In late December 2013, a civil war erupted in South Sudan plunging the country into chaos. More than three years of sustained conflict have forced over one million people to flee their homes toward Uganda, leaving them with no access to medical assistance and overwhelming the Uganda government ability to respond.
Doctors Without Borders/ Médecins Sans Frontières (MSF) operates projects in six of the ten states of South Sudan and responds to the humanitarian crisis in Uganda with medical, water and sanitation activities.
"They just slaughter you, whether you're a man, woman, or child. I lost all my brothers and my relatives. Life here is very difficult. With no man, nobody helps you.”
That is the testimony of Maria*. She is just one of hundreds of thousands of refugees who, since Julhave fled to northern Uganda following the renewed violence in South Sudan.
Since the conflict went off in South Sudan, over 630,000 refugees have arrived in Uganda and thousands continue to arrive every week, bringing the total South Sudanese refugees and asylum-seekers to over 900,000.
Uganda now hosts more refugees than anywhere else in Africa by accepting more immigrants than the whole of Europe granted asylum to in 2016.
While those arriving are in relatively good health, many have stories of horrific violence in their place of origin or on their journey. The scale of the refugee influx has also pushed Uganda’s progressive refugee policies to the limits, overwhelming reception conditions and the government’s ability to respond.
“Despite the large-scale humanitarian mobilization, the emergency response is still far from being sufficient, and many people have been left with insufficient water, food and shelter,” says Jean-Luc Anglade, MSF head of mission in Uganda.
Poor conditions and supplies force refugees to leave Uganda
Many newly arrived refugees are forced to sleep under trees, and delays in food distributions and a lack of potable water have even prompted some refugees to return to South Sudan. In addition, despite over 85 per cent of the new arrivals being women and children, and despite widespread reports of sexual violence in South Sudan, there are very few organizations responding to their specific protection needs.
“As the flow of refugees shows no sign of abating, a sustained and long-term effort will be needed to assist these people over the next months, if not years,” says Anglade.
In addition to its operations in South Sudan, since July 2016, MSF has been responding to the humanitarian crisis in Uganda with medical, water and sanitation activities.
MSF is currently working in four refugee settlements in the north-west: Bidi Bidi, Imvepi, Palorinya and Rhino. Our teams are providing in and out patient medical care, maternity care, nutrition, community health surveillance, and water and sanitation. MSF also responded to an influx into Lamwo district, on the border with South Sudan after an attack in Pajok, a South Sudanese community in Eastern Equatoria. Since then, activities were handed over to other organizations.
Water distribution needs urgent improvement
Access to water is one of the biggest challenges in the refugee settlements and MSF has been scaling up operations in water support. In Palorinya, Uganda, MSF produces an average of two million liters per day from the River Nile, supporting over 100,000 people.
In April alone, MSF produced a staggering over 52 million liters of clean water in Palorinya.
“There is a never-ending cascade of challenges,” says Casey O’Connor, MSF Project Coordinator in Palorinya.
“We can treat millions liters of water a day but it all needs to be trucked to water tanks in refugee settlements that are 150-250 square kilometers. After heavy rains, many roads become impassable. This leaves tens of thousands of people without water for days,” says O’Connor.
“In the rainy season, if people can’t get clean water, they will resort to using dirty, disease-ridden standing water. This can turn the health status of a population on its head – from relatively healthy to disease outbreak in a matter of days,” he points out.
In addition to responding to the refugee influx, MSF runs regular programs in Uganda providing sexual reproductive health services for adolescents in Kasese, HIV/AIDS care for the fishing communities on lakes George and Edward, and viral load services in Arua regional hospital.
*For confidentiality the real name of Maria had been changed.