Striking Photographs of South Sudanese refugees in Uganda

Over 900,000 South Sudanese refugees are in need of humanitarian aid

Wednesday, May 24, 2017 — Uganda

"They just slaughter you, whether you're a man, woman, or child. I lost all my brothers and my relatives. Life here is very difficult. With no man, nobody helps you.” Maria* (not her real name), is just one of hundreds of thousands of refugees who have fled to northern Uganda since July 2016, following renewed violence in South Sudan. Over 630,000 refugees have since arrived in Uganda and thousands continue to arrive every week, bringing the total South Sudanese refugees and asylum-seekers to over 900,000. Uganda now hosts more refugees than anywhere else in Africa, accepting more refugees than the whole of Europe granted asylum to in 2016.

While those arriving are in relatively good health, many have stories of horrific violence in their place of origin or on their journey. The scale of the refugee influx has also pushed Uganda’s progressive refugee policies to the limits, overwhelming reception conditions and the government’s ability to respond.

“Despite the large-scale humanitarian mobilisation, the emergency response is still far from being sufficient, and many people have been left with insufficient water, food and shelter,” says Jean-Luc Anglade, MSF head of mission in Uganda. Many newly arrived refugees are forced to sleep under trees, and delays in food distributions and a lack of potable water have even prompted some refugees to return to South Sudan. In addition, despite over 85% of the new arrivals being women and children, and despite widespread reports of sexual violence in South Sudan, there are very few organisations responding to their specific protection needs. “As the flow of refugees shows no sign of abating, a sustained and long-term effort will be needed to assist these people over the next months, if not years,” says Anglade.

In addition to its operations in South Sudan, MSF has been responding to the humanitarian crisis in Uganda since July 2016, with medical and water and sanitation activities. MSF is currently working in four refugee settlements in the north-west, Bidi Bidi, Imvepi, Palorinya and Rhino; providing inpatient and outpatient medical care, maternity care, nutrition, community health surveillance, and water and sanitation. MSF also responded to an influx into Lamwo, on the border with South Sudan after an attack in Pajok, Eastern Equatoria, but has since handed over these activities to other organisations.

Access to water is one of the biggest challenges in the refugee settlements and MSF has been scaling up operations in water support. In Palorinya, MSF produces an average of 2 million liters per day from the River Nile, supporting over 100,000 people. MSF produced a staggering 52,519,000 litres of clean water in Palorinya in April alone.

“There is a never-ending cascade of challenges,” says Casey O’Connor, MSF Project Coordinator in Palorinya. “We can treat millions liters of water a day but it all needs to be trucked to water tanks in refugee settlements that are 150-250 square kilometers. After heavy rains, many roads become impassable. This leaves tens of thousands of people without water for days.  And in the rainy season, if people can’t get clean water, they will resort to using dirty, disease-ridden standing water. This can turn the health status of a population on its head – from relatively healthy to disease outbreak in a matter of days.”

In addition to responding to the refugee influx, MSF runs regular programmes in Uganda providing sexual reproductive health services for adolescents in Kasese, HIV/AIDS care for the fishing communities on lakes George and Edward, and viral load services in Arua regional hospital.

Doctors Without Borders (MSF) South Africa

A woman cooks posho (maize flour) on an open fire in a settlement within Palorinya refugee camp.<br/><br/>Food is scarce as rations are not regualrly distributed in parts of the camp so people eat what they can. Some have brought bags of casava, maize, and flour with them, others have to forage for food in the bush. Photographer: Fabio Basone/MSF
An MSF staff member adds chemicals to purify water at MSF’s water treatment plant in Palorinya refugee settlement, northern Uganda. MSF produces an average of 2 million litres per day from the Albert Nile River, which is delivered to tanks throughout the settlements by water trucks rented by UNHCR. Bad road conditions make it difficult for trucks to access all areas of the settlements after heavy rains, leaving several areas vulnerable to water shortages. <br/>By 5 May 2017, there were over 901,755 South Sudanese refugees in Uganda, with the number expected to rise to nearly one million by the end of the year. Some 86% of the South Sudanese refugees in Uganda are women and children under 18, and an average 2,000 new refugees arrive each week. Uganda is now the largest hosting country for South Sudanese refugees, and also the country hosting the largest population of refugees in Africa. Photographer: Yuna Cho/MSF
Photographer: Fabio Basone/MSF
Water pumps are seen at MSF’s water treatment plant in Palorinya refugee settlement, northern Uganda. MSF produces an average of 2 million litres per day from the Albert Nile River, which is delivered to tanks throughout the settlements by water trucks rented by UNHCR. Bad road conditions make it difficult for trucks to access all areas of the settlements after heavy rains, leaving several areas vulnerable to water shortages. <br/>By 5 May 2017, there were over 901,755 South Sudanese refugees in Uganda, with the number expected to rise to nearly one million by the end of the year. Some 86% of the South Sudanese refugees in Uganda are women and children under 18, and an average 2,000 new refugees arrive each week. Uganda is now the largest hosting country for South Sudanese refugees, and also the country hosting the largest population of refugees in Africa. Photographer: Yuna Cho/MSF
Clothes are hung out to dry as heavy rain drenched parts of Palorinya refugee camp, Uganda. In some parts of the camp people sleep under poorly constructed shelters which offer very little protection from the rain. The situation will only get worse, a rainy season approaches. Photographer: Fabio Basone/MSF
A water truck is stuck in the mud in Palorinya refugee camp, Uganda.<br/><br/>People take the opportunity to get much needed water when a water truck gets stuck in the mud after heavy rain. The impending rainy season will only make the situation worse as vehicles struggle to get around the camp. Photographer: Fabio Basone/MSF
Refugees gather to collect water at one of the water tanks in Palorinya refugee settlement. <br/>MSF produces an average of 2 million litres per day from the Albert Nile River, which is delivered to tanks throughout the settlements by water trucks rented by UNHCR. Bad road conditions make it difficult for trucks to access all areas of the settlements after heavy rains, leaving several areas vulnerable to water shortages. <br/>By 5 May 2017, there were over 901,755 South Sudanese refugees in Uganda, with the number expected to rise to nearly one million by the end of the year. Some 86% of the South Sudanese refugees in Uganda are women and children under 18, and an average 2,000 new refugees arrive each week. Uganda is now the largest hosting country for South Sudanese refugees, and also the country hosting the largest population of refugees in Africa. Photographer: Yuna Cho/MSF
A refugee from Kajo Keju, South Sudan sits with her suitcase in Palorinya refugee camp, Uganda. Thousands have fled here from neighbouring South Sudan after fighting erupted, bringing only what they can carry. Photographer: Fabio Basone/MSF
A water truck is seen at MSF’s water treatment plant in Palorinya refugee settlement, northern Uganda. MSF produces an average of 2 million litres per day from the Albert Nile River, which is delivered to tanks throughout the settlements by water trucks rented by UNHCR. Bad road conditions make it difficult for trucks to access all areas of the settlements after heavy rains, leaving several areas vulnerable to water shortages. <br/>By 5 May 2017, there were over 901,755 South Sudanese refugees in Uganda, with the number expected to rise to nearly one million by the end of the year. Some 86% of the South Sudanese refugees in Uganda are women and children under 18, and an average 2,000 new refugees arrive each week. Uganda is now the largest hosting country for South Sudanese refugees, and also the country hosting the largest population of refugees in Africa.<br/>population of refugees in Africa. Photographer: Yuna Cho/MSF
MSF staff members pause on the road to look at the location of a sample household in Palorinya refugee settlement, northern Uganda. <br/>MSF runs a health surveillance system in Palorinya to monitor and detect changes within the population and to help inform its medical and humanitarian interventions. <br/>Quotes from Sam Hoare, a public health physician who recently returned from Uganda where he was working on an emergency health surveillance system in Palorinya: “We also use the information and data to advocate for more services from other organisations that can support the refugee population with things like latrines or hand washing facilities.<br/>The team collects information about births, deaths and ill health from individuals through weekly household interviews, while also collecting medical data from health facilities in and around the settlement. Household interviews are a really important part of our data collection work, as we can build a better understanding of peoples lived experiences and needs, rather than only being exposed to those who are able to visit health facilities. <br/>In acute emergencies like this, when large communities are in chaotic new environments and new countries, it can be very difficult to understand their health status, making the population particularly susceptible to epidemics and diseases. Outbreaks of infectious diseases are common; in addition, the rainy season increases outbreaks of diseases like malaria, and often hinders access to health services. A functioning health surveillance system helps us detect changes in the health of the population, meaning we can respond to identified needs.<br/>We have trained a team of over 100 surveillance officers from within the refugee settlement in the hope that they are more familiar with local customs, language and culture, and can collect more accurate information on sensitive topics such as deaths. We use this data to inform medical activities, and project trends such as birth and death rates across. Photographer: Yuno Cho
Koboji John is a refugee from Kajo Keji, South Sudan, living in Palorinya refugee camp, Uganda. <br/><br/>Koboji has built a basic shelter for his family but is struggling to make ends meet. Photographer: Fabio Basone/MSF
A water truck is stuck in the mud in Palorinya refugee camp, Uganda.<br/><br/>People take the opportunity to get much needed water when a water truck gets stuck in the mud after heavy rain. The impending rainy season will only make the situation worse as vehicles struggle to get around the camp. Photographer: Fabio Basone/MSF
Nola Aniba Tito, 27, is one of the medical translators working in MSF health centre in Ofua 3 zone, in Rhino settlement. Originally from a town in the Equatoria region, she fled violence in South Sudan in July 2016 with her children and started working with MSF in March 2017. As 86% of all South Sudanese refugees in Uganda are women and children, Nola is one of the many female head of households. In this photo she is pictured with her baby, Aaron.<br/>Full testimony from Nola: “I was living with my two children and expecting another child. My husband was in Juba. In my neighborhood, everyone was fleeing because we were seeing child abduction, rape, looting, forced marriage, and killing between tribes almost every day. Schools were attacked and children slaughtered like chicken. If people from the other tribe come, they kill everyone from the other tribe and leave their own tribespeople. Moreover, there was no access to health care, especially after many NGOs left the country.<br/>One day, men knocked on the door of our house and threatened to open it. I was very scared so I didn’t open it, but instead carefully opened the window and saw them holding guns. I cried and shouted so much that neighbors came and the men just left. That’s when I decided to leave my home right away, without any belongings, just with my children and three of my brother’s children, who hasn’t been able to cross into Uganda. Even on the way to Uganda, there is fear of killing and violence and that is why my brother is still in South Sudan.<br/>I was lucky to make it to Uganda. But upon arrival in the camp, we found no water, no food, and no health services. Sometimes we had no water for more than a week. How can we live without any water to use and drink? I also had to walk a very long distance to the hospital outside the camp to deliver my baby, who is now seven months old. We left with nothing, not even a penny to buy food or to pay for transport to hospital. So the start of MSF health service. Photographer: Yuna Cho/MSF
A water truck rented by MSF is shown getting water from the groundwater in Rhino refugee settlement, northern Uganda. MSF produces an average of 2 million litres per day from the Albert Nile River, which is delivered to tanks throughout the settlement by water trucks rented by UNHCR. Bad road conditions make it difficult for trucks to access the whole camp after heavy rains, leaving several areas vulnerable to water shortage. Access to water is one of the biggest challenges in Rhino settlement. To reach certain areas, water trucks have to drive more than one-and-a-half hours one way, which during the rainy season may be delayed or made entirely impossible. On average in April 2017, the refugee population in Ofua zones received around 4.6 litres per person per day. MSF is working to improve the sustainability of the water delivery system by improving boreholes to bring the water source closer to the settlement. As of May 2017, MSF (OCP and OCA) is working in 4 refugee settlements, Bidi Bidi, Imvepi, Palorinya and Rhino; providing inpatient and outpatient care, maternity care, nutrition programme, and water and sanitation provision.<br/>By 5 May 2017, there were over 901,755 South Sudanese refugees in Uganda, with the number expected to rise to nearly one million by the end of the year. Some 86% of the South Sudanese refugees in Uganda are women and children under 18, and an average 2,000 new refugees arrive each week. Uganda is now the largest hosting country for South Sudanese refugees, and also the country hosting the largest population of refugees in Africa. Photographer: Yuna Cho/MSF
Esther Juru Iin this picture her extended family, including her elderly mother, far right) is a refugee from Kajo Keji, South Sudan. She fled over the border to Uganda after fighting erupted in her home town, and is currently residing in Zone 3, Palorinya refugee camp, where conditions are extremely poor. Her husband was killed during the conflict and she is now looking after her children and elderly mother alone. With no money to buy food or build adequate shelter she is forced to sleep under tarpaulin. Photographer: Fabio Basone/MSF