Uganda: Crisis Preparedness and Emergency Response Presentation for the APHA 134 th Annual Meeting and Exposition: Public Health and Human Rights 8 November 2006 Elizabeth Rowley, Consultant (BASICS)

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

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

Current situation 1.7 million displaced persons in northern Uganda (May 2006, UNOCHA) >90% 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 Source: United Nations Office for the Coordination of Humanitarian Affairs (OCHA) Available at:

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

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 (HU’s “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 gov’t services)

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

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

Possible Measures to Support Stabilization 1.Humanitarian assistance –Continue current programming but with enhanced district level harmonization of partners with government –Add to this a strategy to enhance the country’s 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

Possible Measures to Support Stabilization 2.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

Possible Measures to Support Stabilization 3.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 ACORD’s Good Governance Project; IRC’s Community Resilience and Dialogue Project Address marginalization issues; bridging ethnic divide

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