Uganda responds to refugee emergency with open doors

MOYO, UGANDA – A crop of newly arrived refugees idle at Palorinya settlement’s reception center, arranged in parallel lines. They have just escaped brutal ethnic violence in South Sudan. They now begin a new journey: making lives for themselves in Uganda’s crowded settlements.

Since December 2013, internal conflict in South Sudan, the world’s newest country, has driven almost 2 million people from their homes, according to the United Nations High Commission for Refugees (UNHCR).

According to the UNHCR, a refugee is someone who has been forced to flee his or her country because of persecution, war, or violence.  A refugee has a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group.

Among them is Ojok Kuek, who anxiously awaits registration. Kuek traveled 14 days from Wau, South Sudan just to reach the border with Uganda. From there he was bused to Palorinya

“People are killing themselves,” Kuek said. “I came here for survival.”

“There, my life is at risk day and night.”

Kuek migrated alone. He does not believe the conflict will end in South Sudan.

“If there is security here, I will stay,” Kuek said. He hopes to study in Uganda to become a doctor. His family remains in Wau.

The reception center at Palorinya is busy as new South Sudanese arrivals pour in. More than 10 in this particular group were unaccompanied minors. (Victor Grössling | The Media School)

Uganda’s “open door” immigration policy means people are free to cross in and out of the nation’s border without legal repercussion, according to Rocco Nuri, The communications officer for the UNHCR office in Kampala. The UNHCR estimates that approximately 1,500 new refugees enter Uganda every day.

Settlements cover approximately 350 square miles of land set aside by the Ugandan government, according to the UNHCR. As of June 2017, UNHCR put the total population of refugees in the country at 1,277 million.

Bidi Bidi in Yumbe is now the largest refugee settlement in the world, hosting over 272,000 migrants, mostly from South Sudan.

The majority of the refugees are women and children. In Bidi Bidi alone, 86 percent of new arrivals are women and children, according to Real Medicine Foundation, the UNHCR’s primary health care partner.

Cecilia Tabu, South Sudanese refugee and mother of four, spends time with her children on her plot of land in Bidi Bidi settlement. (Victor Grössling | The Media School)

Refugees are given a 30 x 30 meter plot of land per family unit. Small huts are built and gardens grown. In the maze of makeshift dwellings, Cecilia Tabu, a mother of three, sits in the shade with her children. She has lived in Bidi Bidi for almost two years. Tabu fled her district of Eastern Equatoria with her children in search of safety and a better life.

“They started to burn the houses, even the churches,” Tabu said. “They burned all our items.”

Her fourth child died during escape. Her husband disappeared in the chaos.

She lives in a nonpermanent shelter made from sticks and UNHCR tarp.

“The problem is building a house,” Tabu said. “We don’t have anyone to help us.”

She says the schools close often and that her children don’t have any clothes to wear.

“It’s not enough,” Tabu said. “We are tired, moving from place to place, place to place. We just cry of suffering.”

She prays to God that she will see her husband again.

Cecilia Tabu, South Sudanese refugee and mother of four, sits for a portrait with her children. (Victor Grössling | The Media School)

Imvepi, Uganda’s newest settlement, opened in February. Several hundred migrants arrive each day according to Dennis Mbaguta, the Imvepi settlement commandant with the Office of the Prime Minister’s Department of Refugees. Because Imvepi is so new, it is not yet running as efficiently as other settlements: medical attention is limited and ambulances are few according to Dorothy Lusweti, reporting officer at UNHCR Arua.

Relief for workers is in short supply.

“The time for work is never over,” said Mbaguta. “It’s not easy.”

Mbaguta said access to water is a big challenge for the settlement. Because ground pumps have not yet been drilled, water must be trucked in from 30 kilometers away in Arua. Roads are rough and punched with holes. Residents on the periphery of the settlement must walk several kilometers to retrieve water from the tankers. Four trucks arrive each day and cost the UNHCR about a million shillings each.

The UNHCR reported receiving only forty percent of the 900 billion shillings requested for humanitarian assistance required to maintain the refugee settlements in 2016 according to their office in Kampala.

The only ambulance for Zone 1 of Imvepi district sits in front of a medical center. (Victor Grössling | The Media School)

A child waits for treatment in a medical center in Imvepi refugee settlement. (Victor Grössling | The Media School)

A main road in Bidi Bidi settlement. Refugee settlements in Northern Uganda are widely spread out, and some inhabitants have to walk many kilometers to receive medical treatment in far away clinics. (Victor Grössling | The Media School)

Women walk to collect water from a truck in Palorinya. (Victor Grössling | The Media School)

A woman washes jerry cans provided by the UNHCR with non potable water. The cans are difficult to clean because refugees have no access to soap. (Victor Grössling | The Media School)

Babies’ cries pierce in Zone 1 Medical Clinic of Bidi Bidi refugee settlement. The waiting room was busy. The room hummed with constant chatter of different languages: Dinka, Nuer, English, Luganda and others. A breeze disturbs the tent flaps of
the main entrance, providing momentary relief from the heat.

Bidi Bidi has three health clinics: Reception Centre, Bidibidi and Iyete Health Centers. The first two are housed in tents; the last has no shelter at all. All provide primary healthcare services only. They are maintained and operated by the Real Medicine Foundation (RMF), one of the UNHCR’s partners in charge of medical treatment. There is one health worker for every 1000 people in Bidi Bidi. A report on their website reports, “difficulties in acquiring enough staff and supplies to keep up with the large numbers of new arrivals.”

There are 78 health workers in Zone 1 of Bidi Bidi refugee settlement. There is one doctor in the facility. He takes the next patient in line to an exam room, which is little more than another fold in the tent. Zone 1 is the largest of the settlements five zones, and is home to more than 60,000 according to Monique Nyiratuza, a field officer at Bidi Bidi.

Refugees wait for medical attention in a health center in Bidi Bidi. (Victor Grössling | The Media School)

A child is measured at a health clinic in Bidi Bidi. This particular clinic, one of three in the settlement, receives 150 patients a day on average, with three doctors to tend to them. (Victor Grössling | The Media School)

Pharmacists deliver medications to patients at a health center in Bidi Bidi. (Victor Grössling | The Media School)

A woman peeks into an exam room while a boy awaits treatment at a health center in Bidi Bidi. There are three medical centers for 272,000 refugees. Each sees over 150 patients a day. (Victor Grössling | The Media School)

The RMF reports that health centers face several challenges. Basic sanitation is of major concern due to lack of pit latrines. Water and electricity are in limited supplies. There is very little infrastructure and it has proven difficult to keep sufficient staff to care for so many new arrivals.

RMF conducts outreaches for refugees who struggle to get to clinics. Among these services include testing for HIV and Tuberculosis. Those who require long-term treatment are referred to Barakala Health Centre III for anti-retroviral drugs and TB treatment, according to RMF’s third quarter report in 2016.

Medical scissors at a health clinic in Bidi Bidi refugee settlement. (Victor Grössling | The Media School)

A nurse fills a syringe with anesthesia at a health clinic in Bidi Bidi refugee settlement. The clinic is equipped for minor operations like cyst removal and also uses anesthetics for palliative reasons. (Victor Grössling | The Media School)

A Medical clinic in Bidi Bidi settlement. Med centers are non permanent structures made of stick frames and UNHCR tarp materials. (Victor Grössling | The Media School)

A woman waits outside the maternity ward at Bidi Bidi refugee settlement in Yumbe. (Victor Grössling | The Media School)

Low-budget funding restraints permeate every aspect of settlement life. In May, the World Food Program (WFP) was forced to cut food rations from 12 kg to 6 kg per person per month. These cuts took place at all Ugandan refugee settlements according to WFP. Food rations consists of dry cereals, beans, rice, salt and oil.

Malnutrition can accelerate illness and make it difficult for people to maintain good health in the camps, according to (nurse).

Food is distributed at Palorinya, consisting of pojo, beans and salt. The UNHCR recently cut food rations by 50 percent. (Victor Grössling | The Media School)

Crops are grown on individual plots in Bidi Bidi refugee settlement in Yumbe. The UNHCR provides refugees with salt, beans, vegetable oil and pojo for sustenance. All other food must be grown and harvested by the individual. (Victor Grössling | The Media School)

Greens harvested by a group of unaccompanied minors from South Sudan are laid out before cooking. 35 minors live together on this plot. (Victor Grössling | The Media School)

Uganda will host its first refugee solidarity summit June 22-23, 2017 in hopes of receiving the $2 billion it needs in aid relief to resettle the refugees. The UNHCR is trying to make the refugees displacement from home as short as possible, says Peter Muriuki, the acting officer in charge of UNHCR Arua. In the meantime, life goes on.

Schools continue holding classes in tents with 150 students per teacher. Water continues to be trucked in. Rations are still handed out.

“It is an evolving emergency,” Muriuki said. “But you prioritize. You have to respond quickly.”

Uganda’s doors remain open.