Uganda Humanitarian Situation Report

UNICEF Uganda /UN070271/Ose Uganda Humanitarian Situation Report Highlights On 19 October, 2017, the Uganda Ministry of Health officially declared Marburg Viral Disease (MVD) outbreak as a Public Health Emergency of International concern. By 31 October, three cases and three deaths were reported in Kween and Kapchorwa districts. The current outbreak remains localized. UNICEF supports the social mobilisation, WASH and logistics components of the MVD response. At the start of October, a total of 1,132,590 children and women were registered as refugee and asylum seekers in Uganda. The planning figures in the Uganda Integrated Refugee Response Plan (I-RRP 2018) raised to 1.8 million refugees by end of 2018, including expected new arrivals of 375,000 refugees expected in 2018. The I-RRP will cover all refugees hosted in Uganda from South Sudan, Burundi, DRC and others. UNICEF and partner Uganda Red Cross Society continue to support prevention activities in the two cholera-affected districts, Kasese and Nebbi through door to door social mobilization, surveillance and sensitization on hygiene and sanitation. 8,801 households (35,834 people) and 4,812 households (28,874 people) were reached so far in Kasese and Nebbi districts respectively. UNICEF has a 70 percent funding gap, therefore unable to meet the critical needs of the children affected by emergencies. UNICEF s Response with Partners WASH: Number of people accessing safe water for drinking, cooking and personal hygiene Education: Number of children and adolescents accessing formal or informal education Health: Number of children aged 6 months to 15 years vaccinated against measles Nutrition: Number of children aged 6 to 59 months receiving Vitamin A supplementation Child Protection: Unaccompanied and/or separated children receiving appropriate alternative care services HIV/AIDS: Number of children/adolescents requiring continuation of ART in humanitarian situation (*) Total results for all sectors are cumulative data from 01 January 2017 UNICEF Target Total results (*) 530,000 239,762 179,800 113,757 1,023,000 667,050 446,395 423,989 32,640 13,821 9,000 4,630 SITUATION IN NUMBERS 1-31 October 2017 1.5 million # of children in need of humanitarian assistance (UNICEF HAC 2017) 2.4 million Total # of people in need (UNICEF HAC 2017) 842,536 #of refugee children (OPM, RIMS) 1,381 million total # of refugees (OPM, RIMS) UNICEF Appeal 2017 US$ 52.87 million Funding Status 2017 Carry- Forward amount: $2.97M 2017 funding requirement: $52.87M Funding Gap: $36.87M Funds received current year: $13.03M Funds received to date Funding gap Carry forward * Funds available include funding received against the 2017 appeal as well as USD 2,968,190 carried forward from 2016

Situation Overview and Humanitarian Needs Refugees: Uganda hosts over 1,38 million refugees and asylum seekers as of October, 2017, of whom over 1 million refugees are from South Sudan, 236,000 from DRC and 39,000 from Burundi. The number of new arrivals from South Sudan decreased in October, possibly because of heavy rains in South Sudan making difficult to cross overflowing rivers. The main reason reported for flight of Congolese refugees is the Mai-Mai militias threatening Kinyabwisha tribal group in DRC, accused of Rwandese origins in October, average daily arrival rate of DRC refugees was 65. In Nakivale, a total of 241 (97 Female, 144 Male) Burundian arrivals were received at the Kabazana Reception Centre. UNICEF has been among key players in finalizing the Uganda Integrated Refugee Response Plan (I-RRP) for 2018, under the leadership of OPM and UNHCR. For the first time, the I-RRP will cover all refugees hosted in Uganda including refugees from South Sudan, Burundi, DRC and others. In 2017, Uganda was chosen as one of the first allocations for Education Cannot Wait (ECW) to scale up strategic, financial and political support and commitment to the education sector. The Estimated refugees in Need of Humanitarian Assistance (Estimates calculated based on initial figures from UNHCR and OPM, September 30, 2017) Start of humanitarian response: RRP (Jan-Dec 2017) Total Male Female Total Population in Need 1,381,207 662,980 718,228 Children (Under 18) 842,536 412,843 429,693 Children Under Five 151,656 74,311 77,345 efforts of the ECW initiative in Uganda will likely contribute to the prioritization of learning in the refugee response, to prevent having generations of refugees doomed to become marginalized and excluded from economic opportunities. Preparations have begun for a Uganda Refugee and Host Community Education Response Plan. A Task Team Co-Chaired by Ministry of Education and UNHCR with technical input from UNICEF is leading the multi-year strategy development process. A final draft of the strategy is expected to be ready for approval in December 2017 and is envisaged to facilitate critically needed support to address gaps in learning within the refugees and host communities. Food security in Karamoja region: Food security has significantly improved since July in most parts of Uganda as the second major rainfall season commenced including Karamoja region. The situation is anticipated to continue improving since harvests are underway and as the rainfall forecast currently indicates favourable conditions in the region. The Uganda National Meteorological Authority (UNMA) forecast for October to November is positive, indicating an increased likelihood of above average rainfall in most parts of Uganda with near normal (average) rainfall in South Western Uganda and near normal to below normal rainfall conditions over Karamoja region. Cumulatively, severe acute malnutrition (SAM) and Moderate Acute Malnutrition (MAM) trends of admissions in the seven districts of Karamoja region from December 2016 to July 2017 indicate a total 8,633 new cases of severe acute malnutrition were admitted into a total of 114 inpatient treatment centres (ITC)/outpatient treatment centres (OTC) and 86,058 cases were admitted into the supplementary feeding program (164 SFP sites). The graph shows the monthly trend of admissions into OTC/ITC as well as supplementary feeding. Disease Outbreaks and Epidemics: Cholera outbreaks were confirmed in two districts of Kasese and Nebbi on 27 September and 4 October respectively. Total cases reported are 178 (164 Kasese and 14 Nebbi). 30 percent of the reported cases are children under 5 years. The cases are decreasing as of 24 October, 2017. Key community interventions like social mobilization (interpersonal communication) and community case search, distribution of water purification tablets and enforcement of bye-laws have contributed to the reduction of the daily case load. Marburg Virus Disease (MVD): On October 17, 2017, the Public Health Emergency Operations Center of the Ministry of Health of Uganda was notified by the Uganda Virus Research Institute of a confirmed case of Viral Hemorrhagic Fever. Since October 17, 2017, the National Task Force (NTF) has been activated and meets daily. WHO and UNICEF supported NTF to develop a National Response Plan and Budget based on rapid containment scenario. As of October 31, 2017, the outbreak remains localized and the Public Health Emergency Operations Center of the Ministry of Health (MoH) reported three cumulative cases of MVD, including two laboratory-confirmed cases and three deaths. Response is focusing on three high risk 1 and three moderate risk 2 districts in Eastern Uganda. UNICEF support focuses on communication and social mobilisation, WASH and logistics. The outbreak response has been hampered by community resistance to share 1 Kween, Kapchorwa and Bukwo 2 Napak, Nakapiripirit, Bulambuli

information on contacts and unwillingness of symptomatic contacts to be isolated. This was prompted by rapidly spreading rumours and misinformation about the disease in the affected communities and a low trust in Government health workers. In response to the risks, the Uganda National Task Force on Outbreaks called for prioritization of a strong communication and social mobilization activities in the affected districts, as well as contact tracing and follow-up. Proximity of the outbreak to the Kenyan border coupled with potential increase in population movements due to post-election violence continue to pose risks for cross-border transmission. WHO and IOM have been supporting the Governments of Uganda and Kenya with the sharing of information and cross-border dialogue. Uganda continues to experience sporadic outbreaks of measles across the country as of 30 October 2017, six districts have reported cases. UNICEF is providing technical and financial support to strengthen routine immunization using the Reaching Every District /Reaching Every Community/child approach through social mobilization and increasing outreaches to reach areas with inequities. The country has applied to Measles Rubella Initiative (MRI) to introduce measles rubella containing vaccine into routine. District Number of Measles cases Kampala 310 Wakiso 313 Jinja 3 Lyantonde 36 Lwengo 17 Kayunga 48 Humanitarian Leadership and Coordination The Department of Refugees in the OPM and UNHCR are the lead coordinators for the refugee response in the country. The OPM s Department of Disaster Preparedness coordinates and leads the country s humanitarian response efforts, primarily through a National Disaster Risk Reduction Platform. The National Platform and District Disaster Management Committees coordinate response to disasters caused by natural hazards and internal displacement caused by floods or conflict, while humanitarian response to disease outbreaks is coordinated through a multi-stakeholder National Task Force co-chaired by the Ministry of Health and WHO. District led epidemic disease control task forces support local level containment of disease outbreaks. UNICEF provides technical support within these humanitarian coordination mechanisms, within the sectors of WASH, Child Protection, Health, Nutrition and Education. Humanitarian Strategy UNICEF s humanitarian support to refugees in Uganda continues to hinge on the long term ReHoPE strategy aligned to the government s Settlement Transformation Agenda (STA). The ReHoPE strategy and other interventions in turn contribute to the Comprehensive Refugee Response framework (CRRF) pilot in Uganda. Through the country programme, UNICEF supports the most vulnerable districts, including all refugee hosting districts, to cater for the expansion of routine social services in health, nutrition, WASH, education and child protection to reach both refugees and host communities. UNICEF employs systems strengthening approach, building the adaptive and response capacity of districts affected by natural hazards and continues to support the government s emergency preparedness and response to mitigate the effects of disease outbreaks. UNICEF utilizes Communication for Development (C4D) as a cross-cutting approach to achieving programme results in all sectors. Summary Analysis of Programme Response Health and Nutrition Refugee hosting areas: UNICEF in partnership with District Local Government supported the implementation and monitoring of the October 2017 integrated child health days in all refugee hosting districts. Services (including immunisation, nutrition assessment, and provision of Vitamin A and deworming) were provided to nationals and refugees to supplement routine services and ensure that all children are reached by bringing services closer to the beneficiaries. Results of the exercise will be communicated next month. In October 2017, rollout of Vitamin Mineral Powder intervention among children 6-23 months in Yumbe district started with training of 78 health workers from health facilities in Yumbe host community. Karamoja region: UNICEF with NGO partner Doctors with Africa (CUAMM) has maintained continued response to the negative trend in nutrition with supplies as well as critical support to strengthen the adaptation of district and health facility services to manage increased malnutrition caseloads. UNICEF is currently collaborating with WFP to provide during the lean season (up to September) protective rations for families with children in outpatient treatment centres. A multi sector (nutrition, WASH, ECD and child protection) intervention in Karamoja region has most recently been scaled up. A Food Security and Nutrition Assessment has been conducted across the seven districts of Karamoja by UNICEF with WFP and the report is yet to be shared. The unfunded priorities for supporting response to affected children in Karamoja region include limited access to high impact nutrition interventions; improvement of multi sectoral coordination to respond to increase/ change in needs; and; need to strengthen integration of nutrition into district emergency contingency planning to respond to malnutrition spikes, preparedness, timely disaster risk reduction, and mitigate potential impact.

Cholera response: Reduction in Cholera cases in the outbreak in Nebbi and Kasese Districts is attributed to good coverage in the response, including the provision of supplies and technical support facilitated by UNICEF, WHO, MOH and Médecins Sans Frontières (MSF). UNICEF provided additional support for WASH, social mobilization, surveillance and case management that included chlorine powder, Aqua tabs for treatment of water, soap and a diarrhoea kit. In Kasese, UNICEF provided and distributed 64,292 Aqua tabs to the affected sub counties. This has provided an equivalent of 642,920 liters of safe water for 8,492 households. Marburg Virus Disease: UNICEF Uganda has been supporting the Ministry of Health since the onset of the outbreak. UNICEF staff participate in the daily NTF meetings and have supported the development of the Marburg Hemorrhagic Fever Outbreak Response Plan and Budget through the NTF sub-committees. At the inter-agency level, UNICEF coordinates support to the outbreak with the World Health Organization, Medecins Sans Frontieres (MSF) and the Uganda Red Cross Society. UNICEF team has been deployed to affected districts (Kween and Kapchorwa) to support coordination and response activities by the District Task Forces (DTFs). Main focus of UNICEF support has been: communication and social mobilisation; water, sanitation and hygiene; logistics and coordination. UNICEF supported MoH in the adaptation, translation and production of key messages and communication materials for advocacy and social mobilization activities. Communication materials were provided to districts and financial support disbursed to support social mobilization activities on the ground. Innovations, such as e-hmis/mtrac and U-report are being used to send key messages to health workers and young people to increase awareness on the outbreak, key protective and case-seeking behavior, identification and reporting on contacts. In Water, Sanitation and Hygiene, UNICEF completed a health facility assessment and mobilized the District teams to implement sanitation and hygiene related actions to ensure running water in the isolation and treatment facilities. In addition, UNICEF has provided chlorine powder, cartons of soap, water tanks, aqua tabs and hand washing equipment to the two high risk districts for use at health facilities and community levels. UNICEF supported preparedness activities within neighboring districts at risk including Bukwo, Amudat, Nakapiripiti and Bulambuli. Education Early Childhood Development (ECD): UNICEF and Lodonga primary teachers college conducted a training on local material production to promote play and stimulation as part of the ongoing ECD kit evaluation. 60 participants (48 caregivers and 12 partners and college staff) attended. In this reporting period, a total of 464 homes were visited to provide home based support to parents on care for child development as well as follow up on the actions agreed during parenting sessions that were previously conducted at ECD centres in Yumbe and Adjumani districts. The results show general improvement in sanitation and hygiene practices. Adolescent Development: UNICEF and partner Danish Refugee Council (DRC) organized and participated in music, dance and drama programme as part of the life skills development amongst adolescents. This was conducted in Eden, Ofua II and Katiku II and Ariaze villages of Rhino Camp in Arua district for the adolescent girls and boys. DRC and CARE International facilitated a life skills training in Tika for 48 adolescents (28 school going and 20 out of school). Career guidance sessions were conducted for 60 adolescents (12 male and 48 female) in Siripi and Ofua V villages for informed selection of appropriate vocational skills training. Accelerated Learning Programme: All the 10 centres established by UNICEF and Norwegian Refugee Council are now operational, 1,078 adolescents (461 girls and 617boys) have enrolled. 60 teachers from the mainstream and host community primary schools were trained to enhance their capacity to deliver quality education for children. Scholastic materials were provided to the 1,078 adolescents each receiving seven note books for their class work and assorted text books provided for the teachers as well as lesson plan books to enhance their class preparation. WASH During this reporting period, UNICEF and Oxfam completed construction of a high production well yielding 40 cubic litres per hour in Zone 2, Bidibidi settlement expected to benefit 13,500 people. Efforts to eliminate water trucking continue in the settlements by WASH partners. UNICEF and partner Samaritan Purse (SP) is implementing construction of high production wells in Zone 2 Point I and Zone 3 Point A, all in Imvepi settlement in Arua planned to serve an estimated 11,088 refugees with about 4,157 households. Similarly, UNICEF partner Water Mission Uganda is motorizing two systems in Imvepi 1 and 2. These systems will be operational by the end of November and expected to serve 25,000 children and women. With the existing systems constructed by UNICEF in West Nile and Kiryandongo, about 239,762 children and women are served with safe and reliable clean water. UNICEF and partners Oxfam, DRC and Samaritan Purse are supporting sanitation and hygiene through household latrine construction and hygiene promotion in Yumbe Zone 1,2, and 4. In October, 185 latrines and 177 Persons with Special Needs (PSN) latrines were completed and installed with hand washing facilities. Primary schools and health facilities still lack adequate access to sanitation facilities and across the settlements in Bidibidi in Yumbe and Imvepi in Arua districts. Due to

limited funding, UNICEF is unable to address this sanitation challenge which requires urgent attention or else these institutions will become potential source of cholera outbreak which in turn may affect the overall performance in schools. During this reporting period, 14,149 persons (4,042 HH) were reached by the hygiene promotion team through malaria prevention campaign, safe excreta disposal, hand washing practices and safe water chain. Child Protection Due to the continued influx to Arua district (all new arrivals are settled in Imvepi settlement, Arua currently), at least 258 un accompanied and separated children (UASC) were registered in October and are receiving case management support by UNICEF and partner Save the Children International (SCI). At least 377 children with concerns were supported using a multisectoral approach to service provision through referrals to appropriate partners. Reasons for referral include poor health, lack of education, shelter and food/ration cards. The partners continue to strengthen and work with the community based child protection committees to extend services to the children. Peer to peer activities with adolescents continued. 833 (428 boys, 405 girls) were engaged in peace building talks, debates, on emerging protection issues in the surrounding environments and other child rights activities in 12 locations within the different settlements. In Kiryandongo and Arua districts, meetings with 543 (254 males, 289 females) foster parents were conducted on parenting skills focusing on their key roles on ensuring the well-being of the children at home, addressing key child protection challenges (including child abuse, child neglect, exploitation and corporal punishments among others) affecting the children and family based solutions to address simple issues. In addition, 411 children in foster care participated in meetings organised on child rights and responsibilities and ensuring stable relationships with their caregivers. During this reporting period, 95 UASC were registered at the transit centre in Kisoro. Seven children were reunited with parents while still at the transit centre in Kisoro, while six were reunited on spot with caregivers when they reached Rwamwanja settlement in Kamwenge district. A total of 217 children are currently receiving alternative or foster care in Kamwenge and Hoima district refugee settlements. In October, around 4,385 3 children received psychosocial support and benefited from recreational activities through child friendly spaces (CFS) in the districts of Kisoro, Hoima and Kamwenge as part of the humanitarian support for Congolese refugees. HIV & AIDS UNICEF and Infectious Disease Institute, District Local Governments of six refugee hosting districts in West Nile continue to carry out social mobilisation through educative messages to the host and refugee communities on behavioural change and communication (SBCC) and link to services as appropriate. Over 80 percent of the population have been reached with these messages. UNICEF continues to support provision of HIV care and treatment services including elimination of HIV transmission from mother to baby and diagnosis and treatment of Paediatric Tuberculosis (TB) in West Nile region. In Kyaka II settlement, capacity building on identification and management of paediatric TB, contact tracing, cohort analysis and data collection for health workers and village health teams was carried out. Supply and Logistics As part of the response to the Marburg outbreak in Kween and Kapchorwa districts, UNICEF has provided direct support by supplying a first wave of WASH commodities (chlorine, water tanks, hand washing facilities) for a period of three months. UNICEF is working with Ministry of Health, Médecins Sans Frontières (MSF) and WHO to assess supply needs for response based on the agreed scenario for the Marburg outbreak. In response to the Cholera outbreak in Kasese and Nebbi District, UNICEF and partner Uganda Red Cross Society delivered and distributed 30 boxes of Soap, 150 boxes of water purification tablets, 10 hand washing facilities, 2500 pieces of IEC materials and 1 Diarrhoeal Disease Set/cholera kit. UNICEF continues to support nutrition programmes in refugee hosting districts with supplies required for treatment of Severe Acute Malnutrition. A distribution exercise was conducted by UNICEF in quarter 3, including 107 metric tonnes of Ready to Use Therapeutic Feeds (RUTF), as well as therapeutic milk and Resomal. 3 488 children in Kisoro, 1178 in Hoima, 2719 in Kamwenge district.

Communications for Development (C4D), Community Engagement and Accountability UNICEF with the Ministry of Health (MoH) National Task Force sub-committee on social mobilization has adapted, translated and distributed IEC materials to districts affected and/at risk of Marburg outbreak (Kween, Kapchorwa, Bulambuli and Bukwo) in English, Kupsabiny & Lumasaba. UNICEF is working with Inter- Religious Council of Uganda to disseminate key messages on Marburg through Religious Leaders in the affected districts. UNICEF supported the MoH to use electronic Health Monitoring Information System (ehmis)/mtrac for risk communication messaging to health workers three times a week (from 23 October, 2017), within at risk districts. In addition, from 23 October, 2017, UNICEF sent out key messages on Marburg (awareness, symptoms, spread, prevention, cultural practices/beliefs, reporting, feedback) via to 1,675 U-Reporters (1,018 in Kapchorwa and 666 in Kween). Marburg prevention and control radio spots, DJ mentions and radio talk shows are ongoing. Risk communication staff (6) from the MoH (Health Promotion and Education unit) have been deployed to support the social mobilisation interventions in the districts of Kween and Kapchorwa alongside UNICEF s C4D Specialist and WHO s Risk Communication Specialist. In addition, UNICEF s communication section is providing support to MoH Public Relations Department to develop accurate and timely press releases on the Marburg outbreak. A social media plan for Marburg has also been developed by the UNICEF Communication team and is being implemented. Key Cholera awareness messages were sent to 6,388 U-reporters in Kasese district to share information on Cholera outbreak prevention and control. UNICEF is supporting Kapchorwa and Kween districts to implement the following activities: 1. Orient members of District Task Force and opinion leaders (religious leaders, cultural leaders, teachers, traditional healers, etc.) with basic information on Marburg to enable them to participate in social mobilisation/ community sensitization. 2. Social mobilisation using the film van (community film/talk shows)/pickups mounted with public address system and radio talk shows by the district leadership. 3. District leadership and health workers to conduct community and school dialogue. 4. Dissemination of IEC materials. 5. Media orientation on Marburg outbreak by the District Health Teams (DHTs) and MoH. 6. Sensitisation of VHTs on Marburg to ensure dissemination of accurate public information/ health education. 7. Follow up and support supervision of the subcounty and parish mobilisers by the DHTs. Funding UNICEF is grateful to all donors for their contributions to Uganda, including the Central Emergency Response Fund (CERF), the Department for International Development (DFID), the United States Agency for International Development (USAID), European Commission (ECHO), the Government of Japan and Belgian Committee for UNICEF. Their support to preparedness and response has, in addition to UNICEF core resources, supported timely humanitarian action. UNICEF s 2017 Humanitarian Action for Children (HAC) appeal for Uganda is US$ 52.87 million and to date US $15.99 million is available, leaving a funding gap of $36.87 million or 69.7 percent. With the most recent Marburg Virus disease outbreak and continued influx of refugees from South Sudan, UNICEF will not be able to meet the needs of children and women in humanitarian situation unless additional funding is made available. Appeal Sector Funding Requirements (Uganda HAC 2017) Requirements (*) (USD) Funds available Funds Received Current Year (**) Funding gap Carry-Over USD % Nutrition 6,700,000 2,544,804 551,015 3,604,181 53.8 Health 10,385,000 1,974,241 534,584 7,876,175 75.8 Water, sanitation & hygiene 12,210,000 4,523,534 966,262 6,720,205 55.0 Child Protection 13,061,000 1,094,915 756,052 11,210,033 85.8 Education 9,113,000 2,893,619 115,001 6,104,380 67.0 HIV and AIDS 1,401,000 0 45,276 1,355,724 96.8 Total 52,870,000 13,031,113 2,968,190 36,870,697 69.7 (*) The requirement for cross sectoral support has been included in sub-costs for Nutrition, Health, WASH, Child Protection, Education and HIV/AIDS. (**) Funds available exclude USD 3,238,342 from DFID which are rephrased for 2018 implementation.

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Annex A SUMMARY OF PROGRAMME RESULTS UNICEF Uganda Humanitarian Targets 2017 NUTRITION 2017 targets Results as of October, 2017 Number of children under 5 years admitted for SAM treatment 31,000 31,327 Change since last report No change Number of children aged 6 to 59 months receiving vitamin A 446,395 423,989 supplementation 40,375 Number of pregnant women receiving folic acid 345,000 286,120 176,217 EDUCATION Number of children and adolescents accessing formal or informal education HEALTH Number of children aged 6 months to 15 years vaccinated against measles WASH 179,800 113,757 1,023,000 667,050 752 376,267 Number of people accessing safe water for drinking, cooking and 530,000 239,762 personal hygiene 39,075 Number of people with access to appropriate sanitation facilities 318,000 148,980 12,180 HIV/AIDS Number of children/adolescents requiring continuation of ART in humanitarian situation CHILD PROTECTION Unaccompanied and/or separated children receiving appropriate alternative care services 9,000 4,630 32,640 13,821 384 16