UGANDA Last update: 27 July 2004

Transcription

1 UGANDA Last update: 27 July 2004 Present context Since July 2002, the humanitarian situation in Uganda has continued to deteriorate. The 18-year-old conflict in Northern Uganda has escalated and caused further displacement. The previously affected districts of Gulu, Kitgum, Pader and Katakwi have now been joined by an additional four: Apac, Lira, Kaberamaido, and Soroti. Drought exacerbates the situation, rendering people less able to meet their basic needs. Ongoing conflict in the North has affected approximately million people, of whom 1.7 million 2 are internally displaced within Uganda (see annex). An additional 210,000 3 refugees were estimated to reside in Uganda, mainly from Sudan. The situation appears to be worsening; in the past two years, the number of internally displaced persons () has increased three-fold. Conditions in the IDP settlements, which are located mostly in the districts of Gulu and Kitgum, are the ingredients for a humanitarian crisis on par with that of the Darfur in neighbouring Sudan. Food insecurity is widespread. In addition, populations lack access to basic services such as water and sanitation, and health care. The result is spiralling mortality in some camps. They also face extremely high levels of insecurity, thus are unable to create the stability necessary for sustainable livelihoods that could enable them to better meet their needs. Crisis-affected populations in the North are also subject to or live under the constant threat of violence (particularly rape and violence)..an estimated 80 per cent of are women and children 4. Homeless and trying to survive, many are subjected to sexual violence and other forms of exploitation. Children are particularly vulnerable; the LRA has abducted 12,000 children since June An additional 44,000 children travel to towns from outlying areas at night to escape abduction, rape, and/or attack by the LRA. 1 Integrated Regional Information Network, UN, 15 June 2004) 2 Source: WFP, 9 July Source: UNHCR, Global Report Source: UNICEF, 25 May 2004.

2 Main Public Health Issues and Concerns Health status The 1995 Burden of Disease Study in Uganda (which used mortality data only) found that 75% of life years lost to premature death are due to ten preventable diseases. The following accounted for 60% of the burden: perinatal and maternal related conditions (20.4%), malaria (15.4%), acute lower respiratory infections (10.5%), AIDS (9.1%) and diarrhoea (8.4%). There is significant regional variation. HIV/AIDS, and TB rates are major concerns. HIV/AIDS is the leading specific cause of death in adults followed by TB and malaria. The majority of displaced persons live in open places without shelter and blankets, with increased vulnerability and exposure to risk factors for Respiratory Tract Infection and malaria, especially during the rainy seasons. During the rainy season, pregnant women have limited access to qualified assistance for delivery. Of the total displaced population approximately 12.4% (124,000) are children under five, about 69% (686,000) persons comprise the sexually active group and an estimated 2.4% (24,000) are pregnant women. 5 The population affected has continued to suffer with hopes for a negotiated peaceful resolution repeatedly dashed. Water provisions are not adequate and per capita daily usage of water is far less than the minimum recommended 20 litres. In most areas water source per population ratio is over 1,500 persons per source of water compared with the standard of 1 source per 200 persons. The lack of availability of potable water causes increase rates of water born diseases like diarrhea, dysentery, cholera hepatitis and typhoid. The living conditions in most of these camps are conducive to propagation of HIV infection. Gulu s Lacor Hospital HIV Sentinel surveillance site indicates the highest prevalence rate of 11.3 % among pregnant women compared with the national average prevalence of about 5.4%. Post exposure protection, especially for rape cases, and for treatment of the sick and prevention of vertical transmission, is not done. Vaccine preventable diseases represent a problem in the affected areas. Emergency measles campaigns have been carried out in 2003, in addition to the national measles campaign carried out in all districts. These campaigns have prevented major measles outbreaks, but follow-up emergency campaigns need to be carried out in insecure areas, especially since routine immunization rates are very low. Malnutrition is also on the rise, because rebels loot and burn food of the affected population who lack secure and adequate land to grow their own food. Recent assessments in the IDP camps of Gulu and Kitgum reveal under-five global malnutrition rate of 31.6% in Anaka camp (Gulu) and 12.5 % in Agoro camp (Kitgum). There are currently eleven Therapeutic Feeding Centres (TFCs) in northern Uganda and these have, on average, doubled their intake during the last 12 months. There is a clear need to increase the number of TFCs, especially in the IDP camps. At the moment, all TFCs are in hospitals but additional TFCs will have to be established in health centres to allow out-patient treatment of severely malnourished children, while ensuring that mothers who cannot leave their homes can still access TFCs. With overcrowding turning out to be a growing problem, there is also an urgent need to take pressure off existing TFCs. Health system 5 Calculations made from standards population structure.

3 Only 49 per cent of households have access to health care, due to poor infrastructure, especially in the rural areas where the majority of the population lives. The Government has developed a Health Sector Strategic Plan (HSSP) that addresses the issues of access by utilizing the existing political structure of the country. At the lower administrative level it is expected that there will be minimal facilities to directly address the immediate health needs of the village dwellers. The human resource base for the health sector is grossly inadequate. Therefore, in the first few years of the implementation of HSSP, capacity-building of the human resource base is one important aspect that the Governmentwants to address. Decentralization in Uganda is part of the national policy, but is still in its early stages. Therefore, there are issues like ownership of the programmes, planning cycles and accountability which still need to be improved upon. The health care delivery system in the areas of Gulu, Kitgum, Pader, Katakwi, Apac, Lira, Kaberamaido, and Soroti has continued to break down with the closure of many peripheral health units and the migration of health workers to safer areas. Access to the affected districts is a problem and the health workers in the affected district have inadequate skills in emergency health care provision. In addition, these health services are dependant upon humanitarian foreign assistance (drugs and other supplies). Although data from the health information system in the affected districts is not accurate, data show that the the highest incidence of diseases is caused by poor sanitation. For example Gulu district with a reporting rate of 46% in the months of February 2003, recorded 1,389 cases of dysentery compared with Ssembabule and Ntungamo districts with 100% reporting rates recorded 17 and 25 cases of dysentery, respectively during the same time. MOH Staffing levels are insufficient and the necessary finances to enable them to conduct mobile clinics to access the affected populations are not available. Despite the protracted crisis, health planning has failed to shift to an emergency mode, in order to address the most urgent needs. A number of stakeholders, governments, NGOs and donors, have continued to support the MoH. However, the response has been guided by the hope that the situation was to last for a short time. There is, therefore, a need to adapt the response to factor in the chronic nature if the situation. Some children of the abducted children have been lucky to be rescued. However, psychosocial support to address trauma especially for these former abducted children and their parents is conspicuously inadequate. Main Sector Priorities In the UN Consolidated Appeals Process (CAP) for 2004, health agencies appealed for control and prevention of common diseases, especially epidemic potential diseases (WHO), and for a variety of nutritional and public health interventions. The latter included immunisation, malaria control and provision of essential drugs. The health sectors objectives outlined in the CAP include: To support and strengthen the provision of drugs and supplies for health care including mosquito nets; To support and strengthen efforts to reduce malnutrition, especially among children; To support/strengthen efforts for building capacity for health care delivery in the affected areas to support establishment of the health units in camps; To conduct social mobilisation of communities to address health problems;

4 To periodically conduct situation assessments; To support the efforts to control the spread of HIV infection and care of HIV patients; To support the provision of RH services; To support budget provisions for logistics and incentives for health workers in affected areas; To support the improvement of water and sanitation provision. Summary key gaps and challenges: Ongoing conflict and insecurity; Government under-estimation of the conflict; Limited access to health services mainly in the north and shrinking local health services; Numerous street children in the conflict-affected areas. U Other priority humanitarian needs The main immediate challenges to the aid community are to 1) Get regular humanitarian access to the 104 IDP settlements and to increase their access to preventive and curative Primary Health Care services including referral to regional and national hospitals. 2) As the majority of death in complex emergencies results from avoidable communicable diseases, the early detection and response to disease outbreaks and management of common diseases and malnutrition is one of the key priorities. Main Sector Actors Besides the national and district MOH, the UN agencies specially UNICEF and UNHCR and UNFPA, NGOs are providing various range of health services on some of the 104 camps in the north. These include Save the Children;Coopi, AVSI, GUSCO, Rachele Rehabilitation Centre, Kitcwa, Concerned Parents Association, Rufou, Noah s Ark, AMREF, MSF, TPO, Norwegian Refugee Council (NRC), DED, LWF, AAH, AVSI, JRS, MSF-France, Maltheser, IRC, Gulu Support the Children Organisation (GUSCO), World Vision, CRS, ACF-USA, CPA, Uganda Red Cross Society (URCS), IMC, GOAL (U), Christian Children s Fund (CCF), Action Aid Uganda (AAU) Disclaimer The crisis country profiles are not a formal publication of WHO and do not necessarily represent the decisions or the stated policy of the Organization. The presentation of maps contained herein does not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or areas or its authorities, or concerning the delineation of its frontiers or boundaries. Contact Details Ministry of Health J. Muhwezi, MoH The Permanent Secretary of MOH Ministry of Health

5 PO Box 8 Entebbe, Uganda Fax: Tel: ; ; (Secretary) WHO Representative Dr Oladapo Walker WHO Representative in Uganda Tel: walkero@who.imul.com UN Resident Coordinator Mr Daouda Toure UN Resident Coordinator and UNDP Resident Representative, Kampala Tel: +256 (41) / Fax: +256 (782) / daouda.toure@undp.org Key Documents WHO Health System Profile Database (AFRO) UN-CAP Uganda 2004: Country Cooperation Strategy Uganda 2001:

6 Annexes Annex 1: Health Profile 6 General Indicators Population 26,700,000 Refugees 200,000 Internally Displaced Persons 1,700,000 Healthy life expectancy at birth m/f (years) 41.7/ 43.7 GNI (Gross National Income) per capita (US $, 2002) Infant Mortality rate (deaths/1000 live births) 89 Under-five mortality rate (deaths/1000 live births) 147 Total adult literacy m/f % (2000) 78/57 Population using improved drinking water sources 52% Population using adequate sanitation facilities 79% UNDP's Human Development Index ranking 8 147/175 Health Systems Profile Total expenditure on health as % of GDP 5.9 Total per capita health expenditure (US $) 14 Nurses rate per 100,000 population 18.7 Midwives rate per 100,000 population 13.6 Hospital Beds per 1000 population 0.9 Tuberculosis Prevalence per 100, Mortality rate per 100, HIV/AIDS 9 Adult prevalence of HIV/AIDS (15-49 years) (2003) % Estimated number of adults living with HIV/AIDS (2003) 350, ,000 Reported number of people receiving antiretroviral therapy (15-20, years) (June 2004) Orphans due to AIDS (2001) 884,000 Malaria Mortality rate per 100, Immunization 10 BCG 96% DPT3 72% Measles 77% Polio 73% Pregnant women receiving tetanus vaccine 50% Women's Health Total fertility rate 7.1 % of antenatal care coverage 87 % of skilled attendant at delivery 37.8 Maternal mortality ratio WHO/CDS baseline statistics unless otherwise indicated 7 The World Bank Annual Report

7 Annex 2: Internally Displaced by District - Map

8 Annex 3: Trends in Numbers of Affected Populations Affected Populations District Beneficiary Type Mar/Apr 04 Trend Adjumani Refugees (Su) 61,901 unchanged Arua Refugees 19,092 unchanged - Imvepi (Su) - Rhino Camp (Su, DRC, Br) - Madi Okollo 26,173 6,928 Yumbe - Ikafe 7,874 unchanged Gulu 438,639 up Hoima Refugees (DRC, Su, Ky, Br) 17,226 unchanged - Kyangwali Kabarole Refugees - Kyaka II (DRC) 6,066 unchanged Katakwi Soroti Kaberamaido Kitgum Pader Lira rural camps Lira municipality Mbarara Masindi Moroto, Kotido Nakapiripirit Moyo Refugees - Oruchinga (Rw) - Nakivale (Rw, DRC, others) Refugees - Kiryandongo (Su) 144,945 42,220 97, , , ,139 81,857 4,258 15,304 up down unchanged up unchanged up down unchanged unchanged 14,184 unchanged Drought Affected - - Refugees (Su) - Palorinya 31,520 unchanged Urban areas Refugees (mix) 134 unchanged Total Refugees 210,660 unchanged Total 1,563,964 down Total Drought Affected - - Total 1,774,624 down Source: (Humanitarian Update for Uganda, May 2004 Volume VI, Issue V)

9 Annex 4: HIV/AIDS5