Since August 2022 and the closure of the transit camp in Kisoro, 30,000 persons from Democratic Republic of Congo (DRC) have arrived in Nakivale settlement in Uganda, fleeing fighting linked to the resurgence of the M23 armed group in the province of North Kivu. Already home to over 175,000 people of several nationalities, this refugee settlement has received a new influx of refugees. This influx has not been met by an adequate increase in aid, leaving people in a worrying humanitarian and medical situation.
People from the DRC wishing to find refuge in Uganda generally pass through Kisoro, Matanda and the Nyakabande transit centers in the Kanungu district in western Uganda. They are then resettled in the Nakivale settlement, the world's eighth-largest refugee camp, created in 1958. Rubondo, one of its three administrative zones, serves as the settlement for newly arrived refugees. Originally designed for 40,000 people, it now accommodates 75,000. This is also where Médecins Sans Frontières has been providing medical assistance since the beginning of 2023.
"Despite the arrival of thousands of refugees over the last year, no extra sufficient resources or infrastructure have been implemented by international or national organizations or by the Ugandan authorities to accommodate them properly, whether in terms of shelter, food, or access to water and sanitation. People are provided with too little help in terms of quantity and quality to start living here in good conditions", explains Denis K. Mbae, MSF project coordinator.
In some villages within the Rubondo area, the current water supply per person stands at 5 liters per person per day, as opposed to the 20 liters as per minimum standards in a humanitarian response (Sphere standards). With insufficient access to clean water, people are now resorting to water from the surrounding swamps and lake, consequently heightening the risk of diseases. In addition, food rations are not sufficient: in the South West, a refugee with a 40% food ration currently receives only four kilos of corn, two kilos of beans, and half a liter of oil per month, while wood and fuel needed for cooking are also in shortage. As for shelters, they are being built by the newly arrived refugees themselves, with only a few wooden poles and plastic sheeting supplied to each household on arrival.
"Many refugees tell us that they can only eat one meal a day. The poor living conditions in the settlement are compounding to the development of health problems. For example, mosquito nets cannot be set up in these precarious shelters, impacting the number of people infected by malaria" explains Denis K. Mbae.
On site, MSF teams are providing assistance with access to primary healthcare via five mobile clinics set up as close as possible to the refugees. From January to June, 22,400 consultations were carried out, particularly during the seasonal malaria peak. Among the patients who underwent malaria tests, 40% tested positive. Only one other medical organization is present in the settlement, and there is a dire need for malaria prevention and treatment, as well as care for people with non-communicable diseases such as chronic illnesses (diabetes, hypertension...). The needs of the population in terms of mental health and sexual and reproductive health are also important, particularly in the care of victims of sexual violence, but also in terms of family planning and prenatal care. The situation is exacerbated by major shortages of medicines, affecting both the health structures in the settlement and the United Nations High Commissioner for Refugees (UNHCR), which manages the settlement in conjunction with the Ugandan Office of the Prime Minister (OPM).
“Despite people's considerable immediate need for food, shelter and water in correct quantities, United Nations agencies, their partners, donors and the Ugandan authorities are disengaging from emergency humanitarian aid, in favor of the self-reliance model. The aim is to make people self-sufficient rather than aid dependent. While this is a laudable objective, it fails to consider the fact that, in order to become self-reliant in the long term, refugees arriving must first receive emergency aid for a period of time which enables them to meet their basic needs before they can make a fresh start. However, this basic emergency aid is not in place today," explains Augustin Westphal, MSF's head of mission in Uganda.
Indeed, due to lack of funds, access to food in correct quantities remains a major problem for refugees, and the situation is set to worsen with WFP's (World Food Programme) introduction of the General Food Assistance prioritization in July, which will lead to food ration cuts even for the most vulnerable. The healthcare system for refugees has also deteriorated over the last year with drastic reduction of funding and drug shortage, even in the face of an increasing refugee population. Water remains a challenge in terms of quality and quantity. Furthermore, it is estimated that people require between six months and one to secure the necessary resources for constructing a brick shelter, replacing the initial structure made of wood and tarpaulin upon arrival.
"It is absolutely necessary to maintain emergency humanitarian aid until people are able to move towards the self-reliance system advocated by the government and international organizations", concludes Denis K Mbae.