Inadequate healthcare is just one of many challenges facing the 16,200 refugees in this sprawling camp in western Uganda, which is served by a single doctor.
Among those waiting in one of the camp’s two health centres when IRIN visited was Mirian, 30, whose child was shivering with fever, most likely caused by malaria. “I walked two hours to reach the clinic this morning and have been sitting here for three. I hope the doctor can help my child – he is getting worse and worse every minute,” she said.
"We are very stretched in terms of resources to meet all our needs," Juliet Muhumunza, project manager with the German development agency (GTZ), the UN Refugee Agency’s (UNHCR) implementing health partner, told IRIN. "Lack of medical staff is only the tip of the iceberg of our humanitarian assistance gaps.”
Kevin Tsatsiyo, UNHCR's public health officer, told IRIN that conditions in the camp deterred many health professionals from working there.
Only basic services are available at the two health centres inside the camp.
For emergency services such as caesarean sections, minor surgery and blood transfusions, patients must go to Kyegegwa Health Centre 15km away. Patients requiring major surgery are referred to Fort Portal, a government hospital about 140km from the settlement.
Because Kyaka II sprawls over 209sqkm, some residents end up walking for hours to reach the facilities. Moreover, there is only one ambulance serving the whole settlement, complicating and delaying emergency services.
"By the end of 2010, we may have some bicycle ambulances and some stretchers but, so far, all the referral services are limited to the use of the one ambulance," Tsatsiyo said.
At the nine-bed paediatric ward in Kyaka II, senior nursing officer Prisca Asiimwe told IRIN that on 6 March, 27 children had been admitted - three patients to a bed.
"The facility also lacks an isolation ward, and in case of epidemics or infectious diseases like TB, patients are accommodated in beds in the corners of the ward," Asiimwe added. "This is not an ideal solution but though a proper isolation ward is among our priorities, we do not have funds yet to build one."
Asiimwe said the needs to be addressed included a proper storage room for drugs, another generator for a third refrigerator storing medicines, vaccines and another laboratory.
Tsatsiyo said: “There is a new, bigger laboratory being constructed at the HIV clinic, where there will be two laboratory staff. It will not only be used for HIV/AIDS, but many kinds of blood tests.”
Photo: Caterina Pino/IRIN
|A patient undergoes a monthly physical exam|
According to GTZ officials, available medication was sufficient, although procurement was, at times, slower than expected.
Asiimwe said: "Though we have enough anti-retroviral [drugs] in stock to supply the demand, we often receive complaints from our patients who say they find the medicine hard to swallow without having eaten anything.”
Food security inside the refugee settlements is very fragile, especially among Rwandan refugees, and this is likely to affect their health, Asiimwe said.
According to an agreement between the Ugandan and Rwandan governments, after July 2009 Rwandans were prohibited from farming in a bid to ensure their voluntary repatriation. The situation is dire, especially for those Rwandans who have been in Uganda longer than two years, as they no longer receive food rations from the UN World Food Programme (WFP).
Asiimwe said about 50 percent of the diseases common among patients in Kyaka II were malaria and waterborne diseases such as dysentery.
Another issue of concern is the prevalence of sexual gender-based violence (SGBV), especially among the Congolese refugees.
Muhumunza said one or two cases of SGBV were reported every month in the settlements. However, she expressed concern that many more cases may be going unreported for fear of shame and stigmatization.
"Last week, a 14-year-old Congolese girl was raped in one of the villages," she said. "Her neighbours informed the community workers and we went to her family to investigate. However, we couldn't find the girl and her parents denied that the incident took place. We were later told by the family's neighbours that the case was solved between the two families with an exchange of money."
Since 2009, GTZ has increased sensitization of the refugee communities towards reporting of rape and SGBV.
Muhumunza said: "We recorded an increase in reported cases in 2009, but we cannot tell whether it is the number of crimes committed that has increased or the number of reported cases."
According to a sentinel surveillance conducted by the Uganda Virus Research Institute in 2008, the HIV incidence in Kyaka II was 7.6 percent – compared with a nationwide average of 5.4 percent in 2009.
Muhumunza told IRIN that among the refugees, who comprise nine nationalities, most HIV cases had been recorded among Congolese. More than 45,000 Congolese refugees live in Nakivale and Kyaka II settlements.
Both health facilities at Kyaka II offer counselling services for patients with HIV/AIDS, post-traumatic stress disorder and psycho-trauma.
According to GTZ, there is one counsellor for the whole settlement, but another was to be employed by the end of 2010.
"The problem is the lack of staff; we have only one counsellor in the camp, and the demand for psycho-social support is very high," a Congolese refugee, who requested anonymity, told IRIN. "Our traumatic experiences [in DRC] are not taken into due consideration. We need more doctors, not more Panadol [pain killer]."
UNHCR’s Tsatsiyo said the lack of staff with skills in mental health and psycho-social support was among the gaps identified during the agency's public health annual workshop.
"We are trying to respond to our challenges with the means we have," she said. "But again, because of funding issues, we can only afford visiting specialists who come to Kyaka II once a month and refer people to facilities where they would provide follow-up and the appropriate treatment and support."