Q & A Session on Health Challenges and Necessitated Interventions in Refugee Camp Communities;

A Case Study of Rwanda Internally Displaced Persons Camp in Kapkwata Sub-county, Kween District of Uganda

Nandozi Carolyn- ICT and Climate Adroit, Global Health Corps(GHC) Fellow, co-founder and working with Agricultural Innovations Systems Brokerage Association(AGINSBA) partnering with Makerere University

Kiprotich Denis Moi — Educator and Farmer, Young African Leadership Initiative (YALI) Fellow, founder and working with Youth Empowerment Solutions (YES) Uganda

Health as a human right has never been at the fore front fighting than before as in this present 21st Century. However, as we vigorously address the health issues and equity in every community while creating more opportunity skills training and update of the healthcare professionals today, can we pose and ask ourselves- how much have we done or could do more for the displaced persons?

As we celebrate World Refugees Day on 20th June, 2017 let us share with you the key insights of health challenges faced and possible interventions in camp settlements as from the Q&A we carried out in Rwanda internally displaced persons (IDP) camp settlement community of Kapkwata community in Kween district of Uganda. As Uganda was celebrating its hero’s week this year, a few change makers and future young leaders of the global village found their hero in Kapkwata community whom they celebrated with- while promoting Sustainable Development Goal Three (SDG3) by ensuring inclusive education and promoting menstrual hygiene through the 8th June, 2017 community outreach event which aimed; at mentoring to help students visualize their future as key leaders, training on sexual reproduction health (SRH) involving menstrual hygiene and making of pads by girls and boys including parents and teachers at Kapkwata Secondary School which educates hundreds of IDP children while employing community members- as it borders Rwanda internally displaced persons camp

Rwanda IDP camp unlike other camp settlements came about as a result of the deliberate move by government to gazette Mt. Elgon area as a national park to protect its biodiversity and mountain animals in 2000. One February morning of 2000, Uganda Wildlife Authority (UWA) rangers and Uganda People’s Defense Forces (UPDF) soldiers stormed homes in Kapkwata on Mt. Elgon in Kween District.

Chemutai, aged 26 remembers well when the storming soldiers destroyed their homes saying “This is not your home, you must leave, this is national park land, and you are encroachers on government land. You must leave now.”

Over 624 homes of Benet, Kapsegek and Yatui communities were evicted rendered homeless; leaving behind burnt houses and crops including confiscated birds, cattle and other animals. These homeless people resorted to establishing temporary homes on a hilly rocky piece of land which became their new home as donated by a horrified sympathizer. Despite government’s promises each year to give the people land since 2011 for permanent settlement, until today it is just an imagined statement with nothing coming their way.

With the camp existing for almost 17 years now, it was bound to face many challenges of which health is among the top pressing issues requiring addressing as has been divided into challenges, existing interventions and how to improve as per the sessions we held with groups and individuals of school children, teachers, community members and leaders within and those surrounding the IDP camp as highlighted below;

A. What are some of the health challenges you have found while living within or next to the camp settlement?

1. Lack of a school health facility; we have a school nurse which is great. However, the nurse has no office to seat or work full time as we have no established health facility like a sickbay at school which would house the nurse’s office, treatments and beds, among other health requirements. Thus, the nurse who is always mobile is not present all the time as she is a full time worker at the government health center. Therefore, in case of emergencies, the pupil has to be carried about a kilometer below the hill to find treatment to the health center since we are located at the top of the hill.

2. Deficiency of medicines and tools; despite the existing health center for access there isn’t enough medicines and tools for use. For example we girls going through menstruation would require extra medicines to help us through the pain but can only access the less effective drugs like Paracetamol which may not help some of us a lot, and at school any child who gets sick is required to pay for the medicines brought for the treatment which is quite expensive since we expected such a cost to be part of our school fees which is not necessary the case, thus would have suffer through your pain. Worse still, in the community, people always finds when medicines are over at the health centers requiring them to buy expensively from the market or clinics where upon they find the government funded medicines for their free access have been stolen from the health center for sell in the market at ridiculous prices. This is compounded by lack of the right tools for use such as the syringes, bandages and blades.

3. Lack of laboratory facilities; without the facilities to test your blood for the right diagnosis of the disease, the treatment we get is rarely fruitful with constant taking and change of medicines until you’re lucky that the diseases cures.

4. No facilities of pregnant women; pregnant women lack the right health care treatment in our community, with many who have dying due to lack of treatment after birth, thus they have to walk about 7Kms to find the right health facility.

5. Limited health facilities and working system; for years we lacked a single health center in the whole sub county requiring us to walk over 10Kms to find the nearest center for treatment. However, with the government providing two health centers, these are still not enough for the growing population in the camp settlement including the surrounding areas accessing the same services, thus having limited access to health services.

6. HIV/AIDs high prevalence; the sub-county has the highest HIV/AIDs prevalence in the district due to very high sex trade, given that the poverty levels for people to afford living with no access to land that once one can be offered a quarter of a dollar in sex trade- they feel why not take it and survive, a business which has young girls who would be at school to engage in the trade to make a living. This has resulted into high death rates in the camp from the HIV/AIDs disease among other diseases like cholera and diarrhea.

7. Women experience high Urinary Tract Infections (UTIs) cases; this is due to the poor hygiene in the camp, especially in the accessing the poor established toilets coupled with limited access to water for use and poor disposal of waste everywhere resulting into quick catch of various diseases.

8. Lack of toilets; for almost ten years since its establishment, the camp had no single toilet with people disposing waste everywhere, then later with high prevalence of diseases such as cholera, diarrhea, we started to build toilets. However, due to the location of the camp on a very rocky and stony hill, the toilets cannot be dug more than 2 meters lower, yet fill up fast due to the high population, resulting into high existence of non-permanent toilets everywhere on the small piece of land, and for those who would get a better location, it is expensive for them to establish. The government established a more permanent toilet over ten years ago through ECO funds but due to the high population congestion, we were unable to maintain it and it got full for any more use, thus resorting back to our non-permanent structures. This creates more problems given the untreated waste flows down from the camp to the school especially during the rainy season when the full toilets over flow pushing waste everywhere downhill while causing a polluted smelling environment for the studying students, surrounding communities and the camp.

Figures 1 &2: Structure of non-permanent school toilet on the left and the only government donated toilet on the right

9. Poor sanitation; we live in a congested area with a very high growing population living on limited resources of access like toilets, water, polluted environment due to the poor sanitation handling in our community. There is especially lack of proper hygiene in the area starting right from homes which lack cleanliness and proper waste disposal.

10. Lack of water; water is one of life’s most important components yet very lacking in our community especially in the camp. Despite the government trying to provide piped water, water is still very little for the high congested population- worse still with the over flowing poor disposed waste which contaminates the little available water for use. This challenge especially affects the menstruating girls who will need water during their period for proper hygiene, especially to be able to hand wash the reusable pads we have been trained to make- otherwise lack of which would result into UTI and diseases, while some have to miss out on classes escalating the problem to another level.

Figure 3: Students and community standing next to the exposed water pipe that passes in the camp settlement to the school

11. Inadequate materials and detergents for pads making; as girls, we menstruate every month yet lack access to inexpensive disposal pads for use throughout this period. While we have been trained in making reusable pads today- a skill we much appreciate, we still face a big challenge to access the materials like the firm polythene bag, clothes, sewings for making new pads including retraining expertise given the wear out of the reusable pads is 6months. Furthermore, there is insufficient availability of detergents like soap, water for washing and cleanup to keep the proper hygiene especially for reusable pads creating more difficulties during for this period to miss out on classes.

12. Poor nutrition; we don’t have the proper feeding with our diet missing the important nutritious components like regular fruits and vegetables. At the school children eat full course meals of just posho and beans, a similar pattern at homes in the camp. This is due to the limited area we have to grow our own vegetables and fruits to spice up a better diet, while at the same time we do not have enough money to afford these nutritious components.

13. Unfair distribution of relief items; sometimes we get provided with relief especially during the peak hunger times given we have limited area to cultivate our crops to have enough food. However, due to the poor leadership we have in the community, of the 100,000Kgs of food brought for distribution in the camp, over 800Kgs will be owned by eight people who are some of the top leaders in the community who take it for themselves only to sell it in the market expensively for us to meet the cost thus leaving us in further hunger without something to eat.

14. Poor roads; our sub-county and district has one of the poorest roads in this country! The roads are so muddy during the rainy season creating difficulties for access of any services especially in health and education- as school children will not be able to climb the hill to reach school and it will be very difficult for patients to slope down the hill to access the health center a kilometer away from the camp for health treatment. And in case there are large emergency cases, it complicates movement of the vehicles to large hospitals given the slippery road complicated with the unavailable ambulances in the sub county.

Figures 4 & 5: Left is road passing through the forest to the settlement camp and right is the main road

15. Lack of leaders; we have a complicated policy where local leaders are chosen by the president of the country as a government implementation policy which is quite unfair as we shall never be able to have the local leaders who fully address our problems such as those that affect our health every day to lay them in local meetings or parliament to address the necessary needs as the instituted leaders only care for themselves other than the community.

B. What are some of the interventions that have been put in place to address some of the health challenges you have meant in the camp settlement as a community?

Health outreach event; your outreach event where we have been mentored, taught on menstrual hygiene and pads making is the most recent intervention and first of its kind we have had in years. We would like to get more outreaches like these occasionally to sensitize and motivate our people and leaders to rethink critically.

Figures 6 & 7: Left is mentorship session with students and right community donations during the outreach

Nets provision by government; given high cases of malaria we have had, we got some nets to help cab the diseases through the nets the government provided though few people got the nets while some are now already worn-out for further usage.

Supply of tapped water; the government has established piped water helping us have more access to cleaner water available now nearest to us.

Established health center; the government has provided us with two health centers IV in the community, though the facilities still lack the skilled personnel, medicines and equipment for use.

Relief provision; the government through ministry of disaster preparedness feeds us especially during peak hunger by giving food relief though to only a few people as most of the food is divided among the leaders themselves only to resell into the market expensively as the rest of the people die of hunger. Relief has also included the human rights team visiting to distribute some clothes in the camp.

Establishing roads; before the roads where really very poor especially with no proper road reaching the camp, however the government has put in place a widened road now reaching the camp though it still has its own challenges of improvement.

Provision of Eco latrine; over 10 years ago the government through ECO funds provided the first permanent toilet in the community for proper waste disposal. Unfortunately only one toilet was provided and given the high population it filled up quickly and could not be maintained that it is now no longer of use that people resorted back to the non-permanent structures impossible to build on a rocky hill.

C. What interventions can be put in place to improve the health challenges you meet in the camp settlement community?

Advocacy for resettlement of the camp people; the camp is very highly populated thus very congested with hardly any land available. The people need to be resettled to a new large area provided with land to be able to grow their own food to live healthy while earning economically. The government keeps promising us every year but it has never really taken the implementation initiative forward and we are still waiting.

Sensitization of people; our people need constant sensitization on every aspect in health if we are to have any improvement. We need sensitization right from within homes about simple aspects like the importance of boiling water for drinking, proper hygiene, slashing the bushy areas and improved drainage to remove stagnant water. People need to be sensitized about the infectious diseases and their danger especially HIV/AIDs and its realities and how to test and seek proper treatment for those who are infected especially with the virus.

Proper waste disposal training; people need to be sensitized about the importance of proper waste disposal such as digging pits to dump and burn the rubbish, body disposal or otherwise face the dire consequences that may result into high diseases outcomes such as cholera, diarrhea and UTIs which could be prevented including tree planting to improve the polluted air with cool breeze of fresh air…

Mentorship and entrepreneurship training; people have lost hope that they think they can no longer fed for themselves thus engulfed in commercial sex to earn atleast the quarter a dollar for women while men drink all day long. They need to be given renewed hope of living and economic independence all which can be achieved with the right mentorship and entrepreneurship attachments to families and schools.

Establishing a school health facility; the school should provide a health facility such as in form of a sickbay for timely treatment of the students to save us from walking miles to the nearest health center. This would perhaps help institute a full time nurse with an office combined with a well-equipped clinic with medicines and tools for treatment of patients.

Establishing health centers; given the high population there is need to establish more health centers in the areas specifically within the camp, where the camp community and school can easily access health services other than walk the kilometers searching for the treatment.

Equip the health facilities with medicines and tools; this includes establishment of the right labs for better diseases diagnosis other than guess work including standardizing and well stalking the health center with all the required tools and medicines for the right treatment. A working well stalked center would encourage more skilled worker force availability equipped with the right tools and medicines for a treatment a motivation to make their work easy. This would also greatly prevent pregnant women walking long distances in search of with the right services and treatment as now they would be near to them, consequently helping reduce death of pregnant women and still births. This stalk should also include the availability of ambulances lacking for use especially in cases of emergencies.

Nutrition sensitization; people have to be sensitized on importance of nutrition especially for their health more so among the HIV/AIDs patients who need to improve their immune systems functioning. Thus, families and schools should be encouraged to engage in farming of nutritious crops such as greens, fruits among other nutritious components.

Bring more health outreach events; the health and mentorship, leadership and health outreach even we have had with you is the first of its kind bringing various insights to us to think about as we establish our future. We thus request to increase more search outreaches in our community as it helps sensitize people on various aspects of life especially in health like the menstrual hygiene among women while the men have been mentored to support women in this area as never thought before.

Construction of more permanent toilet structures; we really need the intervention in helping us construct more permanent toilets in the area given the hard rocky area we live on which makes it hard for us to dig pits not even lower than 2metres deep thus fill up quickly. This intervention would greatly improve the hygiene in the area.

Improvement of shelter; people need help in establishing more permanent structures in replacement of the current existing small wooden houses we live in which are in dire conditions hardly creating any warmth for us thus high prevalence of breathing diseases as the hilly area surrounded by the forest is very cold.

Increase in water availability and protection; the water contamination can be handled with better pipes and all linkages sealed to prevent contamination during flow along with proper waste disposal. While the increase in water would not just help improve the domestic use and hygiene including health facilities, schools but the girls would be greatly helped during their menstrual periods for proper cleanliness.

More service of goods brought nearest to people; these include goods like the pads making materials to make more pads and training, detergents like soap to help in the washing, including availability of inexpensive disposable pads along with proper training on the right disposal. Meeting such tiny detailed needs greatly encourages and motivates girl child education.

Figures 8, 9, 10& 11: Girls, boys, teachers, parents and community during pads making training session and product outcomes

Mobile communication; communication is an important aspect today especially if people are to travel to work in long distance areas away from their home towns such as Kapkwata. Thus, having an established good communication network in place would greatly motivate the skilled workers who come to work in the community thus boosting the labor force. In addition, the world is all about technology today thus everyone wants to live in a place which can easily support the use of their technologies daily and this can be achieved with a good network. Therefore, perhaps communication companies should revise their network connections in Kapkwata area.

Conclusion

Just like other camps settlements in the world, Kapkwata community hosts another Rwanda IDP camp which faces a variety of challenges among which health is the most common among camps. Therefore, just like we strive to address health issues and equity everywhere and in every grassroots community, let the important focus also be put on camps settlements which hosts many young leaders of tomorrow who need the necessary help for survival to reach their dreams like other former camp settlers now turned leaders where able to. With so many health implementations that have worked elsewhere they also make a great replica for testing in Rwanda IDP camp and community such as the distributions of Mama kit which has never been heard of in this community, the e-health services, technological health; as the government, relief agencies, NGOS, private sector and motivated individuals help to fully address the interventions Kaptwaka community has highlighted for support.