Uganda: Crisis Preparedness and Emergency Response

1
Uganda Crisis Preparedness and Emergency
Response

• Presentation for the
• APHA 134th Annual Meeting and Exposition
• Public Health and Human Rights
• 8 November 2006
• Elizabeth Rowley, Consultant (BASICS)

2
Presentation Outline

• Patterns of fragility
• Current situation in northern Uganda
• Challenges to service delivery
• Key actors and relationships
• Challenges to harmonization of humanitarian
  response
• Possible measures to support stabilization
• Windows of vulnerability and opportunity

3
Patterns of fragility

• Context and drivers of fragility
• Military insecurity
• LRA, ADF, WNBF, Karamoja, border areas
• LRA insurgency specifically, IDP camps, current
  situation
• Underlying drivers of fragility in Acholiland
• Historical patterns of violence in politics
• Marginalization
• Marginalization of the Acholi
• Marginalization of the conflict

4
Current situation

• 1.7 million displaced persons in northern Uganda
  (May 2006, UNOCHA) gt90 of district populations
• 20-year armed conflict between LRA and UPDF
  (army)
• Multiple attempts to negotiate peace deal,
  currently mediated by Sudanese Vice President
• Ceasefire declared 26 August 2006 but
  implementation problematic
• LRA demands for review of peace deal, revisions
  on-going

As of February 2006. Source United Nations
Office for the Coordination of Humanitarian
Affairs (OCHA) Available at www.reliefweb.int
5
Current situation

• Camp conditions extremely poor
• Congestion
• Limited water/sanitation
• Malnutrition
• Communicable disease
• Limited health infrastructure
• 300,000 returnees to date (mainly Lira
  District) UNHCR anticipates 300,000 more to
  return before the end of the year

Source Sven Torfinn/IRIN. Accessed from
http//www.irinnews.org/S_report.asp?ReportID5171
1SelectRegionEast_Africa
6
Challenges to service delivery

• Challenges impacting on perceived legitimacy and
  effectiveness
• Insecurity
• Staffing (no additional incentives)
• Logistics (referrals, drug supplies, outreaches,
  support supervision and quality of services)
• Inequitable distribution of services across camps
• Lack of harmonization beginning formal
  coordination some camps very underserved
• Parallel services (HUs owned by government but
  delivery by NGOs in many cases)
• District absorptive capacity and management
  issues
• Special needs due to conflict environment
• Mental health, rehabilitation (not well developed
  govt services)

7
Key actors and relationships

• Legitimacy and effectiveness
• Government (central)
• OPM, line ministries (MOH, MOWLE, MOE, MOLG,
  MOFED)
• Government (district)
• LC5, CAO, Directors of technical depts, DDMC
• Civil society
• Sub-county and village administration, camp
  administration, community groups
• UN and INGOs

8
Challenges to harmonization of humanitarian
response

• What is harmonization and is it happening?
• What are the challenges to harmonization and
  coordination?
• National level
• Policy making vs. operationalization through line
  ministries
• Donor harmonization issues, cluster lead approach
• District level
• Staffing, funding, planning
• Difficulties coordinating actors on the ground
• What is impact on legitimacy and effectiveness?
• The humanitarian dilemma
• Save lives in the short-term support local
  systems in the long-term

9
Possible Measures to Support Stabilization

• Humanitarian assistance
• Continue current programming but with enhanced
  district level harmonization of partners with
  government
• Add to this a strategy to enhance the countrys
  humanitarian response capacity
• Development of a national humanitarian response
  capacity support it through harmonization and
  partner strategies to work through government
  adopt a longer-term view
• Plan for return to communities

10
Possible Measures to Support Stabilization

• Development of health service delivery
• Strengthening of DDHS and DHMT (onsite technical
  and material support through partners) to address
  capacity issues and support legitimacy of local
  structures
• Harmonization in health sector planning
• With the MOH, with other donors
• Ensure district level harmonization of partners
  efforts with local structures and other
  initiatives

11
Possible Measures to Support Stabilization

• Support community level responses
• Health sector
• Support efforts to strengthen CORPS and VHTs
• Democracy and Governance
• Expand on-going activities with community-based
  projects
• Based on needs and documented successes, support
  to projects such as ACORDs Good Governance
  Project IRCs Community Resilience and Dialogue
  Project
• Address marginalization issues bridging ethnic
  divide

12
Windows of Vulnerability/Opportunity

• Vulnerabilities
• Insecurity and unresolved drivers of fragility
  (history of violence as political strategy
  marginalization)
• Unacceptable conditions in IDP camps
• Inadequate harmonization of efforts at
  central/district levels
• Opportunities
• Current improvements in security, possible
  winding down of the conflict
• Government demand for harmonization
• Focused attention by key actors (mortality
  survey)
• New funding mechanisms (UN, World Bank, EU)
• Proactive response to possible resolution of
  conflict