Both refugees and host communities in Uganda lack basic services such as water, sanitation and shelter, according to a study by the U.N. Children's Fund and Uganda's Economic Policy Research Center.
The main refugee hosting areas for the more than 1.4 million refugees in Uganda are in districts such as Yumbe, Moyo, Adjumani, Arua and Isingiro — among the country's poorest and least developed.
The issue is one of supply and demand, notes Ibrahim Kasirye, the principal researcher at the Economic Policy Research Center.
"The report shows that there are serious challenges in terms of implementation, especially when the government plan for a given number of [people in the] population, and the population that ends up using these services doubles within the same year in which these plans were made. The fact that they've had to deal with that huge number, their level of deprivation has increased," Kasirye said.
The report notes that 69 percent of refugees who have lived in the country more than five years don't have enough clean drinking water, while one-fourth lack sanitation and about a half are in need of shelter.
For members of host communities, about two-thirds do not have water and close to one-half lack sanitation.
Though Uganda has been praised for its progressive refugee policy, which includes providing the refugees with land for shelters, Diego Angemi, head of the social policy team at UNICEF-Uganda, says this is still a major challenge.
"When you look at it from the point of view of integration and if we believe that adequate shelter is a good proxy for integration, then refugee communities are now perfectly integrated with host communities," Angemi said. "But, we are still talking about one in two households, whether they are hosts or refugees, being deprived of adequate shelter, and that is simply not good enough."
Sixty percent of refugees in Uganda are below the age of 18, and thousands arrive unaccompanied. According to the report, 70 percent do not own a blanket, 84 percent do not eat three meals a day and nearly one half do not visit a health facility when ill or get the prescription medication needed to treat illnesses.
Additionally, out of five senior medical officers needed in an area, only two are available, says Manga Godfrey, assistant district health officer in the Adjumani district.
"We don't have medical officers, special grade pediatrics and to us, it's a gap. We also need that physician," Godfrey said. "Our disease burden is mainly malaria, intestinal worms, dysentery. Now, these two special-grade medical officers we have, may not help much if the issue of medicines and other health supplies is not addressed. Currently, we are receiving medicines from [the] National Medical Store every two months, but these medicines are planned for the host community only, excluding the refugees."
Researchers stress the need for government and international humanitarian organizations to go beyond emergency response and build systems and capacities for all social services in refugee-hosting districts.