MIHA Module 5 Assignment

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Department of Politics
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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.
22

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
24

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.
25

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
27

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
28

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
29

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.
30

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.
31

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