1. DISPLACED PEOPLE WITH CHRONIC CONDITIONS - HOW TO TACKLE THE PANDEMIC ON THE MOVE
Presented by Joshua Wamboga, Board chair elect, IAPO AT 70TH WHA, GENEVA 24/5/17

2. BACKGROUND
South Sudan gained independence from Sudan in July 2011, but the hard-won celebration was short- lived.
In December 2013, political infighting erupted
Since December 2013, brutal conflict in South Sudan has claimed thousands of lives and driven well over a million of people from their homes.

3. Background continued
Since the conflict began, some 3.6 million citizens have been forced to flee their homes
more than 1.5 million people have escaped to neighboring countries in search of safety
more than 2.1 million are trapped inside the warring nation. South Sudan is now the third-most fled country in the world, behind Syria and Afghanistan.
you-need-know-about-south-sudan-crisis

4. Uganda as a host country
Since 1st January 2017, Uganda has received 170,710 refugees and of these, 58 per cent are children, 86 per cent are women and children and by 28th February 2017, the Office of the Prime Minister reported a total of 1,139,374 refugees.

5. Uganda as a host country continued
MSF field clinic providing primary and secondary health care for emergency treatments to patients who come with chronic conditions- hypertension and uncontrolled diabetes in deplorable conditions in camps

6. Challenges
flow of refugees in the country has overwhelmed the existing transit centers, reception centers, and refugee camps with numbers exceeding. A single settlement- 270,000 refugees 
Nearly 75 percent of our patients arrive with prior diagnoses of chronic disease—hypertension and diabetes; Non-communicable chronic diseases- cardiovascular disease, hypertension, diabetes, asthma, and cancer these diseases with complications such as heart attack, stroke, kidney failure, and the onset of blindness, Mental health
health system constrained. female refugees are pregnant while the children are malnourished from the limited food supplies on the way to the camps and in the camps.

7. Challenges continued
A doctor spends extremely limited time with a patient – 8-10 min on average. Can he perform an examination on chronic condition , make a diagnosis, decide on the treatment, explain it all to the patient and prescribe the necessary drugs ?? What innovations can help to adapt Treatment Protocols to Humanitarian Emergencies for refugee patients with chronic conditions on a long term basis in a low resource setting like those from south Sudan in camps in northern Uganda?

8. Challenges continued
In the refugee camps, communicable diseases are the predominant causes of morbidity and mortality during the emergency phase of encampment. Timely and effective management of communicable diseases including malnutrition and trauma are crucial to avoid high mortality amongst refugees, coupled with the provision of essential requirements and services such as water, sanitation, food, shelter and immunization.
Reported deaths-sick, over crowding and exhausted
Double vulnerability-refugee patient
local and international communities prioritize communicable diseases such as malaria, cholera and malnutrition

9. Challenges continued
High prevalence of chronic non communicable conditions among adult refugees vs health services focused on the detection of infectious disease, with relatively limited data on chronic NCDs among refugees from S.sudan.
What are the implications for practice and policy
NCDs remains under-investigated
refugee patients medical records?
Access to medicine Vs Health workers and humanitarian staff
We need to ensure that refugees with chronic health problems from south Sudan in camps remain healthy for increased life expectancy

10. Insufficient Resources-Patients advocates rise voices
Main healthcare service providers for Sudan patient refugees include : Uganda Ministry of Health, Office of the prime minister, Local governments; United Nations High Commissioner for Refugees ; Real Medicine foundation; MSF; International Rescue Committee; Concern Worldwide and ACF (nutrition); patients advocates raising voices among other partners.
The need- UN has requested $781m (£625m) to care for the 1.6 million people coming out of South Sudan. So far, it has received just 8%.

11. Our thoughts
Fundraise and support refugee patients from south Sudan with chronic conditions
For Sudan refugees in Uganda, health services need to accommodate screening and treatment for chronic NCDs and NCD risk factors
Study to assess utilization and access of health services for chronic health conditions among refugees from s.sudan in camps in northern Uganda
Where are the rights of patient refugees with chronic conditions?
Where are resilient health systems during emergency health care for refugees to ensure access to health services?

12. Our thoughts
“We are at breaking point. Uganda cannot handle Africa’s largest refugee crisis alone,” said UN High Commissioner for Refugees Filippo Grandi. “The lack of international attention to the suffering of the South Sudanese people is failing some of the most vulnerable people in the world when they most desperately need our help.”
“Uganda has continued to maintain open borders,” said Rt. Hon. Ruhakana Rugunda, Prime Minister of Uganda. “But this unprecedented mass influx is placing enormous strain on our public services and local infrastructure. We continue to welcome our neighbours in their time of need but we urgently need the international community to assist as the situation is becoming increasingly critical.”
Upon receiving refugee status, refugees are provided with small areas of land in settlements integrated within the local host community; a pioneering approach that enhances social cohesion and allows both refugees and host communities to live together peacefully.

13. Our thoughts
Thank you