Crisis in South Sudan – Need for Humanitarian Care in Uganda

Tuesday, January 2, 2018

Paul Orieny, Ph.D., LMFT, is CVT senior clinical advisor for mental health

“For many of us, our husbands are absent and there is a lot of ongoing stress,” a woman from South Sudan told me. Today, she is an interpreter in the refugee camps in Uganda. She said, “There are many individuals who are separated from family, orphans, single moms, and many are trying to cope with this, but it’s not easy. Many of the husbands are left in South Sudan and may even die in the war. As women, we struggle with the children and with the need for services.”

A colleague and I carried out an assessment visit to Uganda in September 2017, at the tail end of what has been called the 2016 South Sudan refugee influx. In 2016 as the South Sudanese crisis continued, the influx of refugees into Uganda peaked with 1,800 people arriving in Uganda every day, according to the UNHCR, the UN Refugee Agency. This number meant that the refugee population in the northern region of Uganda more than tripled since 2015, reaching over 1 million people and still growing in spite of a current slowdown.

Uganda is now the center of the world's fastest growing refugee crisis, with most of the existing refugee settlements rapidly expanding to their capacity, forcing successive openings of new settlements. When my colleague, Neal Porter, director of international services, and I were on the ground, we were told of and visited some of the new settlements that were just opening. We learned as well that the filled-up settlements were still accepting individuals for the purposes of family reunification, and thus still expanding to an extent.

While the world’s attention remains focused on the refugee crisis in the Middle East, this is one of the world’s biggest humanitarian crises. It is an emergency situation that needs to be highlighted much more prominently on the world stage to gain the attention and support that it needs. Worse still, things are not getting better in South Sudan. The UN has warned that the conflict could slide into genocide at the same time that more than half the country now faces starvation, which implies the crisis could grow bigger and become protracted.

Our observations during our assessment, confirmed by reports we heard, were that as much as settlements were making efforts to stabilize, it seemed that many of the settlements were still under emergency operations or just starting to figure out how to begin the transition to recovery and maintenance. Because of the emergency-like conditions, the main priorities still seemed to be life-saving protection and multi-sector humanitarian response; setting up water, sanitation and hygiene (WASH), health and education facilities; establishment of child protection and sexual and gender-based violence (SGBV) prevention and response mechanisms; and livelihood support. Mental health and psychosocial support (MHPSS) services are either nonexistent or minimal and very crisis-management oriented.

In addition, we learned of the emphasis placed on also addressing the needs of the host communities adjacent to the refugee settlements. We heard that all the operations are required to provide at least 30 percent of their services to the host communities.

The assessment took place during rainy season in this region in northern Uganda, to the west of the Nile River. Visually it’s a beautiful area, with rolling green hills with big patches of tropical forests in various places. The whole land is generally lush green, very fertile, with tall grass mixed with large canopied trees scattered over the landscape. In the villages, mud huts with varied thatch designs depending on local culture, with big mango trees are a dominant scene as you travel across the land. The villages are often surrounded by small cotton, cassava, sweet potato, sesame or pumpkin cultivated fields.

As we traveled to different camps, the reports and stories we heard all confirmed the need for CVT work. These were stories of torture, horrific journeys to get to the camps, and of ongoing stressors that create an urgent need for trauma-informed mental health services.

And in the settlements, the need for basic services is significant. Life after trauma and displacement is very hard. The interpreter I met with said that for many, family structures have been broken: women are single parents or if not, they are in charge of the ration cards, which combined with lack of work, disrupt men’s traditional roles, leading to relationship challenges.

Progress is apparent, however. It’s worth mentioning that as we moved from camp to camp, I couldn’t help but compare the scene with refugee situations elsewhere in the world. I noticed many times that Uganda’s compassion and empathy towards the refugees is very much evident, unlike in many places in the world where refugees are more and more ostracized and unwanted. The policies that allow refugees to cultivate crops, keep animals and live almost like the villagers are indeed unique and humane.

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