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World: International Activity Report 2018

Source: Médecins Sans Frontières
Country: Afghanistan, Angola, Armenia, Bangladesh, Belarus, Belgium, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, Colombia, Côte d'Ivoire, Democratic Republic of the Congo, Egypt, El Salvador, Eritrea, Eswatini, Ethiopia, France, Georgia, Germany, Greece, Guinea, Guinea-Bissau, Haiti, Honduras, India, Indonesia, Iran (Islamic Republic of), Iraq, Italy, Jordan, Kyrgyzstan, Lebanon, Liberia, Libya, Madagascar, Malawi, Malaysia, Mali, Mauritania, Mexico, Mozambique, Myanmar, Nauru, Nicaragua, Niger, Nigeria, occupied Palestinian territory, Pakistan, Papua New Guinea, Philippines, Russian Federation, Senegal, Serbia, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Sweden, Syrian Arab Republic, Tajikistan, Thailand, Turkey, Uganda, Ukraine, United Republic of Tanzania, Uzbekistan, Venezuela (Bolivarian Republic of), World, Yemen, Zambia, Zimbabwe


By Dr Marc Biot, Dr Isabelle Defourny, Marcel Langenbach, Kenneth Lavelle, Bertrand Perrochet and Teresa Sancristoval, Directors of Operations

In 2018, Médecins Sans Frontières (MSF) teams provided medical and humanitarian assistance to people facing extreme hardship in over 70 countries. From treating war-wounded ever closer to frontlines in Yemen, to responding to epidemic outbreaks such as cholera in Niger, or providing assistance to people fleeing violence in the Central African Republic, emergency response continued to be a core part of our work.

As 2018 drew to a close, the Democratic Republic of Congo (DRC) was in the midst of its second Ebola outbreak of the year, and its biggest ever. MSF was part of the response, led by the Ministry of Health. Although rapid and well-resourced, with teams having access to a promising new vaccine and several new drugs with the potential to better protect and treat people, the response, and those managing it, failed to adapt to people’s priorities, and to gain the trust of the community. This lack of trust in the health services meant people delayed or avoided seeking treatment. By the end of the year, the epidemic in North Kivu and Ituri provinces had claimed more than 360 lives and in some areas was still not under control.

Seeking care in war zones

Early in the year, Syrian civilians and medical staff were caught in the violence in Idlib, in the northwest, and in East Ghouta, near the capital Damascus. In East Ghouta, the barrage was relentless in February and March, with waves of dead and injured arriving at MSF- supported hospitals and health posts. As the siege blocked incoming aid, medical staff had few medical supplies to work with. By the end of the offensive, 19 of the 20 hospitals and clinics we supported were destroyed or abandoned, leaving civilians with few options to seek medical help.

The war in Yemen, which has left the country and its healthcare system in ruins, entered its fourth year. The Saudi- and Emirati-led coalition continued to target civilian areas with airstrikes and bombings, including our new cholera treatment centre in Abs. The war is taking a heavy toll on people, who often must negotiate constantly changing frontlines to find care for their war- wounds or their general medical needs. Yemen was the country where our teams treated the highest number of war-wounded in 2018, over 16,000 people. After a major offensive was launched in Hodeidah in June, doctors in our Aden hospital treated Hodeidah residents who had been driven for six hours, the majority of them in a critical condition. Conflict intensified on several frontlines at the end of the year, leading to an influx of people with war-related injuries. We also treated more than 150 people wounded by mines planted by Houthi-led Ansar Allah troops around Mocha. Constant attacks on our staff and patients at facilities in Ad Dhale forced us to withdraw from the town in November.

Uganda: UNICEF Uganda Humanitarian Situation Report – May 2019

Source: UN Children's Fund
Country: Burundi, Democratic Republic of the Congo, Kenya, South Sudan, Uganda


  • Nearly 11,200 refugees from the Democratic Republic of the Congo (DRC) and South Sudan arrived in Uganda in May, bringing the total population of new arrivals since January 2019 to approximately 44,000 people.

  • With UNICEF support, over 18,800 children were immunized against measles in refugee-hosting districts.

  • Over 412,000 children aged 6-59 months have received Vitamin A supplementation in West Nile since the beginning of the year.

  • Following several months of dry weather that threatened crop and livelihoods in eastern Uganda, rainfall levels increased towards the end of May. However, severe food insecurity—particularly in the regions of Karamoja and Teso—is ongoing.

  • Since the start of the year, over 8,000 children with Severe Acute Malnutrition (SAM) in Karamoja and across 12 refugee-hosting districts have been treated for SAM by the Government of Uganda (GoU) with support from UNICEF.

Situation Overview and Humanitarian Needs.


Uganda remains the largest refugee-hosting country in Africa with over 1.2 million refugees and asylum-seekers, according to UNHCR and the Office of the Prime Minister (OPM). Approximately 815,831 people are from South Sudan, 339,476 from the DRC, 39,647 from Burundi, and 29,170 from Somalia. Over 44,000 refugees from South Sudan and DRC arrived in the period January to May 2019.
Despite the signing of the Revitalized Agreement on the Resolution of the Conflict in the Republic of South Sudan (R-ARCSS) on 11 September 2018, the humanitarian situation in the country remains grave, with UNHCR, OPM, UNICEF, and other partners preparing for a possible surge in refugee arrivals from the Equatoria region of the country in the wake of reports of deteriorating security conditions. Preliminary reports indicate that a majority of South Sudanese in Uganda are not willing to return home due to insecurity, generalized violence, and a lack of political stability. UNICEF and humanitarian partners are continuing to prepare for a similar surge in new arrivals from eastern DRC due to security concerns.
In May, OPM, UNHCR, and partners launched the revised Refugee Response Plan (RRP) for Uganda for 2019-2020, calling for more funding to support refugees and host communities given anticipated increases in the refugee population (from 1.25 million to 1.3 million) by the end of 2020. The plan, which stands at US$ 927 million for 2019 alone, was revised downwards following verification of the numbers of refugees registered in Uganda in 2018.1 The plan articulates ongoing needs to support emergency response, restoration of the environment, and support to livelihoods.

Disease Outbreaks

Ebola Preparedness and Response: By the end of May 2019, the Public Health Emergency Operations Centre at the Ministry of Health (MoH) had not reported any suspected or confirmed cases of EVD in Uganda. However, by 11 June, there were three confirmed EVD cases in Kasese district in Uganda. The three individuals had travelled to Uganda from the DRC, and all three have since died. The UNICEF response to the confirmed cases of Ebola is being reported in a separate EVD Situation Report. The EVD section of this report relates to UNICEF’s preparedness efforts in May.
Uganda remains the most at risk country in the region for cross border importation of EVD. Since August 2018, UNICEF, in partnership with the Uganda Red Cross Society (URCS) and district health teams, has supported MoH in reaching over 2.3 million persons with information on Ebola prevention, control, reporting, and care-seeking through approximately 340,000 household visits and 14,000 community group meetings at primary schools, churches and mosques, market places, bus stops, and funeral gatherings.
Measles Outbreaks: A total of 91 districts (71 per cent of all districts in the country) have investigated at least one suspected case of measles in their jurisdiction. The Ministry of Health has tasked all districts with conducting active searches for measles cases in their health facilities and communities to increase detection and reporting. In May, UNICEF supported the government in immunizing a total of 18,882 children against measles, bringing UNICEF’s achievement against the 2019 target to 30 per cent.
Yellow Fever Virus: In May 2019, MoH declared a yellow fever outbreak after cases were reported in Masaka and Koboko districts, in central and northern Uganda respectively. The rapid response teams of the MoH, in collaboration with district teams, conducted contact tracing and monitoring of line-listed contacts of the index cases. Additionally, MoH drafted a request to the International Coordination Group on vaccines for a reactive campaign in the two affected districts.

Hydro-Meteorological Conditions

Dry Conditions in Karamoja and Teso Regions: Regional monitoring reports show that rainfall from March to mid-May was below 80 percent of the country’s average, delaying planting by four to six weeks in north-eastern Uganda.2 By mid-May, above-average rainfall was reported in the northeast, which may nevertheless produce below-average yields in much of the region. By the end of May, pastoralist populations were reported to have returned to the area after having left in search of pasture and water earlier in the year. The situation continues to be monitored, with UNICEF’s main concern being the overuse of and stress on existing boreholes during the extended dry season, which has led to extensive mechanical failures with the infrastructure.

Uganda: UNICEF Uganda Humanitarian Situation Report – April 2019

Source: UN Children's Fund
Country: Burundi, Democratic Republic of the Congo, Kenya, South Sudan, Uganda


  • UNHCR, the Office of the Prime Minister (OPM), and partners are preparing for a possible surge in refugee arrivals from the Democratic Republic of the Congo (DRC) and South Sudan due to reports of deteriorating security conditions in both countries, along with increased Ebola cases in eastern DRC.

  • Integrated Phase Classification (IPC) analysis for January to March 2019 indicated that 475,200 people were facing severe food insecurity in the Karamoja and Teso regions, with food security expected to continue to deteriorate through June.

  • A total of 2,013 children (987 boys, 1,026 girls) were admitted for treatment of severe acute malnutrition in refugee districts and in Karamoja.

  • With UNICEF support, over 57,000 children (27,329 boys and 29,932 girls) were immunized against measles in refugee-hosting districts.

  • A total of 1,063 unaccompanied and separated refugee children (551 boys and 512 girls) in alternative-care placements in West Nile benefitted from follow-up visits, placements, and referrals by UNICEF and partners.

Situation Overview and Humanitarian Needs

Situation of refugees: Uganda continues to host 1,256,729 refugees and asylum seekers, with approximately 815,831 individuals from South Sudan, 339,476 from the Democratic Republic of the Congo (DRC), 39,647 from Burundi, and 29,170 from Somalia, according to UNHCR and the OPM. This year, joint border monitoring reports by UNHCR and OPM have documented the arrival of more than 33,000 new refugees, most of whom are from either South Sudan (15,000) or DRC (16,500).

Following recent reports of refugees voluntarily returning to South Sudan, UNHCR confirmed that despite the signing of the Revitalized Agreement on the Resolution of the Conflict in the Republic of South Sudan (R-ARCSS) on 11 September 2018, the humanitarian situation in the country remains grave. By the end of 2018, nearly 1.87 million South Sudanese were internally displaced, while another 5.7 million needed life-saving assistance. Of the spontaneous refugee returnees to South Sudan who have been monitored by humanitarian actors, 85 per cent are reported to be living in IDP-like conditions. Many are unable to return to their places of origin or recover property or land they left behind.1 This suggests that the returns to South Sudan may be temporary. Going forward, UNHCR, OPM, and partners are preparing for a possible surge in refugee arrivals from the Equatoria region of South Sudan in the wake of reports of deteriorating security conditions. A similar surge in refugee arrivals from eastern DRC due to security concerns and Ebola may also occur in the upcoming months.

The Ministry of Health (MoH), with support from UNICEF and partners, organized annual planning meetings for all districts, including those hosting refugees, to support the development of integrated district health plans responsive to the needs of both refugees and host populations and inclusive of support of all development partners operating at decentralized level.

The plans for refugee hosting districts are informed by the Health Sector Refugee Response Plan launched in January 2019 and are intended to provide a comprehensive picture of needs, available support and remaining gaps in health sector at the district level. These plans will bridge humanitarian and development nexus in the refugee hosting districts and are expected to contribute to the national objective of improving the health status of host communities and refugees through building a resilient health system that guarantees sustainable and equitable access to essential health services.

United Republic of Tanzania: UNICEF Eastern and Southern Africa Regional Humanitarian Situation Report – Quarter 1, 2019

Source: UN Children's Fund
Country: Angola, Burundi, Democratic Republic of the Congo, Eswatini, Lesotho, Madagascar, Malawi, Mozambique, Namibia, Rwanda, South Sudan, Uganda, United Republic of Tanzania, Zambia, Zimbabwe


  • The ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC) continues to threaten neighbouring countries including Uganda, Burundi, Rwanda, South Sudan, Tanzania and Zambia. UNICEF continues to play a key role in the UN wide Ebola prevention and preparedness response, reaching more than 65,000 people with key Ebola messages and EVD prevention supplies.

  • More than 25,000 children have been vaccinated against measles and approximately 60, 000 refugees and host community members accessed safe water for drinking, cooking and personal hygiene.

  • Rwanda, Tanzania and Zambia host almost 530,000 refugees and asylum seekers, largely from Burundi and the DRC. UNICEF and partners ensured quality and equity-based education for more than 112,000 refugee children in Tanzania, Rwanda and Zambia.

  • UNICEF continues to strengthen community surveillance and referral systems through active case management of acute malnutrition throughout the region. From January to March, 548 children were admitted for treatment of severe acute malnutrition (SAM) in Eswatini, Tanzania and Zambia, including 376 refugee children with SAM in Tanzania.

Regional Situation Overview & Humanitarian Needs

The Eastern and Southern Africa region (ESAR) is affected by recurrent disasters that are undermining the hard-fought development gains of recent years and resulting in major social and economic setbacks. In Eswatini, Lesotho, Rwanda, Tanzania, Zambia - the countries covered by this report- more than 1.6 million people, including over 790,000 children, are in need of humanitarian assistance due to climate-related shocks, health emergencies and displacement.

The Ebola Virus Disease outbreak in the North Kivu and Ituri provinces of the DRC continues to threaten neighbouring countries. As 1 April, more than 1100 people have been infected with the disease, including over 692 deaths since the outbreak was declared on 1 August 2018 (WHO). The response to the outbreak has been hampered by insecurity, frequent movement of people in the affected areas, and resistance from some communities, creating a high-risk of cross border transmission into neighbouring countries in the region. In response to this risk, UNICEF, along with the UNCTs, intensified preparedness levels against Ebola importation in Uganda, Burundi, South Sudan and Rwanda (priority one countries) and Angola, Tanzania and Zambia (priority two countries). Rwanda has 10 districts bordering the DRC and Uganda, and there are more than 10,000 daily travelers between Goma and Rwanda resulting in a high level of risk. During the reporting period, EVD was contained to the DRC and no confirmed cases in the ESAR.

Displacement continues to drive high assistance needs with 4.1 million refugees in the region - 25% of the total global refugee population. South Sudan and Burundi are the main sources of origin for refugees in ESA, while Uganda, Ethiopia, Angola, Tanzania and Rwanda are the main host countries. Armed conflict and political instability in South Sudan, Burundi and the DRC has led to growing humanitarian needs for children and their families, who have been forced to flee into neighbouring countries. Almost 60 per cent of the refugee population are children across the region. Between January and March, some 17,843 Congolese fled to neighbouring countries, with a significant increase in refugee flows to Uganda (UNHCR).

By March 2019, Tanzania hosted 325,291 refugees and asylum seekers. Of these, 282,650 are hosted in three refugee camps in Kigoma region (Nduta, Mtendeli and Nyarugusu), while 42,000 reside in villages and settlements across northwestern Tanzania. The majority of the refugees are Burundians (198,177 who have sought asylum in Tanzania since 2015). This number is added to the caseload of 84,473 refugees from DRC, many of whom have lived in Tanzania for the past 20 years. Fifty six percent of the refugee population are children under 18 years, and children under five comprise 20 per cent of the refugee population. Additionally, there are more than 7,500 unaccompanied and separated children in the camps receiving protection services. Tanzania has not received new asylum seekers from Burundi in either 2018 or 2019, which may be due to the continuing restrictions on access to territory since 2017, including closure of all border entry and reception points for Burundian asylum seekers in 2018.

Voluntary repatriation of Burundian refugees resumed in February 2019, after a temporary hold in mid-December 2018 due to lack of resources. The number of refugees registering for voluntary repatriation has decreased in 2019, with more than 50 per cent retractions, no shows and convoy dropouts reported since November 2018. Since the beginning of the voluntary repatriation exercise in September 2017, a total of 61,342 Burundian refugees have been assisted to return and another 20,000 refugees have shown interest to return. During the reporting period, 5278 Burundi refugees were returned to Burundi from Tanzania through the assisted repatriation programme.

According to UNHCR, there were 148,323 total refugees and asylum seekers in Rwanda as of 31 March. Of the total, 70,570 are individually registered Burundian refugees, while 75,212 are from the DRC. In addition, there were 642 groupregistered Burundian refugees and 1,848 Congolese asylum seekers. From January to March, there were 834 new arrivals (UNHCR). Children makeup 49 per cent of the Burundian refugee population. The Government of Rwanda established Mahama Refugee Camp in April 2015, which hosts 59,319 Burundian refugees, making it the largest refugee camp in Rwanda. In addition, there are over 12,000 Burundian refugees in the urban areas of Kigali and Huye.

By the end of March, there were 78,938 persons of concern 56,082 refugees and asylum seekers in Zambia (UNHCR). Of these, 45,805 are from the DRC and are 14,136 registered refugees (58 percent are children) residing in Mantampala settlement. Following the relative peace after the presidential election in the DRC, the number of refugees in Mantapala refugee settlement has remained stable with only 36 new arrivals in 2019. A smaller number of refugees and asylum seekers are from Burundi (5,583) and Somalia (3,262).

Food insecurity in southern Africa started atypically as early as September 2018 in some countries due to the poor 2018 harvest from prolonged dry spells during the second half of the 2017/2018 rainy season. Prolonged seasonal rainfall deficits since the beginning of the southern African monsoon have negatively impacted the grounds of many countries in the region, including southern Angola, northern Namibia, southern Zambia, and northern Zimbabwe. Many areas across the region are experiencing Crisis and Emergency (IPC Phase 3 and 4) outcomes. October 2018 to March 2019 IPC Regional Map showed areas of concern as southern Malawi, most of Zimbabwe, Grand Sud of Madagascar, southern Mozambique, western Zambia, southern Lesotho, and eastern Eswatini.

According to the findings of the November 2018 IPC assessment in Lesotho, an estimated 325,318 people (273,635 people in rural areas and 51,683 people in urban areas) are in need of humanitarian assistance. In the same period, Maseru, Mohale’s Hoek, Qacha’s Nek and Quthing districts were projected to be IPC Phase 3 (Crisis) or higher while the other six districts were projected to be in IPC Phase 2 (Stressed). Due to the deterioration of the humanitarian situation, the Government of Lesotho and partners undertook a rapid needs assessment in March 2019. The first set of results showed that 487,857 people (407,191 in rural areas and 80,666 in urban areas) are currently in need of humanitarian assistance, especially in the WASH, Health, Nutrition, Child Protection and HIV/AIDS sectors. Furthermore, 640,000 people in rural and urban areas are projected to be food insecure during the period July 2019-June 2020. According to the Lesotho Meteorological Services, in the period March-May 2019, below-normal rainfall is projected, further increasing the possibility of a negative impact on the winter planting and harvest.

In Eswatini, the 2018/2019 seasonal projection by the Department of Meteorology indicated normal to below normal rainfall from January to March 2019. However, cyclone activity along the Mozambican channel (peaking in January to February) influenced the weather pattern, which resulted in above normal rainfall, with national rivers reaching full capacity. With the current rainfall addressing drought projections, the Government focus has been on food insecurity as a result of limited crops. Food security remains a high priority with children at risk of severe acute malnutrition. The June 2018 Vulnerability Assessment and Analysis (VAA) report found that 165,723 people (79,547 children) are faced with acute food insecurity in the lean season.

In Zambia, the 2018/2019 season rainfall forecast was largely influenced by weak state of the El Nino Southern Oscillation and the country faced prolonged dry spell conditions especially in southern and western Zambia representing 51 out of 110 districts in Zambia. This impacted negatively on water supply and crop condition especially on the rural farming households; with projection of increased basic food prices, poor harvest for subsistence farmers, depletion of animal stock and drying of sources of water for humans and animals.

South Sudan: UNICEF South Sudan Humanitarian Situation Report – March 2019

Source: UN Children's Fund
Country: Burundi, Democratic Republic of the Congo, South Sudan, Uganda


  • Integrated Food Security Phase Classification (IPC) projections for February to March, indicate 57 per cent of the population will face acute food insecurity or worse. Currently, UNICEF is funding gap of 42 million in nutrition section. There is a high-risk of a ready-to-use-therapeutic food (RUTF) pipeline break during the last quarter of 2019, if adequate funds are not mobilized before September 2019.

  • On 26 March, the EU-funded Education in Emergency programme was launched in Aweil, Northern Bahr el Ghazal. The programme will be jointly managed by UNICEF and the World Food Programme (WFP), the largest collaboration ever between these two agencies in the field of education in South Sudan. Lasting two years, it aims to reach 75,000 children (33,000 girls) in 150 schools, providing them with access to quality education and school feeding.

  • In the response to the measles outbreak in two Melut and Aweil South counties, reactive measles vaccination campaigns were initiated, targeting 15,502 and 22,071 children aged 6 months to 5 years in Melut and Aweil South respectively.


1.92 million
Internally displaced persons (IDPs)
(OCHA South Sudan Humanitarian Snapshot, February 2019)

2.29 million
South Sudanese refugees in neighbouring countries
(UNHCR Regional Portal, South Sudan Situation 28 February 2019)

5.25 million
South Sudanese who are severely food insecure
(January-March 2019 Projection, Integrated Food Security Phase Classification)

Situation Overview and Humanitarian Needs

According to the Integrated Food Security Phase Classification (IPC) projections for February to March 2019, a total of 6.5 million people or 57 per cent of the population will be in crisis (IPC phase 3) acute food insecurity or worse, including 45,000 in catastrophe (IPC phase 5). Approximately 860,000 children under five estimated to be acutely malnourished including over a quarter million with severe acute malnutrition (SAM). To reach 2019 targets, UNICEF must to mobilize USD 42 million before September 2019 for the RUTF procurement and frontline cost of the programme. There is a high-risk of an RUTF pipeline break during the last quarter of 2019, if UNICEF fails to mobilize adequate resources before September 2019.

The decrease of hostilities following signing of the Revitalized Agreement on the Resolution on the conflict in South Sudan (R-ARCSS), as well as proactive efforts by UNICEF and partners to expand access, has led to incremental but consistent gains in access in many parts of South Sudan. Key road and river routes remain open in Jonglei, Unity and Upper Nile states, improving access to vulnerable people and the transport of supplies for both static and integrated rapid response mechanism (IRRM) programmes. In Western Bahr el Ghazal, UNICEF and partners are exploring ways to expand service provision to displaced communities in Greater Baggari. And through the joint efforts of WFP and UNICEF together with community leaders, the road from Raja to Dolo was opened, enabling the first road-based IRRM mission to the location since services began in early 2018. After several access denials to Koyoki and Birigo in southern Central Equatoria state, UNICEF contributed to successful advocacy efforts by OCHA to secure the agreement of state government officials to enable consistent humanitarian access. And with the decrease in hostilities in the Yei area, humanitarians including UNICEF are beginning to access locations outside of Yei town for the first time since December 2018.

At the same time, UNICEF and its partners continue to face a number of access challenges in reaching vulnerable women and children. UNICEF and partners faced 12 recorded access incidents in March, mostly due to operational interference and violence / intimidation of humanitarian personnel and contractors. Several IRRM missions in Jongeli and Upper Nile were suspended indefinitely due to opposition by state authorities for WFP to biometrically register the population. Several incidents of the looting of nutrition supplies took place in Jongeli following clashes near outpatient treatment centers. In southern Central Equatoria, a humanitarian assessment mission to Koyoki and Birigo was denied access for the second time by state government authorities. And several clashes between state security forces and armed youths in Unity and Upper Nile led to the temporary suspension of humanitarian activities and/or the relocation of humanitarian staff.

Uganda: UNICEF Uganda Humanitarian Situation Report – March 2019

Source: UN Children's Fund
Country: Burundi, Democratic Republic of the Congo, Kenya, South Sudan, Uganda


  • Uganda remains free of Ebola Virus Disease (EVD) as of March 2019. UNICEF is supporting the Ministry of Health (MoH) in extending the National Ebola Preparedness Plan through to September 2019 due to the continued risk of disease importation from the Democratic Republic of Congo (DRC).

  • During the reporting period, 43,364 children (20,249 boys and 23,115 girls) were immunized against measles in refugee-hosting districts.

  • A total of 399 unaccompanied and separated refugee children (199 boys and 200 girls) in alternative care placements in West Nile benefitted from follow-up visits, placements, and referrals by UNICEF and partners.

  • UNICEF, in collaboration with MoH and Uganda’s Infectious Diseases Institute, conducted mentorship and coaching for 45 health workers in West Nile focusing on the elimination of motherto-child transmission of HIV/AIDS (e-MTCT) among refugees and host communities.

  • Concerns about the food security and the nutrition situation in Karamoja and Teso have been raised due to drier-than-usual conditions in March and forecasts of below-average rainfall for April.

Situation Overview and Humanitarian Needs

According to UNHCR and Office of the Prime Minister (OPM), Uganda is host to 1,223,033 refugees as of 28 February 2019, with 95 per cent living in settlements in 11 of Uganda’s 128 districts, and five per cent living in Kampala. Sixty per cent of the refugee population are children. Most refugees are from either South Sudan (801,555), the DRC (326,383), or Burundi (36,256). According to UNHCR, while the refugee influx from South Sudan to Uganda continues, there are recent reports of voluntary returns to South Sudan. UNHCR and OPM are following up with colleagues in South Sudan to ensure the safety of voluntary returnees. If such information is confirmed, the Uganda contingency plan for refugees from South Sudan will be revised accordingly.

Ebola Preparedness and Response Overview: Uganda remains Ebola Virus Disease (EVD) free as of March 2019, although the risk of EVD importation remains very high given the continuous spread of EVD in DRC and significant cross-border population movements from DRC into Uganda. Surveillance of border points and community-based surveillance for EVD continues, including coordinated cross-border contact tracing, to ensure prompt detection of EVD cases and timely initiation of management and control activities.

Measles Overview: Uganda continues to experience measles outbreaks in 38 districts (nine of which are refugee-hosting). Outbreaks are attributed to frequent stock-outs of measles vaccines at the district and health facility levels, compounded by irregular outreach activities. The basic causes are related to chronic underfunding of traditional vaccines, stagnated funding for primary health care services in the context of rapid population growth, and delayed implementation of measles Supplementary Immunization Activities (SIAs).

Climate change: Concerns about the food security and nutrition situation in Karamoja and Teso have been raised due to drier-than-usual conditions in March and forecasts of below-average rainfall for April. The impact of poor rainfall on food security and nutrition could be serious as 2019 could become a second failed season for Karamoja after a below-average season in 2018. SAM admissions in the last few months have shown a higher trend than in previous years.

The District Water Officers in Nakapiripit, Kaabong, Amudat and Moroto do report some water stress although figures are not provided yet. In Loro sub county in Amudat a number of boreholes have dried up, forcing people to move long distances in search for water; while in Nakapiripirt, the pressure from incoming cattle from the Pokots from Kenya, is being felt and some pastoralists migrated with their herds to Teso.

South Sudan: Migration Health (2018 Annual Report)

Source: International Organization for Migration
Country: Democratic Republic of the Congo, South Sudan


In 2018, the IOM health team served more than 862,223 individuals across South Sudan, including
residents of three Protection of Civilian...

World: Children with chronic diseases need our attention

Source: Médecins Sans Frontières
Country: South Sudan, World

While children with chronic diseases – such as heart disease, diabetes, asthma, and epilepsy – are not the majority of MSF's paediatric patients, the needs of these children equally need attention and treatment. Deputy Medical Director Myrto Schaefer explains in this interview some of the diseases our teams see in children in the contexts we work in, and the challenges we face in trying to treat these kids, often in areas of conflict.

What are paediatric non-communicable diseases (NCDs)?

According to the World Health Organization (WHO) an estimated 7 out of 10 deaths worldwide are due to non-communicable diseases (NCD), with over 80 per cent of them occurring in low- and middle-income countries. Although ‘only’ four per cent of deaths will occur in people under the age of 30, the majority of deaths in adults are linked to conditions or behaviours in childhood or adolescence, such as smoking, lack of exercise, poor nutrition or heavy drinking.

Meanwhile, there are chronic diseases that occur in childhood and affect the well-being and the lives of children. Diseases such as rheumatic heart disease, congenital heart disease, type 1 diabetes, asthma; specific cancers such as leukaemia and lymphomas; epilepsy; and diseases of the blood such as Thalassaemia or Sickle Cell Disease. In addition to that, 10-20 per cent of children and adolescents experience some sort of mental disorder.

The term ‘non-communicable diseases’ is a little bit misleading because it suggests that they have no infectious origin. This may be true for many of the diseases we are talking about, but not for all. When we talk about NCDs, very often we mean chronic diseases, irrespective of the origin. They are characterised by their duration.

Why is the topic of paediatric non-communicable diseases emerging now in the context of humanitarian response?

In developing countries, the big challenge with chronic diseases is that we are working in contexts where health systems are often not equipped to deal with them. Particularly in paediatrics, often health systems are so overwhelmed with acute diseases like malaria, respiratory infections or diarrhoea, and already struggle to cope with that. There are often no models to respond to children with chronic diseases in such contexts. This challenge was already brought to light when we trying to respond to kids living with HIV, so it is not new.

Without a healthcare response, chronic disease still exists but is just less visible.

In an emergency, once again, the needs often seem overwhelming, and MSF must first work to avoid death and suffering caused directly by the emergency. But very quickly we also have to assess what the population wants and what their general health needs are beyond the emergency. This includes chronic disease care and continuity of care, in some instances care that was available prior to the emergency. When we started working with Syrian refugees in Lebanon, for example, we quickly released that chronic disease care constituted a big part of what this population really needed.

In conflicts and emergencies, when the priority seems to be to save lives, how can we integrate paediatric non-communicable diseases into our humanitarian response?

It’s true that when deciding where to spend our time, energy and money, there are competing priorities with those diseases that kill immediately. For instance, in South Sudan we are currently treating 48 children with diabetes but in South Sudan what kills exponentially more children is not diabetes but malaria, respiratory diseases, diarrhoea, etcetera. Compared to that, the numbers of diabetes deaths are miniscule, even if every child who presents with diabetes has a 100 per cent certainty of dying if not treated. So why should we invest a lot in diabetes?

In fact, you could argue that diabetes and other chronic diseases affecting children are neglected diseases. So, in this project in South Sudan for example, the big discussion has been: should we treat children with diabetes if we do not know what care they will receive in the long term?

Should we let the child who comes in a diabetic coma die although we have insulin even if we don’t know how to provide quality long-term care? The child might suffer from complications such as blindness in a few years— diabetes has many complications if you don’t control it correctly. Or, should we give the child the chance to survive and invest resources in finding improved models of care and maybe one day she or he will be lucky to have access to better care?

What are the challenges to including paediatric non-communicable disease care in MSF projects?

As mentioned above we don’t see many models of functional integrated chronic care in developing countries, including the necessary continuum of care, and this is particularly lacking in poor, rural settings. Often there is no disease awareness regarding chronic disease, neither by the patient or the caregiver, nor by the health worker. Or by the time the disease is obvious it is often well-progressed and there is no knowledge of how to treat it. Most health workers in these countries have never been trained on any chronic diseases.

There is also a big problem with access to adequate medication. Treating children with chronic disease means availability of specific medication according to the age and adapted to climatic conditions (such as heat); there is a question of cost, and of course of quality and sustainable supply.

Referral to higher levels of care is often not feasible or affordable, and it is questionable whether that care would be helpful at all.
In general, due to a lack of experience and expertise on the ground, mounting a feasible response often requires additional resources. So we need to be inventive and think about how we can equip our teams to respond efficiently to those diseases, but in a “simplified” way. In high-resource settings we usually have a lot of specialists and although drugs might be expensive, they are usually available and the necessary support systems, such as education, are there. In MSF there is no way that we can send all those specialists to our projects, so we need to find good models of care with simplified protocols and support through other channels, such as telemedicine.

In addition, to successfully address chronic diseases, the patient and/or caregiver need to understand and develop ownership of how to deal with the disease. This requires patient education which has to be age- and patient-adapted. Overall, MSF is still very far from this.

If we decide to get further involved, we can have a big role to play here: identifying the gaps, finding better-adapted solutions and pushing for them.

Why is MSF discussing treating paediatric non-communicable diseases now?

For sure, children with non-communicable or chronic diseases are not the majority of our patients, but they do exist and there are a number of chronic conditions we could potentially address. We have started addressing some of these, such as Thalassaemia or epilepsy for example, but we still have a very long way to go. And we almost never talk about these patients and their needs. The last time we talked about chronic diseases in children was when addressing HIV. The topic of chronic diseases is too quickly put into the “too hard” basket. But we are well-placed to take up this challenge. Of course it will need investment and commitment. We have a lot to learn, from our patients and their families, from health workers, and from others working in this field.

Uganda: UNICEF Uganda Humanitarian Situation Report – February 2019

Source: UN Children's Fund
Country: Burundi, Democratic Republic of the Congo, South Sudan, Uganda


  • While Uganda remains the largest refugee hosting country in Africa, the refugee population figure reduced following a verification exercise conducted in 2018 and due to the lower than anticipated refugee influx from Democratic Republic of the Congo (DRC), South Sudan and Burundi.

  • Sixty per cent of the 1,223,033 refugees in Uganda are children who bear the brunt of the displacement and remain at risk of abuse, neglect, violence and exploitation.

  • A total of 29,541 children were immunized against measles by the Ministry of Health (MoH) with support from UNICEF and the Global Alliance for Vaccines and Immunization (GAVI).

  • Over 11,829 children affected by displacement were enrolled in Early Childhood Development learning in Adjumani, Arua and Yumbe refugee hosting districts.

  • About 106 district education actors were trained on Ebola Virus Disease (EVD) prevention and control in Kabale and Rukungiri districts focusing on basic Ebola epidemiology, mode of transmission, signs and symptoms and impact of the disease on child protection.

Situation Overview and Humanitarian needs

According to UNHCR and Office of the Prime Minister (OPM), Uganda is host to 1,223,033 refugees as of 28 February 2019. Of these, 95 per cent live in settlements in 11 of Uganda’s 128 districts, and five per cent live in Kampala. Sixty per cent of the refugee population are children. Most of the refugees are from South Sudan (801,055), the DRC (326,383) and Burundi (36,256). In February, a total of 9,751 new refugee arrivals crossed over, including (4,658) from DRC, (4,635) from South Sudan and (458) from Burundi, which represents an overall increase of 73 per cent from January when 5,900 arrived.

Uganda’s Refugee Response Plan (RRP) 2019-2020 is being revised and it is anticipated the exercise will be completed by mid-March. Compared to the initial projections (June 2018), RRP partners need to plan for 422,000 refugees less in 2019 and 431,000 refugees less in 2020. The refugee population figure in Uganda has reduced following a verification exercise conducted in 2018 and the lower than anticipated refugee influx from Democratic Republic of Congo (DRC), South Sudan and Burundi.

A recent survey was completed by Ground Truth Solutions (GTS) and the Organisation for Economic Co-operation and Development (OECD) on refugees and humanitarian staff in Uganda to understand how people affected by crises and humanitarian field staff perceive the impact of the Grand Bargain commitments. Among the key findings are that despite a modest improvement since 2017, most refugees (53 per cent) do not consider that aid covers their most important needs. Food, healthcare and education were identified by refugees as their primary unmet needs. This compares with 78 per cent of humanitarian staff, who believe that humanitarian aid and services adequately meet the needs and priorities of affected people. Provision of adequate education gives hope for the future (42 per cent), followed by security and peace (38 per cent) and adequate shelter and food (14 per cent). On the fairness of aid provision, refugees have mixed views, with 38 per cent saying that it does not go to those who need it most.

Orphans, people with disabilities, older persons and single mothers are perceived as the population groups most left out of aid programmes. Meanwhile, 92 per cent of staff consider that humanitarian programming adequately targets the most vulnerable population groups. The majority (56 per cent) of refugees surveyed do not see themselves as becoming more self-reliant. Respondents seem better informed about available services than in 2017, with almost half (46 per cent) saying they have the information they need. Yet, 43 per cent do not feel their views are considered in decision-making. A lack of beneficiary consultation, actions based on previous feedback given to aid providers, and a general opinion that there is inadequate respect for refugees and their rights are highlighted as obstacles to encouraging effective and meaningful refugee participation. In contrast, some 82 per cent of staff say they take refugees’ views into account when they make programme changes. Refugees remain positive about their ability to report abuse and mistreatment. Seventy per cent say they know how to make a complaint

Disease outbreaks

Ebola Preparedness and Response: At the end of the reporting period, Uganda remained EVD free. However, the risk of EVD importation remains very high. Contacts with Ebola cases travelling into Uganda have increased during the first quarter of 2019, with reports of people travelling to the DRC for burials of relatives and returning to Uganda without reporting their status. Community based surveillance for EVD cross-border activities between DRC and Uganda continues, including coordinated contact tracing.

A knowledge, attitude, practices and behaviour
(KAPB) survey on EVD was conducted by the Uganda Red Cross Society (URCS) who assessed risk perceptions and beliefs of people living in the high-risk communities of Bundibugyo, Ntoroko, Kabarole, Bunyangabu, Kasese, Kanungu and Kisoro districts in Western and South Western Uganda. The majority of respondents (88.6 per cent) had heard about EVD. Community volunteers (77.6 per cent), as well as radio spot messages, announcements, talk shows, disc-jockey mentions (76 per cent) constitute the main sources of information. Many respondents (85.3 per cent) also expressed fear of contracting EVD. A sizeable number of respondents indicated that EVD is can be treated by local herbalists (58 per cent). Only 48 per cent of respondents believe that the DRC Ebola outbreak could be imported into Uganda. The survey reported high-levels of potential stigma and discriminatory attitudes towards Ebola. The EVD risk communication messaging and engagement by multiple agencies continues to be revised to place more emphasis on propagating correct information on the misconceived views related to EVD transmission, prevention and treatment methods.

Cholera: As of 5 February, 53 cumulative cases of cholera had been listed with three community deaths (CFR = 5.7 percent) since the disease was reported on 4 January in Kampala District. As of 20 February, Kampala had completed 14 days without any new cholera cases; a WHO requirement to declare an end to the outbreak.

Measles: Uganda continues to experience measles outbreaks. As of 28 February, a total of 139 suspected measles cases from 38 districts (nine are refugee hosting districts) were investigated by the Expanded Programme for Immunization (EPI) laboratory, of which 33 samples from 12 districts were confirmed positive for measles specific immunoglobulin. Further analyses confirmed 23 cases were children under five years. Frequent stock-outs of measles vaccines at the district and health facility levels, compounded with irregular outreach activities, are the underlying factors contributing to the measles outbreak. The basic causes are related to chronic underfunding of traditional vaccines, and stagnated funding to primary health care in the context of the rapid population growth.

Uganda: UNICEF Uganda Humanitarian Situation Report – February 2019

Source: UN Children's Fund
Country: Burundi, Democratic Republic of the Congo, South Sudan, Uganda


  • UNICEF in collaboration with UNMISS and the National Disarmament,
    Demobilization and Reintegration (DDR) Commission, successfully released 121 children associated with armed groups (49 girls; 72 boys) on 12 February. Based on the registration exercise of the Country Task Force for Monitoring and Reporting (CTFMR), around 200 children are to be released in and around Nzara, Yambio town, Lirangu and James Diko town and another 100 from Unity state by end of July 2019.

  • The Back to Learning campaign for 2019 was officially launched in Renk, Upper Nile, on 04 February and mobilized communities around the importance of child enrolment. UNICEF supported the Ministry of General Education and Instruction (MoGEI) in organizing the event which included performances of song, dance and poetry by children from local schools as well as speeches by the Minister, State Governor and State Minister for Education, UNICEF’s Representative and a member of the Education Donors’ Group.

Situation in Numbers

1.92 million
Internally displaced persons (IDPs)
(OCHA South Sudan Humanitarian Snapshot, February 2019)

2.28 million
South Sudanese refugees in neighbouring countries
(UNHCR Regional Portal, South Sudan Situation 28 February 2019)

5.25 million
South Sudanese who are severely food insecure
(January-March 2019 Projection, Integrated Food Security Phase Classification)

Situation Overview and Humanitarian Needs

In February, UNICEF and its partners experienced both improvements and challenges in maintaining secure and predictable humanitarian access to women and children in various parts of the country. After fighting in earlier and mid 2018 in Unity, Jonglei and Western Bahr el Ghazal, state-level meetings between the SSPDF and pro-Machar SPLAiO have led to a temporary decrease in hostilities, which has expanded access in several states for UNICEF and its partners.

Road and river movements have improved in Jonglei and Upper Nile, facilitating UNICEF’s dry season prepositioning and delivery of IRRM supplies. UNICEF and partners continue to have predictable access to Greater Baggari, where an estimated 20,000 were recently displaced in the bush due to hostilities in the area. The force protection requirement has also been lifted from Wau to Raja and Wau to Yambio, easing the ability of UN humanitarian actors to respond in these areas. On the other hand, fighting continues in parts of Central and Western Equatoria between armed forces signed on to the R-ARCSS, and non-signatories from the South Sudan National Democratic Alliance (SSNDA). Fighting in Yei, Morobo, Lanya and Mukaya counties has displaced thousands of people and is limiting access to an estimated 15,000 people outside of Yei. This fighting is also hindering UNICEF’s ability to prepare frontline health facilities for potential Ebola cases and risk communication in the area.

UNICEF and partners also faced several restrictions of movement. An inter-agency assessment team was denied access to Lasu (Morobo County) by the SSPDF, preventing the verification of potential refugee returnees. In Raja, state security forces attempted to prevent an UNICEF-led inter-agency emergency response to Dolo, though the mission proceeded after successful access negotiations by UNICEF. An inter-agency assessment mission in Mundri East and West was also suspended at the suggestion of the National Salvation Front, who is present in the area.

Non-state civilian authorities under the pro-Machar SPLA-iO in Jonglei and Upper Nile also continue to impose excessive bureaucratic restrictions and interfere with operations. In Fangak, authorities continue to insist on direct payment of Personal Income Tax (PIT) on national staff despite these taxes having already been paid at the national level. Cattle raiding in Jonglei, Unity and Warrap –continues to negatively impact on access to vulnerable populations.

Looking forward, the trajectory of implementing the Revitalized Agreement on the Resolution of the Conflict in South Sudan (R-ARCSS) over the coming months will have a significant impact on humanitarian access, especially access to women and children. If security continues to improve with the relatively successful implementation of the peace agreement, there is likely to be a further increase in refugee returnees. If not managed and supported effectively, this could lead to inter-communal or inter-ethnic tensions that could hinder access to assist with their resettlement. On the other hand, continued delays or the failure to implement key provisions of the agreement will likely lead to the continuation and or renewed hostilities in several parts of the country, which would have a disproportionate impact on women and children, who are already the most vulnerable and with limited resilience to further violence.

The ongoing fighting in parts of Central and Western Equatoria is likely to continue, limiting access for both UNICEF’s regular programmes and Ebola preparedness activities. Local disagreements over peace implementation are beginning to emerge, particularly in Western Equatoria, Western Bahr el Ghazal and Unity, which could also lead to the renewal of conflict and limited access.
The Integrated Food Security Phase Classification (IPC) analysis report conducted in January and February 2019 was released by the Government of South Sudan on 22 February. The report highlights that between February and April 2019, in the presence of humanitarian assistance, about 6.5 million people (57 per cent of the total population) are projected to be severely food insecure (IPC Phase 3 and above) out of which 45,000 are in Humanitarian Catastrophe (IPC Phase 5). Comparing this projection to the same provided for 2018, the number of South Sudanese in IPC Phase 3 and above has increased 26 per cent in 2019. The food security situation in the country continues to deteriorate due to the cumulative effect of conflict-driven displacement, low crop production, economic crisis, climatic shocks and humanitarian access challenges.

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