in the refugee community. On the other hand the

report from 6 health staff stated low turn up of patients who are showing up for

pre-test counseling, with few could speak up about their health status with the

majority expressed ignorance, fear of disappointment and trauma from rape and

sexual harassment by soldiers while on transit, yet 7 health staff stated lack of

knowledge of HIV/AIDS as common setback in carrying out of awareness

education campaigns to refugees living in the Kiryangdongo refugee settlement

camp.

Real Medical Foundation: Report from 7 field based staff indicated them as part

of the medical teams from USA brought into Kiryangdongo to work alongside

government health workers in addition to provision of drugs to combat spread

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of malaria, diarrheal and typhoid diseases including vaccines of polio and

measles to scale down the impacts on the refugee communities. The report

further stated the organization also carries health education with the

participation of village teams through community mobilization, sensitization and

awareness training on cholera through WASH campaigns

UNICEF: 12 of field based staff reported their participation in the health service

sector as being distribution of vaccines for polio, measles, Diphtheria, Hepatitis

B, meningitis and tetanus to all health units within the refugee settlement camps

to cater for the health of refugees and surrounding communities

Action Africa Help Uganda: Responsible for operation of 1 mobile health unit to

provide emergency medical support as back up to reinforce inadequate

government health facility established at Kiryangdongo refugee settlement

camps. They are deployed to act as health links to handle outbreaks of life

threatening diseases through routine referral support services by providing

carriage to severely affected and bedridden patients to Panyandoli Health Centre

III, a government aided health unit.

Panyandoli Health Centre III is located at Bweyale Sub County outside of the

refugee settlement camps, 7 km along Kampala road which is one of the 8

government funded health units in Kiryangdongo district.

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b) Concerning basic health needs being addressed.

Samaritan Purse: They are involved in the provision of HIV/AIDS pre-testing

counseling services to refugee married couples and youth through village health

team structures operating at camp cluster levels as prevention measures, an

approach to encourage disclosure status by candidates including awareness

creation and sensitization of refugee communities through health education on

possible wide spread of STI related diseases which can affect their health.

Real Medical Foundation: They coordinate participation of visiting medical

teams from USA who always comes on short term work trips of three to four

weeks to provide medical consultancy services at Kiryangdongo refugee

settlement camps helping in the treatment and management of malaria, diarrheal

and typhoid diseases including vaccination against polio and measles.

UNICEF: They provide supplies and distribution of vaccines for polio, measles,

Diphtheria, Hepatitis B, meningitis and tetanus to health units within the refugee

settlements at Kiryangdongo settlement camps to cater for the health of refugees

and surrounding communities.

Action Africa Help Uganda: They operate 1 mobile health unit with 13 health

staff working as emergency medical support to back up the government health

facility established at Kiryangdongo refugee settlement camps.

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Their health workers are deployed to provide service links to handle outbreaks

of life threatening diseases through routine referral support services through

provision of carriage to severely affected and bedridden patients to Panyandoli

Health Centre III, government aided health unit at Bweyale Sub County in

Kibanda County, Kiryangdongo district.

c) Gaps and challenges faced by health service providers.

The four organizations contacted whose staff expressively reported on the

following gaps and challenges they face during implementation:-

Samaritan Purse: They reported on inadequate supplies and distribution of anti-

retroviral by the government of Uganda coupled with low response from the

refugee population who often never show up for pre-test counseling on

HIV/AIDs and STI related infections. They also reported of ignorance by the

majority of Sudanese refugees on HIV transmission since unprotected sexual

intercourse is the common practice supporting widespread of HIV/AIDS among

the refugee settlers in Kiryangdongo settlement camps. Post trauma, stress and

depression was identified as the main contributors of mental health challenges

on the lives of the refugees who have escaped into Northern Uganda from South

Sudan.

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Real Medical Foundation: They reported majority spending of funds on the re-

establishment of emergency health units that were not operational as well

development of functional and effective health system in attempt to improve on

the health service delivery by the time of the arrival of Sudanese refugees at

Kiryangdongo refugee settlement from Arua, Moyo and Adjumani districts

along the Uganda and South Sudan border. It was also reported of frequent

outbreaks of communicable diseases of typhoid, cholera and diarrhea and

infectious diseases of malaria, polio and measles as being the most challenging ill

health occurrence affecting the refugee settlers relocated from mid north western

Uganda to Kiryangdongo settlements.

UNICEF: They reported of the untimely securing and supplying of vaccines for

polio, measles, Diphtheria, Hepatitis B, meningitis and tetanus to all the health

units within the refugee settlement camps to cater for the health of refugees and

the surrounding communities as the most challenging health support activity

being time consuming.

Action Africa Help Uganda: They reported that operating mobile motorized

health services as being very expensive including maintenance from working

sites including carriage of severely affected patients to Panyondoli Health Centre

III for further treatment and management, incurring lots of expenditures.

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Focus 2: Concerning governance of existing health facilities.

a) Condition of existing health facilities.

Apart from government aided health units which had closed down due to

thin national budget allocation whose votes was exhausted shortly after the

influx from the arrival of Sudanese refugees at the settlement camps from

January to March 2014, all the health units and facilities operated and managed

by international nongovernmental organizations in Kiryangdongo refugee

settlements were properly managed and stocked with medical supplies of drugs

and vaccines brought to handle or address contagious diseases which could

paralyze and jeopardize the health of the refugees .

b) Coverage and impact.

There are 8 health units operated under medical tents with the support of

UNICEF and Red Cross donated through the Office of the Prime Minister that

were installed in strategic sites within the settlement camps at Kiryangdongo

being backed up by 13 member staff mobile health motorized unit driven to

designated sites according public calls. There is also one government aided

health Centre III located at Bweyale Sub County that operates referral support

services to severely sick patients brought through or from the health facilities out

of the refugees’ settlements in Kiryangdongo.

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Focus 3: Concerning current health needs and impact.

a) Common leading health needs at the refugee settlements

The leading common health conditions of the refugee settlers that pose as life

threatening diseases and sickness remain to be malaria, upper respiratory tract

infections followed by watery diarrhea being the major health hazards which calls

for corporate treatment from health experts operated back to back with health

education on diarrheal diseases prevention through WASH campaigns at refugee

cluster levels to ensure good health for all refugee settlers at Kiryangdongo

settlements.

b) Risks and challenges

In case of some delays during the supplies of medical drugs, distributions and

treatment of malaria, upper respiratory tract infections including diarrhea which

takes plenty of water and fluids out of the body, one could stand little chance to

survival which means high death tolls of the refugee population at the settlement

camps.

The same applies to having only one mobile motorized health unit and

ambulance serving the overall refugee population at Kiryangdongo settlements

which indicates inadequacy and insufficiency of health service delivery,

especially when it comes to providing carriage of severely sick patients

demanding for referral support to Health Centre III located at Bweyale Sub

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County or any other fully pledged health referral units outside Kiryangdongo

district for further medical treatment and management therefore puts the refugee

community in the settlement camps at high risks of dying in great numbers.

V. Discussions and Recommendations

Based on the above reports the recommendations can be presented according to

study observations and findings as below:-

Focus 1: Considerations of basic health needs and services

a) Concerning operational health facilities and infrastructures

As described in the results, the following international nongovernmental organizations are

working in situations of challenges in one way or the other.

Samaritan Purse struggling to provide emergency health services to the heavily populated

refugees as a result to the influx from transfer of Sudanese refugees from Arua, Moyo and

Adjumani while working from temporary tents as back up service to the 4 government health

units established at Kiryangdongo resettlements. The existing government supported health

units do not have adequate anti-retroviral supplies to provide routine treatment and

management of HIV/AIDS including STI related cases in the refugee community.

Real Medical Foundation overwhelmed by handling treatment of rampant cases of

malaria, diarrheal, typhoid and measles calling for standby emergency health workers 24/7.

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UNICEF tasked with supply and distribution of vaccines for polio, measles, Diphtheria,

Hepatitis B, meningitis and tetanus to all health units within the refugee settlement camps to

cater for the health of refugees and their surrounding communities.

Action Africa Help Uganda operates 1 mobile health unit to provide emergency medical

support to reinforce all the 8 government health units established at Kiryangdongo refugee

settlement camps through referral transfer carriage services to severely sick patients in needs

of further medical attention and management from fully pledged health facilities elsewhere

outside the refugee settlements.

Recommendations:

Government needs to turn emergency health tents and units into Health Centre

III to treat emergency treatment cases while establish Health Centre IV to handle

complex health cases among refugee settlers in the settlement camps.

Government to source routine supply of regular supply of anti-retroviral drugs

which can address HIV/AIDS and STI treatment cases and management among

refugees within the settlement camps.

More village health workers be trained and recruited to work as volunteers and

back up the serving health teams at the settlement camps.

Additional mobile motorized health units urgently needed to reinforce the one

being operated by Action Africa Help Uganda.

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b) Concerning basic health needs being addressed.

As described in the results, the following international nongovernmental organizations

are working to address cross cutting health issues affecting refugees at Kiryangdongo

settlements.

Samaritan Purse involved in the provision of HIV/AIDS pre-testing counseling

services to refugee married couples and youth through village health team structures

operating at camp cluster levels as prevention measures to stop prevalence of HIV/ AIDS

and possible wide spread of STI related diseases among refugee settlers.

Real Medical Foundation coordinates participation of visiting medical teams from

USA who always comes on short term work trips of three to four weeks to provide

medical consultancy services to refugee settlement camps by helping in the treatment and

management of malaria, diarrheal and typhoid diseases including vaccination against

polio and measles.

UNICEF provides supplies and distribution of vaccines for polio, measles, Diphtheria,

Hepatitis B, meningitis and tetanus to health units within the refugee settlements at

Kiryangdongo settlement camps to cater for the health of refugees and surrounding

communities.

Action Africa Help Uganda operates 1 mobile health unit to provide emergency

medical support to reinforce all the 8 government health units established at refugee

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settlement camps through referral transfer carriage services to severely sick patients in

needs of further medical attention and management from fully pledged health facilities

elsewhere outside.

Recommendations:

All health agencies need to strengthen awareness campaigns through

community health education on HIV/AIDS and STI prevention, support and

care.

WASH program to be considered among priority interventions to curb down

outbreak of water borne diseases such as malaria and watery diarrhea among

refugee community in Kiryangdongo settlement camps.

Immunization vaccines to be provided on regular supplies and distribution to

all health units or centres operating throughout the settlement camps.

More health centre III and IV to be established in Kiryangdongo settlements

to help in the treatment and management of communicable diseases among

refugee settlers.

c) Gaps and challenges faced by health service providers.

Samaritan Purse: They are facing challenges of non disclosure of health status by

refugee settlers making it hard to carry out pre-test counseling on HIV/AIDS including

STI related infections to the entire refugee community at Kiryangdongo settlements.

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Majority of female refugees suffering from the effect of mental health due to post trauma,

stress and depression caused by rape and sexual harassment by armed militias

encountered during migration from South Sudan into Uganda.

Real Medical Foundation: Frequent outbreaks of communicable diseases of typhoid,

cholera and diarrhea and infectious diseases of malaria, polio and measles affecting the

refugee settlers at the Kiryangdongo settlements.

UNICEF: Untimely supplying and distribution of vaccines for polio, measles,

Diphtheria, Hepatitis B, meningitis and tetanus to all the health units within the refugee

settlement camps.

Action Africa Help Uganda: Operating 1 mobile motorized health unit which is very

expensive to run as well as financing maintenance from working sites up to carriage of

severely affected patients to Panyondoli Health Centre III for further treatment and

management which incurs lots of expenditures.

Recommendations:

Establishment of AIDS health unit within the settlement camps to handle

HIV/AIDS and STI related infections among refugee settlers.

Set up psychosocial counseling units and employing psychiatrist specialists to

attend to mentally stressed refugee patients within the settlement camps.

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More village health teams to be trained to supplement the work of visiting

medical teams who come from outside Uganda to support emergency health

services at settlement camps.

Focus 2: Concerning governance of existing health facilities.

a) Condition of existing health facilities.

All health units and facilities supported the nongovernmental organizations visited were

being properly managed as well stocked with medical supplies of drugs and vaccines

brought to handle or address contagious diseases which could jeopardize the health of the

refugees within Kiryangdongo settlements.

Recommendations:

Operationalization of health units/centres in Kiryangdongo settlements in

partnerships with government aided health centres/facilities in order to

strengthen health service provision to refugee community in Bweyale Sub

County.

b) Coverage and impact.

The 8 health units operated under medical tents have been installed from

strategic sites within the settlement camps at Kiryangdongo being backed up by

13 member staff mobile health motorized unit driven to designated sites based

on public calls. Their services is linked to Panyondoli health Centre III located at

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Bweyale Sub County that operates referral support services to severely sick

patients brought from within or outside the refugees’ settlements in

Kiryangdongo.

Focus 3: Concerning current health needs and impact.

a) Common leading health needs at the refugee settlements

The leading common threatening diseases remain to be malaria, upper respiratory tract

infections followed by watery diarrhea which calls for corporate treatment from health

experts to ensure good health for all refugee settlers at Kiryangdongo settlements.

Recommendations:

Provision of treated mosquito nets to refugee households would be the safest

way to curb down malaria infections.

Supply and provision of bronchitis syrups to affected refugee patients to

combat respiratory infections.

Supply and distribution of de-wormers including hydrated salt packets to

refugees would help stop watery diarrhea by boosting water context of their

bloodstream, hence improving immunity level.

b) Risks and challenges

Delays of supplies of medical drugs, distributions and treatment of malaria, upper

respiratory tract infections including diarrhea which takes plenty of water and fluids out

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of the body puts the affected refugees at risk of death. This also applies to operating only

one mobile motorized health unit which does not enable the refugees to reach health

services whenever any of them falls severely sick and needs carriage to referral health

facility to access proper treatment and management.

Recommendations:

Routine supply and distribution of medical drugs and malaria injections to

health centres/units for treatment and management of malaria, respiratory

infections and diarrheal diseases.

Additional provision of mobile motorized health equipment to reinforce the

current one in use already to step up emergency and referral transport for

severely sick refugee patients who need to access further medication

management.

VI. Conclusion

This report was able to shed light on the emergency health services delivered to

refugee settlers at Kiryangdongo settlement camps by the four international

nongovernmental organizations contacted during the research study. The

findings on the assessment of the impact of what each organization has been

doing to address critical health issues among refugees related to the provision

and distribution of medical supplies including vaccines to designated health

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units/centres within the settlement camps, the resources both human and

materials invested, the category of refugees accessing health services, and was

also able to give an idea about the quality of the work and the challenges as

expressed by both the refugees and the service providers.

All the four organizations contacted were cooperative as the researcher was able

to meet with all of them and their staff who gave information relevant to

providing of emergency health services to refugee community including the

challenges faced. The refugee household leaders, camp commanders, local

leaders were also contacted whose response was very instrumental and

informative to this study report.

The most valuable contribution from this study report is the recommendation

pointing out the main areas of actions required to address the gaps and

challenges in order to improve the health response to refugee community at

Kiryangdongo settlements. In summary the health and nutritional status of the

refugees living in the settlement camps of Kiryangdongo, located in Bweyale Sub

County in Kiryangdongo district needs corporate funding efforts from both the

government and nongovernmental organizations in order to ensure as well

provide services which support their health safety while they wait for the time

the armed conflict subsides from their countries.

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VII. References

1. Kiryangdongo Local Government Report, June 2014

2. UNHCR-Uganda Emergency Update, June 2014.pp. 6-7.

3. Relief Web Report (January 2014).

4. Brinkerhoff D (2008), From humanitarian and post-conflict assistance to health system

strengthening in fragile states: Clarifying the transition and the role of NGOs.Washington

DC: (USAID).

5. Newbrander W, R Waldman and M Shepard-Banigan (2011), Rebuilding and

strengthening health systems and providing basic health services in fragile states. Disasters,

35 (4): 639-660.

6. Tar Veen A ed. (2009), Health system strengthening in fragile contexts: A report on good

practices and new approaches. June. London: Health and Fragile States Network.

7. Médecins Sans Frontières (MSF) (1999), Refugee Health: An approach to emergency

situations. London: Macmillan. pp. 37-42.

8. Toole MJ and RJ Waldman (1997), The public health aspects of complex emergencies and

refugee situations. Annual Review of Public Health, 18: 283-312.

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