• In 2018, Uganda responded to several crises including the refugee influx from DRC, Burundi and South Sudan, disease outbreaks such as cholera, and flooding in Bududa, Eastern Uganda.
• Those most affected by emergencies in Uganda were women and children. Sixty per cent of refugees and host communities were children still in need of essential services for their survival, development and well-being.
• With UNICEF support, 25,100 children were treated for severe acute malnutrition; and 475,700 children aged 6 months to 15 years were vaccinated against measles in refugee hosting districts. While 4,700 unaccompanied and separated children benefitted from individual support and alternative care services.
• Since the start of the Ebola outbreak in August, in neighbouring Democratic Republic of the Congo (DRC), UNICEF has been involved in Ebola prevention and preparedness efforts with the Ministry of Health and partners
Situation Overview and Humanitarian Needs
In 2018, the Government of Uganda with support from UNICEF and other partners responded to several humanitarian crises including the refugee influx from DRC, Burundi and South Sudan, disease outbreaks such as cholera, the threat of EVD from neighbouring DRC, and flooding in Bududa, Eastern Uganda.
Uganda is home to over 1.2 million refugees. A verification exercise conducted by the Office of the Prime Minister (OPM) and UNHCR in 2018 showed that over 789,099 refugees originated from South Sudan; 312,699 from DRC; 34,981 from Burundi; and over 54,000 from Somalia, Rwanda and other countries.
Children in refugee settlements in Uganda continue to be at risk of abuse, neglect, violence and exploitation. Case management reports from the field revealed that the types of violence against children include separation from caregivers/families, psychosocial distress, sexual and gender-based violence, physical violence, child labour and neglect. New arrivals mainly children continued to display symptoms of distress caused by witnessing violence and conflict in their countries of origin. These protection concerns require adequate and timely provision of critical child protection services.
In 2018, Uganda’s Ministry of Education and Sports with support from partners launched the Education Response Plan for Refugees and Host Communities (ERP) as a means to facilitate the integration of the planning of education services to benefit refugee children and host communities. The increasing number of refugees put pressure on Early Childhood Development (ECD) centres, primary and secondary schools, many of which already face challenges of poor infrastructure and insufficient teachers. For example, in Yumbe district, the school-aged population has more than doubled since early 2016. As a result, many children, adolescents and youth in refugee settlements and host communities are not able to obtain an education, either because they have missed the opportunity for schooling due to the protracted crisis and are too old to join the formal schools, or do not have the necessary examination certificates. Education interventions are particularly important to build social cohesion among refugees and between refugees and host communities. Life skills interventions, accelerated learning programmes and vocational training are essential opportunities for adolescents and young people.
The OPM, UNHCR and REACH Initiative, conducted a joint Multi-Sector Needs Assessment of refugees and host communities in Uganda. The assessment reported high levels of food insecurity among refugees.1 The average Global Acute Malnutrition (GAM) (WHZ < -2 SD) increased from 7.2 per cent in 2016 to 9.5 per cent in 2017; above the WHO emergency threshold. Stunting was also above the WHO emergency threshold of 20 per cent across all settlements in the South West. Across all settlements, women and children suffered from anaemia, which was above the WHO emergency threshold of 40 per cent. There is need to intensify efforts to address micronutrient deficiency, GAM, and stunting to reduce the current burden of Severe Acute Malnutrition (SAM) across the refugee hosting districts. According to the Lancet series, about 20 per cent of all child morbidity and mortality can be averted with appropriate infant and young child feeding practices of breast and complementary feeding and these will continue to be prioritised in 2019.
With an increasing refugee population and anticipated refugee influxes through to 2020, the capacity and resources of primary healthcare institutions remain at a constant risk of being overstretched. In particular, refugees living in urban areas and outside the settlements access government health facilities that have not planned for additional patient caseload, leading to increased workload on health workers, frequent shortage of medicines and out-of-pocket medication expenditures by both refugee and host communities during stock-out periods2 .
On average, refugee hosting sub-counties accessed 16 litres of water per person per day (lpd). According to sector reports, supply was inequitably distributed between settlement, hosting populations and districts. Refugee and host populations from West Nile had the highest lpd (average 17.5 lpd for host community, 18.7 litres for refugees). Households of refugees from DRC and Burundi in the southwest region accessed 15 lpd or less (68 per cent for host community, 74 per cent for refugees) and 10 lpd or less (38 per cent for host community, 49 per cent for refugees) respectively. Seventy nine per cent of households in host community and amongst refugees own a family latrine. The unavailability of materials for construction of family latrines coupled with low levels of community participation to shift from communal to family latrines, especially amongst South Sudanese refugees, is hindering efforts to ensure all households own a latrine.
Child poverty and deprivation in refugee settings
The first study to apply a consensual approach to measuring poverty3 and deprivation in emergency situations in the country and globally – Child Poverty and Deprivation in Refugee Hosting Areas – was launched in June 2018. The study4 assessed child poverty, deprivation and social service delivery and provided unprecedented evidence on the situation and vulnerability of refugees in Uganda, including urban refugees in Kampala, and that of host communities in the main refugee-hosting regions. The analysis identified the determinants of social service insufficiency and provided practical recommendations on how to manage social service delivery equitably for both refugees and host communities. The evidence highlighted that while refugee children tend to be more deprived of socially perceived necessities, deprivation among refugees tends to reduce over time. Within five years of residence, deprivation rates among refugees were on a par with those of host communities; the reason being that levels of deprivation among host communities are already high. As such, the evidence reiterates the urgent need to facilitate integration of services provided for both host and refugees and special focus is for refugee-hosting districts. More details on the report can be accessed on https://www.unicef.org/uganda/ChildPovertyRefugees-FINAL-Lores.pdf
Throughout 2018, refugee producing countries neighbouring Uganda and refugee-hosting areas inside Uganda remained vulnerable to communicable disease outbreaks due to cross border movement, congestion, inadequate sanitation and geographic location of settlement necessitating preparedness and response for disease outbreaks especially at district and local level.
Cholera: In 2018, the Ministry of Health (MOH) with support from UNICEF and other humanitarian partners responded to Cholera outbreaks in eleven districts with a total of 2,699 cumulative cases and Case Fatality Rate (CFR) of 2.22 per cent which is above the WHO threshold. Majority of the cases were refugees from DRC who imported the outbreak Ituri (DRC), other outbreaks to note are Amudat and Bulambuli that were believed to be associated with cross border engagements among the Pokot and Karamojong in North Eastern Uganda.The re-emergence of cholera in Kampala city in December, two months after controlling an earlier outbreak, has been attributed to risk factors of poor sanitation and lack of clean water. There is need to address the risk factors associated with WASH in addition to risk communication and social mobilization for behaviour change.
Crimean-Congo Haemorrhagic Fever (CCHF): Uganda experienced sporadic cases of CCHF in the eight districts of Ibanda, Isingiro, Kabarole, Kakumiro, Kiboga, Kiryadongo, Nakaseke, Masindi and Sembabule, along the cattle corridor. The cumulative number of confirmed cases reached 14 with six fatalities (CFR = 43 per cent).
Rift Valley Fever (RVF): In 2018, Uganda contained a RVF outbreak that was reported along the cattle corridor in 17 districts;33 cumulative cases, and 18 deaths were reported.
Anthrax: In 2018, an Anthrax outbreak was reported in four districts of Arua (West Nile), Kiruhura (South western), Isingiro (West Nile) and Kween (Eastern). Ten cases were confirmed with one death. The outbreak has been contained.
Black Water Fever: Fourteen children were affected by a Black Water Fever in Manafwa District, Eastern Uganda. The MOH deployed a rapid response team and provided timely treatment to the affected thus controlling the outbreak.
Measles and rubella: In 2018, Uganda was hit by a measles outbreak with 76 out of 122 districts affected with 1,216 cumulative cases. About 33 districts also reported a rubella outbreak across the country with 196 cases and zero case fatality rate. With Global Alliance for Vaccines and Immunisations (GAVI) support, the country will now introduce the Measles Rubella combined vaccine into the national immunization schedule in 2019.
Ebola preparedness and prevention: As of 31 December 2018, the MOHhad not confirmed any case of Ebola Virus Disease (EVD) in Uganda. Surveillance continues at the community, health facilities, formal and informal points of entries (POE) in all 30 high risk districts. MOH and partners continue to identify alerts, validate, isolate suspected cases and collect samples which are tested in-country at the Uganda Virus Research Institute.
Floods and Landslides
In October, a flood and landslide occurred in Bukalasi sub county, Bududa district, affecting 13 villages and killing 43 people, including eight children, and injuring 21. The OPM and partners rescue teams conducted search and recovery of the dead bodies and evacuated the injured. Road infrastructure, water and sanitation facilities, and education facilities were destroyed.