The Healthcare Crisis

Two decades of fighting, displacement and neglect at the hands of the Ugandan government and international community have profoundly disrupted the provision of healthcare in northern Uganda. A World Health Organization health and mortality survey conducted in the displacement camps in July 2005 reported that nearly 1,000 people die each week from preventable violence, disease and malnutrition. The lack of sanitation, crowded conditions, and diminished access to medicines and medical facilities lead to poor health outcomes. Up to 58% of all health facilities are not functional. Diseases such as malaria, TB and AIDS are more common in a setting where medication, clinics and hospitals are inaccessible.

The extreme density of IDP camps in northern Uganda creates a climate particularly ripe for the spread of infectious disease. Malaria, both a treatable and preventable disease, is the leading killer of children. Insecurity prevents adequate distribution of mosquito nets for malarial prevention and obstructs effective treatment of children sick with the illness. Likewise, viral and bacterial diarrhea, malnutrition, tuberculosis, cholera and meningitis can move quickly amongst a population living in close proximity. In 2006, outbreaks of both cholera and meningitis struck IDP residents in northern Uganda.

Following malaria, HIV and AIDS accounted for the second highest cause of death (13.5% of all deaths) in all camps surveyed by the 2005 WHO study. Breakdown of cultural norms and reliance on prostitution as an income-generation activity has led to more frequent and dangerous sexual activity, furthering the spread of HIV and AIDS and other STDs. The crowded conditions of the camps and inadequate disease surveillance programs likely contributed to the rapid outbreak of the Ebola virus in northern Uganda in 2000-1, which killed 224 people.

For those who evade these risks to their health and manage to live into their later years, other diseases, such as cancer, cardiac disease, diabetes, hypertension, and pneumonia, will eventually impact their lives. When the tremendous mortality associated with infectious disease is peeled back, more chronic disease looms. However, treatment options are limited due to the difficulties associated with obtaining medication for these conditions.

War also results in tremendous suffering due to traumatic wounds and psychological trauma. The surgical wards of hospitals in northern Uganda are full of soldiers and civilians who have suffered bullet wounds and landmine injuries and must undergo limb amputations. Equally overwhelming are the mental scars of witnessed violence and the hopelessness associated with a twenty-year war. A Doctors Without Borders survey conducted in Pader town found that 62% of women interviewed contemplated suicide. Although unstudied, common sense indicates that depression and post-traumatic stress disorder are common in northern Uganda. Yet, like most resource-poor settings where limited funding is directed by the urgency of treating life-threatening infectious diseases or traumatic wounds, facilities in northern Uganda are woefully inadequate for addressing the psychological consequences of widespread violence.