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Life for Women in the Nakivale Refugee Camp

Reported by Joe DiCarlo, Director of International Programs, Disaster Relief

Imagine living in a village so ravaged by rebel violence, you must flee to a new country with only what you can carry on your back. Now imagine that you must attempt this with small children and a baby on the way.

Thousands of women in the Nakivale refugee camp in SW Uganda have done just that. And Medical Teams International ensures that they are cared for in this community of over 55,000 refugees.

We provide basic health services, reproductive health care, HIV/AIDS and support, nutrition and sanitation and hygiene promotion. We are addressing the sexual and gender-based violence (SGBV) that too many women in this region have experienced. MTI is now training 25 health workers in counseling for SGBV survivors as well as training 20 health workers in how to provide specific and immediate care.

And we are also ensuring that expectant mothers have all they need to safely bring their children into the world. Our maternity clinic has the necessary medicines and equipment and is staffed with well-trained midwives. In fact, the reputation of our facility and staff is such that the number of women choosing to have their babies in a clinic is higher in this refugee camp than the national average for the country of Uganda.

Read more articles about our work in improving women's health in the Reaching Hands Newsletter.

Meet Patricia

Midwife Patricia is working to keep mothers safe and healthy. Learn about her and her work for Medical Teams International in Uganda in this video.

Working with Refugees Affected by Sexual Violence in Uganda

Reported by Trina Chase, Africa Program Manager

Medical Teams International is partnering with the Uganda Ministry of Health; the Bureau of Population, Refugees, and Migration; and UNHCR to serve 60,000 refugees in Nakivale and Oruchinga settlements in southwest Uganda through six health clinics. This partnership began in 2010 as a response to the influx of refugees from the Democratic Republic of Congo and the identified gaps in health care services at the resettlement camps, especially in the area of primary health care.

Medical response to sexual and gender-based violence (SGBV) has been inadequately addressed through the health clinics. The majority of SGBV patients coming to the clinics have not been getting the appropriate attention and the quality of care they should. In most cases, SGBV victims were mixed with the general patient population, thereby compromising the privacy of the victims. 

SGBV is a particularly challenging issue in the resettlements because the refugees come from different backgrounds and have varying understandings about sex, gender and rape. In DRC, for example, girls 13-17 years old are regarded as adults and ready for marriage. Other cultures believe that a woman should never say no to sex or that it is improper for a woman to agree to sex—that she must be coerced. 

According to monthly reports, 13-25 cases of violence are reported monthly in Nakivale. Sixty percent of reported cases are domestic violence and 40 percent are rape and sexually related abuses. Additionally, 35-40 percent of sexual abuse cases are reported at least 72 hours after the incident, thus increasing women survivor’s risk of unwanted pregnancies, sexually transmitted infections, HIV/AIDs, and other health risks. Many SGBV cases go unnoticed, or there is fear to report the attack or to go to a clinic for treatment, therefore these figures significantly under-represent all the incidences of SGBV occurring in the settlements. 

To improve care for victims of SGBV, MTI is working through clinics in the refugee settlements to improve the confidential treatment of sexual violence with appropriate follow-up. MTI is now training 25 health workers in psychosocial counseling for SGBV survivors as well as training 20 health workers in the clinical management of SGBV.

MTI is also working to lower the incidence of SGBV. At the community level, MTI works through community Health Workers to train on SGBV awareness and prevention through educational outreach.

Just this month, a 9-year-old girl in the Nakivale resettlement was raped. She was brought to the health center with a second-degree perineal tear, plus multiple vaginal tears. After the incident, she was so traumatized and intimidated by men that she became aggressive whenever she saw a man. She was treated at an MTI-managed health center in the camp and is now receiving ongoing psychosocial support from clinic counselors.  

MTI’s goal is for all SGBV survivors who report to a clinic in Nakivale to be examined and treated within 72 hours of treatment, to receive psychosocial assessment and counseling in a private area of the clinic, and to be followed up with at home for the following three months.

Kambugu Martin, an SGBV focal person at one of the health centers in Nakivale states, “SGBV is a serious public health problem. Women, children, and elderly people of all age groups and social status are vulnerable to SGBV. It is a major cause of disability and death and has so many adverse consequences for women’s sexual and reproductive health. MTI is working to put community members in control of their lives to prevent SGBV through sensitization and education and to provide survivors of SGBV with the medical and psycho-social support that is needed.”

Refugee crisis in Uganda

Fighting in eastern Democratic Republic of Congo pushed almost 26,000 refugees into Uganda within the span of five days in early July of this year. This displacement of Congolese families is only expected to continue as the vast country grapples with the worst clashes it has experienced in years.

Congo's northern province has been shaken by violence since late March, after hundreds of former rebels defected from the army in support of a renegade general who is wanted by the International Criminal Court for suspected war crimes. The mutiny risks dragging the loosely governed central African state back into war.

“We ran from too many gunshots that went on throughout the night,” said Bwema Matata, one of the refugees being transported from a border transit camp to Rwamanja refugee camp in Uganda.

“My parents died. My siblings have been killed. So we had to run. We ran to the border,” Matata told AlertNet.

Matata’s story is typical of the thousands of Congolese seeking refuge from the violence in their country. Most of the refugees are women and children, and many of the women are pregnant. 

In addition to the more than 26,000 Congolese refugees who have already crossed the Ugandan border to escape the conflict, there is an estimated 9,000 more people waiting to get into Uganda for safety. The rebel violence continues to intensify, sending government forces fleeing and displacing more vulnerable people from their homes in Congo.

Our response

When the massive flood of refugees into Uganda began, Medical Teams International was already on location at the border. In partnership with the United Nations High Commissioner for Refugees (UNHCR), our staff and volunteers were providing health screenings and treatment for incoming refugees. During the height of this crisis, the flow of refugees into Uganda rose from 200 per day to nearly 1500 per day.

The influx created a sudden demand for increased medical services and presented us with an imperative to expand our work. The UNHCR asked us to mobilize additional support specifically by sending our volunteer doctors and nurses to assist our staff in providing primary healthcare services.

We responded to the request with additional teams. Along with the teams, we sent medicines and medical supplies for respiratory illnesses, malaria and other infectious diseases. One team saw up to 2,000 patients in two weeks while serving in Kisoro.

Currently, we are monitoring the situation on a daily bases and preparing to send additional teams.

Millions without care in Uganda

The Lord’s Resistance Army (LRA), a militia led by Joseph Kony, has been terrorizing northern Uganda since 1986. The rebel attacks have driven 1.5 million people from their homes and forced 25,000 children into conscription as child soldiers. The ongoing war has destroyed infrastructure, including the health care system, and left millions without access to critically needed care.

Our work in Uganda

On March 12, 2012, Medical Teams International launched a program to address the growing concern about Nodding Syndrome. This announcement came upon the return of Jeff Pinneo and Bill Essig from Uganda, when new insight was gained on the impact of Nodding Syndrome. Read about their trip and our call to action to address the needs of the children suffering from this mysterious syndrome.

In the wake of the landmark peace agreement between the Government of Uganda and paramilitary groups, two million internally displaced Ugandans have begun to return home to communities that have been ravaged by war and are lacking even the most basic services. Medical Teams International has established and maintained the Ogur Youth Information and Care Center (OYICC) to help internally displaced people rebuild communities, emphasizing HIV prevention, testing and treatment. Through the OYICC, Medical Teams International has made a commitment to providing social, medical and spiritual healing to a community suffering from an AIDS pandemic that went unchecked during decades of conflict.

From 2007 to 2011, the OYICC project has exceeded all expectations by mobilizing 65,000 young men and women in Ogur to participate in HIV prevention education. Through its youth-friendly HIV and AIDS counseling and testing, Medical Teams International has screened more than 24,000 youth, treated 1,623 youth for sexually transmitted infections, treated 3,137 youth for opportunistic infections and provided prevention of mother to child transmission and antenatal care to 5,416 pregnant young women. The facility attracts men and women from all over the Ogur sub-county because it has developed a reputation for being compassionate and having a highly trained staff. Clients come on foot and by bicycle from as far as 50 miles to receive care and to participate in OYICC’s activities.

Medical Teams International will operate six major initiatives in Uganda this year along with emergency response efforts in Southwestern Uganda. We will send three Emergency Medical Care teams and one dental team to support our projects. Our projects include:

• Ogur Youth HIV Information and Care Center
• Emergency Care Training of Nurses and First Responders
• Refugee Emergency Health Response in Southwest Uganda
• Pader Community-based Health Care Services
• Child Survival in Lira Health District
• Malaria Communities Project in Dokolo and Lira

More information about our work in Uganda is in the HIV and AIDS in Ogur County, Uganda report [PDF].

Our partners in Uganda

Hands to Heart International
United States Agency for International Development (USAID)
United Nations Children’s Fund (UNICEF)
World Health Organization (WHO)
Lira District Health Office (Ministry of Health)
Mulago Hospital

Uganda facts

• Uganda is a landlocked country inhibited by conflict and war
• A variety of medical needs exist to which Medical Teams International is responding
• During 2005-08, Medical Teams International implemented the emergency health care program that we began in 2004 in Lira, Apac, and Pader districts.
• We deployed 45 volunteer medical teams to support this program.
• Today:  Medical Teams International initiates HIV, malaria, and medical training projects. 

Please donate or volunteer to help save lives in Uganda.