Uganda

Background
Landlocked Uganda, an east African country of nearly 28 million people, emerged in the late 1980s from several decades of civil war. Stable leadership has brought an invigorated economy, universal adult voting rights, and the rule of law, with much of the country is on its way to relative peace and prosperity. Critically, Uganda conducted a vigorous public education campaign to combat HIV/AIDS, and has managed to reduce its infection rate—which had reached 30 percent in the 1990s—to just 6.7 percent. In many ways, Uganda’s progress serves as a beacon of hope for Africa.

Unfortunately, the ongoing rebellion in the northern part of the country illustrates the very depths of human suffering. The humanitarian crisis brought on by a 19-year conflict between the Ugandan military and the Lord’s Resistance Army (LRA) is perhaps the most underreported in the world.

Tens of thousands of innocent civilians have been killed or mutilated, targeted by the LRA—a rebel group with no discernible goals except to overthrow the current administration and install a government based on its interpretation of the Ten Commandments—for not joining its fight against the government. Men, women, and children have had their noses, ears, and lips chopped off, their hands, feet, and arms amputated. Twenty thousand children have been abducted, forced into combat, and subjected to rape and torture. More than 1.6 million displaced have fled their homes and livelihoods and now live in makeshift camps with little food, poor sanitation, and virtually no access to health care. Consequently, HIV/AIDS, malnutrition, and malaria rates are far worse than the national average, and the infant mortality rate is three times the world average. The U.S. Agency for International Development has said the crisis in northern Uganda is “as bad as Darfur.”

What IMC Is Doing
Seeing an opportunity to improve the accessibility and quality of health care across Uganda, IMC responded in 2003 by establishing programs in the northern and southern parts of the country. While both programs were aimed at providing care directly to the most vulnerable, and training government health workers in the delivery of a variety of essential health services, IMC’s work in the north targeted victims of the civil conflict; in the south, it was refugees who fled conflicts in neighboring DRC, Rwanda, Somalia, and southern Sudan for the security of southern Uganda.

In the north, IMC provides primary health care via its mobile health clinics to seven camps for the internally displaced in two districts. Services include diagnosis and treatment of common diseases, vaccinations, antenatal/postnatal care, and health education. Because Uganda suffers an exceptionally high incidence of tuberculosis, due in part to TB being an opportunistic infection for people with HIV, IMC established a community-based TB education and care program in eight districts in the region. Also, due to the lack of trained local health care professionals, many who left Uganda because of the conflict, IMC has made training and education integral parts of its work in the area, training more than 200 community members to date as traditional birth attendants and supplying each with safe delivery kits.

Insecurity in northern Uganda has disrupted all farming activities, and experts estimate that the amount of uncultivated land there may be as high as 95 percent. The displaced are, therefore, completely dependent upon food rations distributed by the UN World Food Program, and malnutrition rates among children under five years of age are staggering. IMC established eight supplementary and two therapeutic feeding centers in Kitgum and Pader districts, where an average of 500 moderately malnourished children receive supplementary feeding and 50 severely malnourished children receive therapeutic feeding each month. In addition, IMC has trained dozens of government health workers in the management of feeding centers.

In southern Uganda, IMC is the lead agency in a groundbreaking collaborative program aimed at establishing a prevention and response system for sexual exploitation and gender-based violence (SGBV). The program works with refugees— many of them women and the victims of rape and other forms of sexual violence—in three settlements and the surrounding host communities in Hoima and Mbarara Districts.

Through this program, IMC and its local and international partners run community-based advocacy teams and community forums that act as the first layer of response for women and girls experiencing violence, and play a critical role in creating a supportive environment that respects the right to live free of violence. IMC trains service providers, including community leaders, police, and facility- and community-based health care workers, to respond to the needs of survivors of SGBV. IMC works with community volunteers on a variety of activities—including drama, community dialogue, impromptu discussion, door-to-door discussions, and booklet clubs—to mobilize communities around SGBV prevention and to facilitate behavior change within the settlements. Finally, IMC strengthens the social safety net for survivors, bringing women, men, youth, leaders, and elders together to form SGBV Watch Groups, which look out for and document SGBV and help those in need.