Food security, health and nutrition are a major priority in human health during their day to day way of living.

This applies to all human beings right from the time of birth to when they grow up as adults and throughout their life span on earth.

However some people may be privileged to acquire the required dietary food and healthy living facilities while those who lack the money may not. This include refugees who are living in settlements across the country.

The situation became difficult during the 2020 early months as a result of the Covid-19 lockdown where most people including refugees stayed home minus carrying out lucrative activities for their survival.

The health facilities remained operational during the lockdown but most people did not have access due to transport challenges but the situation has since changed to near normal.

Background

According to the February 2020 Relief Web Publication updates complied by United Nations High Commissioner for Refugees (UNHCR, it is stated that assessments for nutrition and health statues in refugee settlements have been carried out since 2003.

These have been conducted with technical and financial support from UNHCR, World Food Programme as well as the various implementing partners and Government.

The report states that until recently, there had not been a clear pattern of improvement or deterioration across the Refugee settlements in the sub-regions of West Nile and South Western part of the country.

“The Government as well as the various partners have constantly put in place interventions to maintain the current levels of food security and nutritional status. While the levels of acute malnutrition and food insecurity in the assessment conducted in 2009 were not of major concern, it was important to reassess the situation in order to find out how it may have evolved. The reassessment is useful in monitoring the effectiveness of ongoing interventions as well as identify any gaps in their implementation.” read part of the report

UNHCR in collaboration with Food and Nutrition Solutions (FONUS), OPM, Uganda Bureau of Statistics (UBOS), Ministry of Health, Ministry of Agriculture Animal Industry and Fisheries (MAAIF), UNICEF, WFP and partners, supported the implementation of primary data collection of the Refugee Food Security and Nutrition Assessment.

The annual periodic survey is carried out in refugee settlements and their hosting districts to estimate the situation of Food Security, Nutrition, WASH and Health.

Facts and statistical figures

The facts are that immunization campaign was carried out in Nakivale refugee settlement following an outbreak of measles in the settlement which affected 52 persons by end of January 2020. A total of 4,475 were vaccinated to this effect.

A total of 195,729 consultations were made in all the refugee serving health facilities in the refugee settlements in Uganda of which 78% of the consultations were refugees and 22% were the host populations.

Top morbidity causes were Malaria at 41%, skin diseases at 6.9%, watery diarrhea at 4%, Urinary Tract infections (URTI) at 10.3%, eye disease at 2% and intestinal worms at 3%.

The number of patients admitted in January in patient’s wards in health clinics were 9,231 out of which 70% were refugees and 30% were the host population.

The main causes for admissions were malaria at 55%, LRTI at 11% and watery diarrhea at 4%

About 4,966 which is 70% Refugees children under 5 years were vaccinated against measles and 4,081 representing 71% Refugees completed the polio vaccination.

A total of 3,522 deliveries were registered in January where 71% were refugees and 29% were nationals with 14,149 people tested for HIV/ Aids of which 60% were refugees and 40% host population.

All those who tested positive for HIV were enrolled into HIV care and treatment. The total number of patients on Anti-Retroviral medicine by end of January is at 18,058 of which 35% are refugees and 65% are host population.

Experts take

Dr Elly Adriko the head of Ochea health centre in Madi Okollo which is responsible for the health service for the refugee settlement in Rhino Camp notes that there are health centres in all the refugee settlements across the country.

They could be health Centre I, II, III and IV under the government setting which takes care of both host communities and the refugees of any ailments which is manageable but in case it is an acute challenge, then the patient is referred to the nearest referral hospital for further attention.

Dr Adriko contends that in most cases the health challenges the refugee children suffer from is malnutrition especially for children under the age of 5 who are not tended to very well by their mothers. Lactating mothers too sometimes suffer the same challenge but usually out of negligence.

Other challenges he said include most refugees and host communities suffering from Malaria since the settlement is close to River Nile where mosquitoes habour.

Others are upper respiratory tract infections which lead to flue and cough but diseases such as Diarrhea are reducing due to hand wash practices that were introduced as part of Covid-19 infection management. 

In a week children received at the health centre with malnutrition challenge in Rhino Camp which is similar to other settlements in West Nile ranges between 4 to 5 in most health centres but those who suffer malaria is at 60%.

Interventions

Dr Adriko and team in most cases engage the affected families in counselling sessions where parents are sensitized on balanced dietary practices especially for the children and lactating mothers.

“The common crops grown in West Nile are millet, sorghum, simsim, beans, orange fleshed sweet potato and various nutritious green vegetables such as jute mallow, cabbages and cow pea among others. The refugees are equally growing these crops which contain food nutrients such as Iron, Zinc, Calcium, Protein, Vitamin A and carbohydrates among others. We encourage families to consume these foods. Besides WFP and other partners distributes families faced with food shortage challenges for the children supplementary powder food which are good for porridge comprising of a mix of soy flour, millet, milk for rehabilitation of malnourished children,” he notes.

Patients who are suffering from other diseases are accorded the required treatment and families are encouraged to use mosquito nets which are distributed in all homesteads.

The Social Distance Operating Procedures for Covod-19 generally has reduced some of the avoidable health infections because people are alert.

However in case a patient is in a critical status, such a patient is referred to Arua referral hospital for the case of West Nile refugee settlements

Kiryadongo refugee settlement health management

Omot Dixon is the in charge of Panyandol Health centre III at Kiryadongo refugee settlement and explaining the health status to Daily monitor while on his desk notes that, the nutrition challenges are the same just like in other refugee settlements in the country.

The malnutrition challenges in children according to him is more of a problem in host communities because they have enough land and are engaged in agricultural initiatives the whole day forgetting to concentrate in cooking and feeding their children with dietary food.

However in general in a week the health centre registers about 3 children who are malnourished some of who are brought for health attention when the situation is acute with skin cracks.

In most cases such children are admitted in the ward but those with minor signs the parents are asked to manage from home.

“The health challenges are administered in two ways, one being facility based and this is where the patients come to us and we administer medication and food supplement services directly. If the situation is not severe, parents are asked to administer the medication and diet from home. They come and report back on periodical basis. The second intervention is community based. This is where we make appointments to reach out to communities and sensitize them as well as provide them health service and food supplements at household level. In most cases we demonstrate how balanced diet food must be prepared because we cook the food and give them to consume so that they can go back and prepare the same in their homes,”

The health centre according to Omot acquired land where demonstration farm is set for growing fortified crops rich in Iron, Vitamin A, zinc, sulphur, protein and carbohydrates among others.

These are improved varieties obtained from National Agriculture Research Organisation such as orange fleshed sweet potato, finger millet, groundnuts, simsim, cassava, carrots and various green vegetable varieties.

Experts from Ministry of agriculture through the demonstration gardens sensitize the refugees and host communities about best practices of growing these crops on the smallest piece of land available as dietary measure.

WFP under the programme provide action against hunger does distribute porridge flour and powder milk for pregnant women who come to the health cemtre for Antenatal service in a bid to boost their immunity and health status. This is to address normal birth of their babies without much complications.

The same service is given to them at least for two years when they are feeding their babies with breast milk.

Treatment

In the event malnourished children or adults suffering from other diseases, the medical team will administer the treatment according to the prescription.

“”Usually once the health team identifies the type of sickness, whether acute malnourished condition which may cause cough, flue and cracking of skin, then we prescribe ant biotics that can treat dehydration. The drugs are usually released by the National Drug Authority upon purchase from manufacturing countries by UNHCR. Since the volume of incoming patients is so high, we are operating at the level of a Hospital,” Omot added.

Giving the statistics, he noted that in a month his team is able to deliver between 200-250 mothersin a month and the centre receives between 300- 400 patients with various sicknesses in a day.

The centre has 15 government workers and partners have tried to recruit about 20% to supplement but the centre is under staffed.

This challenge according to Omot is faced in most health centres in refugee settlements as well as other government hospitals including those in Kampala.

For the case of urban refugees living in Kampala, they receive the nutrition and health services in the nearest health centres and hospitals where they are attached to.