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Where in Uganda is Medair working?
Medair is working in two areas of northern Uganda:
- Pader District: Pader District was carved out of Kitgum District in 2001. Medair works in 11 camps in this region, primarily in Agogo County, serving 115,000 people.
- Karamoja region: The Karamoja region is the most north-eastern region of Uganda, and it is also the country's most remote and underdeveloped region. Kaabong, the location of the Medair base, is in the far north of Karamoja. From this base, Medair serves the five sub-counties of Kabong Rural, Lolelia, Loyoro, Kapedo, and Karenga.
Medair has four objectives in Uganda:
- To provide multisectoral assistance to LRA-affected populations in Pader region. Assistance includes Primary Health Care, Water & Sanitation, and psychosocial assistance.
- To increase the capacity of the Karamojong people, so that they can manage their water and sanitation needs.
- To support the Karamojong people and other populations in northeastern Uganda who have been affected by the cattle raids, ambushes, and disarmament. Support is including health, hygiene, and protection needs focusing on children.
- To establish a rapid emergency response capacity for disease outbreaks.
PADER DISTRICT
Why is Medair working in Pader District?
Until 2006, the LRA had been waging a bush war against the Ugandan Government and the people of northern Uganda over a period of 18 years. Since the violent restart of the LRA conflict in June 2002, an estimated 280,000 people were displaced throughout Pader District. They moved from their villages into eight main IDP camps and a total of 49 smaller camps.
Two other factors have also encouraged the population to congregate in camps:
- The nearby Karamojong warriors have been known to loot local settlements while cattle raiding.
- The authorities encouraged people to live in the camps.
Since September 2006, people slowly started moving out of the main camps, back towards their regions of origin. So far, people have rarely settled back to their land but are still opting to stay at smaller satellite camps in fear of a restart of the conflict or general insecurity in the region.
What are the core issues that Medair is seeking to address?
The original core camps were extremely crowded, with poor water and sanitation facilities; overcrowded schools with unmotivated teachers and sparse financial resources; and almost non-existent medical facilities. Medair has been and continues working in eight of these camps with Water & Sanitation and Health Services, including psychosocial support projects.
With the changing situation, Medair's projects continue to support the population while they move back to their respective areas of origin. The people have to literally rebuild their lives because their houses are not there anymore, and the bush has overgrown their fields. People are settling in satellite camps. Of course, hygiene and water systems are not in place nor is good primary healthcare. Medair seeks to address both the WatSan and primary health needs of the vulnerable population.
Besides physical health problems, the war has caused a negative emotional and social impact, especially on children. Many children live in fear, and often remain idle. Many are also orphans, and so lack basic material support, while even more children are unable to attend school due to the lack of educational supplies.
How is Medair addressing the problems?
Medair is delivering multisectoral relief in Pader District. It aims to reduce the number of people affected by the most common preventable diseases, such as malaria, diarrhoea, and lung infections; to increase access to water and sanitation; as well as addressing the psychosocial needs of children affected by the conflict.
Health Services
Medair's health programme is improving access to basic curative and preventative health care. Medair is running mobile clinics which visit up to eight different locations. The clinics treat patients, support the few remaining official health staff, provide supplementary medicines to Ministry of Health supplies, and vaccinate if necessary.
During these visits, Medair is able to work alongside the health staff within the health facilities, and provide training to ensure a minimum level of satisfactory service. This type of capacity building involves training local health staff on topics such diagnosis and treatment of main diseases, referrals and general health, nutrition, and hygiene. Medair has also distributed mosquito nets to the population.
Medair is increasing awareness and understanding of HIV/AIDS and malaria in all targeted camps, and working with community volunteers to teach appropriate preventative measures to reduce the risk of contracting such diseases.
Support for children and psychosocial program
Medair provides professional psychosocial support, and trains both teachers and IDP children how to provide mental health services for people who are suffering emotional distress as a result of the conflict. The children act as peer counselors for other children who are experiencing emotional distress. This work has enhanced the support network among the IDPs, and has given confidence to people that they can be a voice for the orphaned children, who are among the most vulnerable groups in this area.
Medair distributes books, pens, and pencils to children - many of whom lack motivation - in an effort to encourage them to return to school. Medair also distributes sports equipment, and promotes sporting activities and competitions in primary schools. Other essential basic commodities are distributed to orphans.
Water & Sanitation
Medair continues to construct new water points in underserved areas, and in new camps as they are developed. However, the water supply project will now focus on transferring capacity to the community for the operation and maintenance of all existing systems developed over the last three years. This will be done through further training of the Water User Committees (WUCs) that exist for each water point. It will also involve setting up a WatSan committee in each camp to support the numerous WUCs and improve the sustainability of supply.
Medair aims to significantly decrease the number of households who need to share a latrine. Using the experience gained over the past two years, Medair will increase household latrine construction and maintain a high level of community participation in the process.
Medair will continue to train hygiene promoters and mobilisers to identify unsafe hygiene practices within their community. Trainees are taught how to promote alternative messages that support hygienic practices, and are given related items to distribute to the community, such as jerry cans, soap, and hand-washing facilities, which enable them to put the valuable lessons into practice.
KARAMOJA
Why is Medair working in Karamoja?
Although Karamoja is not an "emergency crisis" in the sense that it does not involve a massive displacement of people, a survey done in the spring of 2006 revealed that living conditions may be worse in Karamoja than they are in the IDP camps of Pader District. Objective indicators revealed high levels of mortality, morbidity, malnutrition, and minimal access to safe water. Chronic underdevelopment has left the population extremely vulnerable to disease outbreaks and food insecurity, and with very limited capacity to respond to crises.
As in most of Uganda, malaria is a major health hazard. However, the Karamojong people have no means of protection against mosquitoes, and in rural areas, they have limited access to good health care. Water and sanitation-related diseases are also common. Diarrhoea is the third highest cause of morbidity, and cholera is endemic. It seems like it will only be a matter of time before the next outbreak of cholera or dysentery, given the poor sanitation, minimal hygiene awareness, and lack of safe water.
What are the core issues that Medair is seeking to address?
Medair is tackling one of the main reasons behind the high prevalence of waterborne diseases. Many boreholes are not functioning properly, in poor technical condition, and/or have poor sanitary conditions around the handpump. This problem is connected to the inability or unwillingness of the community to pay for spare parts. In turn, this is linked - at least partially - to the absence of a well-trained, motivated, effective Water User Committee (WUC).
For a number of years, the central government maintained the local boreholes, but through a new policy of decentralisation, that maintenance has been transferred to local communities. These communities are now responsible for all the operation and maintenance of the hand pumps. Unfortunately, the transition of responsibilities happened without enough training, so Medair is now working to increase the community's capacity to maintain the boreholes, and to address and identify other hygiene issues.
How is Medair addressing the problems?
With funding from UNICEF and ECHO and Private Gifts, Medair aims to increase the capacity of the Karamojong people to maintain a safe and sustained water supply, using a community-based approach to rehabilitate existing handpumps. This builds on Medair's past experience conducting WatSan projects in Karamoja, and is a sector where Medair believes it can have a well-targeted intervention with a significant impact.
Establishing effective Water User Committees (WUCs) will be the key to establishing sustainable rural water sources in Karamoja. The project will invest significant time in the field, where Medair will support, train, and monitor the WUCs. This will help to ensure that the boreholes are kept functioning and in a hygienic state. The successful establishment of WUCs will serve as entry points for a second phase that will further develop good sanitation and hygiene practices in the community.
Another key objective of this project is to develop emergency response capacity for Karamoja, given the general vulnerability of the population, including the high risk of disease outbreak such as cholera or dysentery.
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