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HUMANITARIAN SITUATION DETERIORATES IN NORTHERN UGANDA Ngaire Caruso is a doctor from Western Australia working for Medecins Sans Frontieres (MSF) in Lira, Northern Uganda. More than a million people in Northern Uganda live in Internally Displaced Persons (IDP) camps, as a result of the 20 year old conflict between the Ugandan Government and the rebel group called the Lord’s Resistance Army. Ngaire has written two letters since September 2005, while the most recent was received in January 2006 – combined they present a telling story. Since 1986 the Lord’s Resistance Army (LRA), led by Joseph Kony has waged a war in Northern Uganda. The LRA attack Ugandan Government forces and civilians. During the conflict, the LRA have abducted more than 20,000 children, forcing them to be child soldiers and for sexual exploitation. The insecure situation has forced over 1.2 million people to move from their villages into Internally Displaced Persons (IDP) camps. In northern Lira District it is estimated that up to 80% of the population is currently displaced and living in IDP camps. Living conditions in these camps are terrible. The tukuls (huts) are packed tightly together. Access to fields for cultivation (and therefore food production) is largely restricted because of the insecurity. Basic services such as clean water, sanitation and medical services are grossly lacking. We have a large project here in Lira District and a large team of 13 expatriates (the medical team comprises a team leader (me), three doctors, three nurses, one laboratory technician and one mental health officer. We also have over 400 national staff. We work in seven sites – six IDP camps and a therapeutic feeding centre here in Lira town. Between 20,000 - 40,000 people live in each camp, so in total we serve a population of around 170,000 people. In each of the six camps we have a clinic which provides basic health care, and a water and sanitation program. The camp clinics each see around 600 patients per week. Malaria is overwhelmingly the major cause of morbidity. The other main causes of morbidity include diarrhoea, respiratory tract infections, wounds and skin infections. At the moment we are not testing or treating HIV/AIDS, but clinically suspect the prevalence is quite high. In keeping with the HIV/AIDS prevalence, there is quite a lot of tuberculosis as well. It’s remarkable how many lives can be saved with antimalarial drugs and simple antibiotics – a far cry from the way we practice medicine back home. On the other hand, it’s difficult to cope emotionally with the other 5% or so of patients for whom we can do nothing here, but could easily be helped if we had adequate resources. As well as basic medical care in the camps we do antenatal care, have a supplementary feeding program for moderately malnourished children and are starting family planning. We are working in conjunction with the Ministry of Health to provide immunizations. The therapeutic feeding centre in Lira town provides feeding and treatment for severely malnourished children. Our occupancy varies from around 150 up to 320 patients. We’re also treating malnourished children who have tuberculosis, and are planning to expand our tuberculosis program to treating people of all ages in the camps. Access to clean water is a nightmare for the IDPs – earlier this year a survey found they have access to 1.7 litres/person/day. The internationally recognized minimum standard is 15-20 litres/person/day. Following our water and sanitation program, access has increased to 5.6 litres/person/day, but there is obviously still a long way to go. MSF has been building bore holes, protecting springs and digging shallow wells. We are also providing tools and equipment for the construction of 2,244 latrines – the international standard is 20 people per latrine. In our camps we found a ratio of around 130 people per latrine. I really enjoy spending time in the field – meaning in the camps, rather than in Lira town. When you consider the conditions under which these people are living, it’s amazing that the camps are not an oppressive depressing place. Walking around the camps you see old men sitting around playing cards, young men playing soccer, women preparing food or carrying water or washing their children (as usual it is the women doing the work). We are met with friendly smiles and greetings, and followed by a hoard of barefooted dirty laughing children chanting “munu, munu” (white person). Some small babies just howl with fear when they see these strange white people, much to the amusement of everyone else.
Unfortunately the situation in Northern Uganda has deteriorated further since September 2005. There has been a recent spate of attacks on Non Government Organisations (NGO) within the region. The first such attack here in Lira District - a vehicle was ambushed on the road, but not one of ours. Two victims were evacuated to Kampala by helicopter and both fortunately survived. Four more attacks on NGO vehicles occurred over the next two weeks. Five aid workers were killed in those ambushes. It is not completely clear whether these attacks were all perpetrated by one group, or why NGOs are being targeted. However it is clear that the risk to NGOs working in the region has increased significantly. As a result of these attacks, most NGOs stopped or restricted their movements to the IDP camps where they are working. Of course this situation has made life even more difficult for the 1.2 million people living in camps in Northern Uganda, who are forced to rely upon NGOs to meet basic needs such as adequate water supply and health care. There was a lot of fear in the camps that MSF would leave. – as one local said to me “If MSF leave it will be like before – our children will just die.” Fortunately we have been able to continue our work in the camps, running our clinics by “remote control” from Lira town. This is largely due to the dedication and hard work of our Ugandan staff who have continued to work in the clinics, travelling to the camps on public transport. The reduced expat team has remained in Lira town, and has worked hard to support our Ugandan staff in the field. By mid December (2005) things were looking up – there had been no attacks on NGO vehicles for several weeks, our clinics were running well on remote control, and we were starting to consider travelling back to the camps. While districts further north were still suffering from ambushes, killings and abductions of civilians, at least Lira District seemed quiet. Then on December 13th, a public transport vehicle was ambushed on the road between two of the camps we work in. People were made to hand over their belongings, and then strip naked. Then the gunmen began to shoot. At least six people managed to escape, including a man and a young boy who made it to our Clinic in Omoro. At least eight people were killed. Over the next week more incidents occurred in Lira. Four people were abducted from the outskirts of a camp. Two people were abducted very close to another camp where we work. There were several other abductions within Lira District, and ongoing looting, ambushes, murders and abductions in the surrounding districts. Fortunately in the last week of December, things quietened down again, at least in Lira. However the situation is very unpredictable and could flare up again. With the National Elections scheduled for February 23rd there is significant potential for violent unrest in the next few months. I am leaving Lira next week. After a holiday I will return to my comfortable
life back in Australia and escape the dilemmas and difficulties of life
here. But for the Ugandan people there is no escape –for the 1.2
million people living in the camps in appalling conditions, lacking basic
services such as clean water, education and health facilities. The war
in the north has been going on for twenty years, and at the moment there
is no reason to predict it will not continue for twenty more.
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