Uganda: Crisis Preparedness and Emergency Response

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

2. 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

3. 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

4. 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 2006. Source: United Nations Office for the Coordination of Humanitarian Affairs (OCHA) Available at: www.reliefweb.int

5. 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 http://www.irinnews.org/S_report.asp?ReportID=51711&SelectRegion=East_Africa

6. 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)

7. 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

8. 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

9. Possible Measures to Support Stabilization • 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

10. Possible Measures to Support Stabilization • 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

11. Possible Measures to Support Stabilization • 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

12. 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