Increasingly brutal attacks on civilians and abductions of children have led to widespread fear among people throughout the north. In addition to mounting an emergency response in Lira, Gulu, Soroti and Katakwi for people affected by the escalating conflict, MSF continues to treat people with infectious diseases such as HIV/AIDS, malaria and kala azar in remote parts of the country. In the past few months, MSF set up an emergency project responding to the needs resulting from the growing conflict in the northern part of the country.

Since armed attacks on the district started in November 2003, an estimated 230,000 people have sought refuge in nearly 30 makeshift camps located both inside the town of Lira and in rural areas throughout the district.

MSF teams helped staff at Lira Hospital treat people wounded in two major attacks during February 2004. MSF works in four camps inside Lira town that shelter 80,000 people (Erute, Bala Stock, Starch Factory and Anai Ober) and six more camps in more rural areas (Aloi, Apala, Barr, Obim, Agweng and Aromo).

Access outside Lira town has been limited due to insecurity, but mobile teams are reaching people in some of the peripheral areas. MSF suspects increased levels of malnutrition in these rural areas from diminished food security caused by displacement. Currently, MSF treats nearly 170 severely malnourished children in a therapeutic feeding center (TFC) in Lira and is building an extension to accommodate an additional 150.

Poor water and sanitation conditions in these congested camps have led MSF to provide water, latrines and hygiene education. Because many people have been exposed to extreme levels of violence and a profound disruption in their lives, MSF also began a psychosocial care program in the camps, feeding center, and hospital. In Gulu, 5,000-7,000 children seek shelter at Lacor Hospital every night, part of the 12-15,000 children seeking safety as darkness approaches.

MSF treats 400-600 children nightly for scabies at Lacor Hospital, and is expected to expand its care for these children. MSF is also preparing additional health projects to support several camps north and south of Gulu, providing care as needed. Incursions by the LRA into new areas, further south near the town of Soroti in June and July 2003, triggered massive displacement, with 100,000 people crowding into Soroti town in search of security and relief.

Since then, many people have left Soroti because conditions in the town have become difficult. Some of these people moved to secure villages closer to their areas or origin. An estimated 23,000 people remain living in about 20 camps in Soroti town. Now that the initial crisis has stabilized, MSF is returning the management of the pediatric department at the Regional Hospital and the TFC to the Ugandan Ministry of Health.

However, MSF continues to support two outpatient health facilities (one built by MSF) in which an average of 1,500 consultations are performed each week. MSF has also trained community health workers and monitors the health situation in 11 camps. Assessments regarding the newly arising needs in the transitional settlements are ongoing. Security constraints prevented access to the town of Amuria until mid-January 2004.

Today, about 28,000 displaced people live in one camp. MSF activities there include refurbishing Amuria's looted 24-bed health center and giving support to the inpatient and outpatient departments and maternity ward. The outpatient department performs about 150 consultations each day.

The MSF team provides water and sanitation support to the camp and has trained community health workers who actively monitor the health situation in the camp. In Arua, MSF staff work in collaboration with the regional hospital to provide medical care for nearly 2,500 people living with HIV/AIDS. At present, nearly 650 people are using antiretroviral (ARV) therapy and MSF plans to enroll 60-80 new patients on treatment each month.

In the next few months, MSF will open an additional HIV/AIDS care program in Koboko, north of Arua, located near the border with Sudan and the Democratic Republic of Congo.

This program will link treatment and prevention of mother-to-child transmission of HIV with existing voluntary counseling and testing programs. The program also supports Arua Regional Hospital in the implementation of adequate universal precautions and improvement of waste management and quality of nursing care in the hospital environment.

In Amudat MSF fights kala azar, providing treatment for approximately 30-35 people with the disease each month and carrying out a number of research projects related to prevention and diagnostics of kala azar. The team there also gives general support to this hospital in the remote area of eastern Uganda near the Kenyan border.

Additional MSF activities

Based in Mbarara, MSF's epidemiological research unit, Epicentre, conducts epidemiological studies on such topics as the efficacy of malaria treatments, trypanosomiasis and retrospective mortality surveys, all designed to improve and ensure high-quality patient care. Uganda also hosts a regional auto repair workshop for MSF and other NGO vehicles. Staff provides auto repair training for mechanics working in projects throughout eastern Africa. MSF staff based in Uganda also support projects in southern Sudan and eastern DRC.