N. Uganda: Hepatitis E Epidemic Unanswered

The Hepatitis E epidemic in N. Uganda rages on, as contaminated water sources and poor sanitation provided by government and NGO's for a decade produces conditions ripe for disease outbreaks.

James Abola writes in the Monitor about the government's slow response to the epidemic.

For about two years now there has been no fighting within Acholi between the Uganda Peoples Defence Forces and the Lords Resistance Army.

Reports that Hepatitis E, a viral disease that can lead to liver failure has spread from Kitgum District to other districts in Acholi, killing some 97 people in the process, provides a rude reminder that the absence of war is not necessarily the presence of peace.

The ministry of health announced last week that it was launching a Shs10 billion programme in conjunction with the World Health Organisation (WHO) to counter the outbreak of Hepatitis E. The programme will among other things educate the population, improve water and sanitation conditions in the Internally Displaced People’s camp and help to set up an early warning system so that such high fatalities are avoided in future.

The primary reason why the disease has spread throughout most of Kitgum District where it was first observed in October 2007 and has spilled over to other districts is because of the conditions in the IDP camps.

The IDP camps have been notorious for being a poverty trap and their continued existence will only deepen the widespread poverty in the region.

The settlement patterns within the IDP camps provide the perfect recipe for outbreak of communicable diseases: houses are huddled together, with a very high population concentrated in a very small area . . . Many people in the northern region have been begging that the government and development agencies help them to return to their homes by providing three things, namely: open access roads, build or repair drinking water supply, provide seeds and agricultural implements.

Unfortunately these appeals have so far fallen on deaf ears. The billions from the ministry of health and the WHO would have done a more long lasting good if they were applied to building and rehabilitating water supplies to people return to their homes.

The minister of health said that the programme to counter Hepatitis E outbreak will also set up an early warning system.

That sounds good but will it really work?

From the statement issued by the minister the first case of the disease was observed as far back as October 2007. I visited Kitgum District in January 2008 and was informed by a Non Governmental Organisation as a well as a medical officer at St. Joseph’s Hospital that Hepatitis E had been identified in areas such as Kitgum Matidi.

Is the reason for the slow response by the ministry of health to counter the hepatitis outbreak a result of the absence of an early warning system or is it just another case of poor leadership and incompetent management?

I would love to know if the officer in charge of Health Services in Kitgum did not inform his superiors in Kampala early enough about the outbreak. Not long ago a foreign tourist died after being bitten by a bat and government officials were trampling over each other to be first to respond to that situation.

How is it that it took 97 deaths before there was a response to the Hepatitis E outbreak?

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Even if Kony is caught, Ugandans will still suffer

Once in awhile, the mainstream media prints the truth about northern Uganda. In this case, we get a half-truth from aid worker Andrew Cuddy, who recently writes in the Ottawa Citizen about his recent visit to Uganda.

Cuddy restates a common myth regarding the Ugandan government's involvement in the violence inflicted upon the people of Northern Uganda during the decades of war -- namely that all the violence was inflicted by the rebels. In actuality, both the rebels and the government committed unspeakable acts.

Cuddy writes emphatically:

"Although Kony's rebels are the only people raping, murdering, and kidnapping,"

then goes on to speak of President Museveni and the NRM regime's indifference, and details what he observed in the camps in the North.

"Horrendously corrupt and from another tribe, Museveni is far from concerned with the plight of Northern Ugandans.

I learned of this disturbing reality when I travelled to northern Uganda. I saw the countless thousands starving on two meals of rice a day while the corrupt government officials ran the refugee camps on plump full stomachs.

I visited the hospital wards where women and children did not come for treatment; they came to die.

I interviewed ex-child soldiers who, after managing to escape from Kony's rebels, had received no support from anyone. And I spoke to community leaders who tried to leave the refugee camps, only to discover that their lands had been expropriated by the government for industrial farming. I was even detained by the Ugandan army, who were worried that we were journalists attempting to expose the situation.

So, even if the ICC succeeds, Kony is caught, and the violence ends, it will take far more than that to help the millions of Northern Ugandans who have suffered for over two decades.

As Canada continues to neglect our commitment of spending 0.7 per cent of gross national income on development aid, it's clear we're far from ready for what it would take."

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Museveni: No Support for Al-Bashir

Uganda's President Y.K. Museveni says of the ICC's indictment of the Sudan's President:

“I do not condemn the International Criminal Court indictment against Sudanese president Omar Hassan al-Bashir”

Apparently Museveni is not worried at the present, however the conviction of senior Ugandan officials by the International Court of Justice has brought the potential for justice in the Great Lakes region a little closer to Museveni's door.

Meanwhile, the short arm of justice has already begun to catch Ugandans abusing international law abroad -- several government officials and advisors have recently been arrested for various crimes committed while using diplomatic passports.

President Museveni, who is the sitting Chairman of both the Commonwealth and East African Community, has not commented on the arrest of Ananias Tumukunde, Museveni's adviser on science and technology, who is on trial in London for money laundering and allegedly dealing in chemical and biological weapons. [See: "Museveni advisor has case to answer" Weekly Observer]


IWPR Reports on Museveni's Stance on the ICC's indictment of Al-Bashir:

"The Ugandan leader was speaking four days after cancelling a press conference that was supposed to follow his meeting with Egyptian president Hosni Mubarak, who has been urging African leaders to condemn the ICC’s move.

Mubarak’s visit to Uganda followed Moreno-Ocampo’s announcement that he was asking the ICC to indict al-Bashir.

The prosecutor’s request came three years after the United Nations Security Council asked him to investigate Darfur.

Moreno-Ocampo argues that al-Bashir masterminded and implemented a plan to destroy a substantial proportion of the Fur, Masalit and Zaghawa peoples who populate Darfur.

These ethnic groups have been targeted in a campaign of violence and devastation waged by the Sudanese regular army and allied militia forces known as “janjaweed”, ostensibly to root out rebel guerrillas.

“His [al-Bashir’s] motives were largely political,” Moreno-Ocampo has said. “His alibi was a ‘counterinsurgency’. His intent was genocide.”

Although Museveni has spoken out against the West becoming too involved in African justice issues, his latest comments revealed his antipathy for the Sudanese leader.

The government in Khartoum was a major backer of the Lord’s Resistance Army, LRA, which fought a long war in northern Uganda from 1986 to 2006. "

> Read the Full Article / Source: Institute for War and Peace Reporting

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Dr. Adam Branch: The Legacy of Forced Displacement in Northern Uganda

Dr. Adam Branch, a professor of political science at San Diego State University gave a presentation on "IDPs" (Internally displaced persons) in northern Uganda, at the Friends for Peace in Africa (FPA) annual conference recently held in San Diego, California.

Dr. Branch raised critical questions regarding usage of the term "IDP" and the erroneous attitudes commonly held regarding "IDPs." His report also details the daunting issues facing people as they begin the process of rebuilding their lives, after being forcibly displaced by the Ugandan government for over 10 years.

Branch also helped to author a Human Rights Focus Report, released September 2007, after living in an internment camp for one year.

An excerpt from Dr. Branch's presentation:

"When the US now toys with the idea of interning American citizens of Arab descent, do we prepare for an IDP influx, collecting jerry cans, tarps, and making food aid appeals to help IDPs? When the US drove native Americans from their land and forced them onto reservations, did we call them IDPs?

No. We condemn the government for its grave violations of human rights and constitutional rights, and demand that our fellow citizens and fellow humans be released from their illegal, humiliating, and often deadly forced detention.

So when it comes to northern Uganda, I think we need to have this same honesty about the origins and perpetuation of forced displacement and internment.

We Westerners have a tendency to ignore the politics that are involved in conflicts in Africa and to see those conflicts in purely humanitarian terms— helpless civilians who need our assistance.

The practice of terming the Acholi "IDPs" fits squarely within this pattern. By doing so, we hide the reasons for displacement, and make the so-called IDPs solely the responsibility of international aid organizations. We reduce mass forced displacement to a humanitarian issue, and hide its political and legal dimensions.

But mass forced displacement in northern Uganda is not primarily a humanitarian issue.

It is first and foremost a political issue and a legal issue, and by labeling the interned Acholi "IDPs" we hide the fact that they did not flee voluntarily for their safety, but were forcibly displaced and interned in prison camps by the Ugandan government though a campaign
of military terror. They have been forced for years to live in camps so wretched that the excess mortality rate reached 1,000 people a week. Indeed, the camps themselves produced the humanitarian crisis, not the other way around!

Displacement is a political issue because it was a political decision on the part of the Ugandan government that created the camps, where the humanitarian crisis exploded.

It is a legal issue because that mass forced displacement and internment was a war crime under the Geneva conventions and a crime against humanity. The humanitarian crisis, which is very real, was an entirely avoidable consequence of the Ugandan government's illegal and
unjustifiable counterinsurgency strategy."

Read the rest on FPA's Website

[Photo source: davidkilgore.com]

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Mismanaged Epidemic: Hepatitis E Death Toll Climbs to 97

In March, the Red Cross reported poor latrine coverage (over 100 people sharing 1 latrine in many camps) as the largest contributing factor to the spread of the deadly Hepatitis E epidemic.

The epidemic continues to spiral out of control as the government slowly begins to respond to an outbreak first reported in October of 2007.

The Ugandan government's negligence in the face of dire disease outbreaks like Ebola, have contributed to the ongoing genocide in northern Uganda.

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97 Dead as Epidemic Ravages the North

The Monitor (Kampala)/ 1 August 2008 / By Evelyn Lirri / Kampala

The government yesterday announced an emergency plan to fight the Hepatitis E epidemic in northern Uganda after the death toll from the preventable disease rose to 97.

At least 25 people have died in the two weeks since July 17 when the Ministry of Health last issued an update, while the number of infected people rose from 4,829 to 5,779 in the last fortnight.

Health Minister Stephen Mallinga told journalists in Kampala yesterday that the government was launching a Shs10 billion "accelerated emergency response plan" to contain the epidemic in Kitgum, Pader and Gulu districts.

Hepatitis E is an acute viral disease that can cause liver failure. The virus is transmitted to humans through consumption of drinks or food contaminated with faecal matter.

An infected person develops a fever, headache, general body weakness, muscle pains and eventually develops yellow eyes and passes urine of a deep yellow colour. Hepatitis E initially struck Kitgum District in October 2007, but has since spread to Gulu, Pader and Yumbe.

The Health minister revealed that while it is not easy to get infected, the appalling hygiene in the affected districts - where many people displaced by the Lord's Resistance Army insurgency live in squalid conditions in camps - had fuelled the disease's spread.

"You have to take in a substantial amount of faeces -- about one gram-- to be able to get Hepatitis E," Dr Mallinga said. "I don't think anyone intends to eat faeces but because of poor hygiene they end up consuming food with faeces."

He added: "The main thrust of the accelerated response will be to break the transmission chain at individual and household levels where the problem originates."

The emergency response will focus on teaching residents about proper hygiene, improvement of sanitation through construction of boreholes and pit latrines in internally displaced people's camps, and monitoring infected people to ensure they are treated.

Dr Mallinga told a press conference yesterday that the ministry and other partners also plan to strengthen early disease detection and reporting by village health teams and community members.

"The accelerated response will also reinforce case management through provision of medicines and supplies and increase the number of qualified health workers in some health facilities," he said. Gulu District Woman MP Betty Ochan said the epidemic has affected every sub county in the Acholi sub region with women being more prone.

"The Ministry of Health should send film vans to carry out sensitisation because much as we are blaming the local leaders for not doing enough to sensitise the people, the people at the centre have also not done much," she said. "We need these technical people to tell us what interventions they have put in place."

The Ministry of Health has also discouraged the use of clay pots to store drinking water, which they say were found to be harbouring the Hepatitis E virus. Instead, the population is being urged to use chlorine to purify their water before drinking. Twenty-litre jerry cans will also be given to people in the affected districts to store their drinking water.

The acting World Health Organisation representative, Dr Jean Baptiste Tapko, pledged more support to control the outbreak. "We are committed to supporting the government to prevent and control this outbreak. In this regard we are supporting training of village health teams," he said.

Uganda has recently been hit by a string of epidemics including; Ebola, Meningitis, cholera, Bubonic plague in West Nile and yellow fever. A rare strain of cholera ravaged the eastern districts Pallisa, Tororo, Butaleja, Mbale and Manafwa in June, killing 28 people out of 350 who were infected.

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