Hepatitis E Outbreak in Kitgum

I arrived in Kitgum yesterday to find UNICEF (as well as every other major NGO in the area), on emergency footing…

A Hepatitis E outbreak is sweeping the region. This dramatically altered my previous plans to work with a local school testing a new UNICEF communications strategy. Instead, I was quickly given a prominent role assessing the monitoring of the epidemic in a quickly constructed UNICEF rapid reaction team. We are rushing to put together a plan for social mobilization and preparing a proposal for emergency funding…

During twenty years of civil war in Northern Uganda, over two million people were displaced. The majority of these people live in camps spread throughout the region, consisting of hundreds of tiny huts packed tightly together in appalling conditions with limited access to water and, if they are lucky, a few rancid latrines.

Many livelihoods such as farming are an impossibility, as these internally displaced people (IDPs) have no legal access to land. Additionally, as they are not officially refugees (in that they have fled to a neighboring country), international organizations such as UNHCR have no mandate to provide basic services. A much anticipated peace deal with Joseph Kony, leader of the notoriously sadistic Lords Resistance Army responsible for the violent displacement and recently indicted war criminal, has fallen apart. As of yesterday, the government truce expired and Koney has pulled out of peace talks.

Kitgum, a large frontier town near the border of Sudan, was at the epicenter of the civil war. Surrounded by IDP camps, with serious water and sanitation concerns, the Hepatitis outbreak was a disaster waiting to happen. There have already been thousands of reported cases and rough estimates show around 100 deaths so far. However, because of disinformation, many IDPs are not forthcoming and deaths are being concealed. International NGOs are struggling to mobilize resources to address the problem, as cases are now appearing in nearby districts. Making matters worse, Kitgum itself has been without water or electricity for weeks.

This afternoon, after hastily receiving a security travel clearance, I was surprised to find myself representing UNICEF at an Emergency Task Force Assessment and Coordination Meeting in Paloga, one of the worst hit IDP camps in the region. I was joined by representatives from the other major organizations working in the sub-district, including the World Health Organization, Medecins Sans Frontiers, the International Refugee Committee, and Oxfam. We spent a couple of hours touring the IDP camp and assessing the impact of recent (and critically inadequate) interventions meant to improve hygienic conditions. In Paloga, these have not been effective in halting the spread of the outbreak.

One of the most serious problems at the camps was the latrine systems. Locally built latrines had collapsed earlier in the year due to floods and NGO donated latrines (similar to western versions) were not appropriate for local conditions. They are very cramped and closed, trapping heat, flies and the smell of festering feces inside. Additionally, there is no local ownership of the latrines, effectively ensuring they will never be cleaned without payment by outside organizations.

Additionally, because of poor harmonization of messages (primarily that Hepatitis has no cure), people are staying away from health clinics, and prices for chickens are skyrocketing as people seek help from local witchdoctors.

It will be a difficult couple of weeks as we fight to contain the spread of the epidemic. I don’t expect there will be much time to rest in the foreseeable future. After devising a work plan with my team this morning, we plan to be back in the IDP camps by midday.