Since August 2022 and the closure of a transit camp in Kisoro, 30,000 people from the Democratic Republic of Congo (DRC) have arrived in Nakivale settlement in Uganda. Those arriving have fled fighting linked to the resurgence of the M23 armed group in North Kivu, DRC.

Already home to over 175,000 people of several nationalities, this settlement has now received a new wave of refugees. But despite this massive influx of people, an adequate increase in aid is lacking, leaving people in a worrying humanitarian and medical situation.

People from the DRC hoping to find refuge in Uganda generally pass through Kisoro, Matanda and the Nyakabande transit centres in the Kanungu district of western Uganda. They are then resettled in the Nakivale settlement, the world's eighth-largest refugee camp, created in 1958.

Rubondo, one of its three administrative zones, serves as the settlement for newly arrived refugees. Originally designed for 40,000 people, it now accommodates 75,000. This is also where Médecins Sans Frontières (MSF) has been providing medical assistance since the beginning of 2023.

“Despite the arrival of thousands of refugees over the last year, no extra resources or infrastructure have been provided. People are not being accommodated properly, whether in terms of shelter, food, or access to water and sanitation,” says Denis K Mbae, MSF project coordinator.

In some villages within the Rubondo area, the current water supply per person stands at five litres per person per day, as opposed to the 20 litres as per minimum standards in a humanitarian response (Sphere standards). With insufficient access to clean water, people are now resorting to water from the surrounding swamps and lake, consequently heightening the risk of diseases.

In addition, food rations are not sufficient: in the southwest, a refugee with a 40 per cent food ration currently receives only four kilos of corn, two kilos of beans, and half a litre of oil per month, while wood and fuel needed for cooking are also in shortage. As for shelters, they are being built by the newly arrived refugees themselves, with only a few wooden poles and plastic sheeting supplied to each household on arrival. 

“Many refugees tell us that they can only eat one meal a day. The poor living conditions in the settlement are compounding health problems,” says Mbae.

“For example, mosquito nets cannot be set up in these precarious shelters, which in turn impacts the number of people infected by malaria,” he says.

On site, our teams are providing assistance with access to basic healthcare via five mobile clinics set up as close as possible to refugees living in these precarious conditions. From January to June, 22,400 consultations were carried out, particularly during the seasonal malaria peak. Among the patients who underwent malaria tests, 40 per cent tested positive.

Only one other medical organisation is present in the settlement, and there is a dire need for malaria prevention and treatment, as well as care for people with non-communicable diseases such as chronic diseases.

The needs of people in terms of mental health and sexual and reproductive health are also growing, particularly regarding victims of sexual violence, but also in terms of family planning and prenatal care.

The situation is exacerbated by major shortages of medicines, affecting both the health structures in the settlement and the United Nations High Commissioner for Refugees (UNHCR), which manages the settlement in conjunction with the Ugandan Office of the Prime Minister (OPM). 

“Despite people's considerable immediate need for food, shelter and water in adequate quantities, United Nations agencies, their partners, donors and the Ugandan authorities are disengaging from emergency humanitarian aid, in favour of the self-reliance model,” says Augustin Westphal, MSF head of mission in Uganda.

“The aim is to make people self-sufficient rather than aid dependent,” says Westphal.

“While this is a laudable objective, it fails to consider the fact that, in order to become self-reliant in the long term, refugees arriving must first receive emergency aid for a period of time that enables them to meet their basic needs before they can make a fresh start. However, this basic emergency aid is not in place today,” he says.

Due to a lack of funds, access to food in adequate quantities remains a major problem for refugees. The situation is set to worsen with the World Food Programme's introduction of the General Food Assistance prioritisation in July, which will lead to food ration cuts even for the most vulnerable. 

The healthcare system for refugees has also deteriorated over the past year, with a drastic reduction of funding and drug shortages, even in the face of the increasing number of refugees. Water remains a challenge in terms of quality and quantity.

“It is absolutely necessary to maintain emergency humanitarian aid until people are able to move towards the self-reliance system advocated by the government and international organisations,” says Mbae.