When Aid Fails in Uganda

This article contains graphic descriptions that some readers may find disturbing.

"Even if in Congo there is insecurity, they die with bullets instead of dying with hunger," said Jean-Marie Nibitanga in early August, speaking about people who fled the war in the eastern Democratic Republic of Congo (DRC) to the Ugandan refugee settlement of Kyangwali. This is where he works in community-based rehabilitation with Humanity and Inclusion (HI). "Some are planning to go back," he added. 

Fighting in eastern DRC escalated in January, when the M23 militia – largely ethnic Tutsis – waged an offensive and captured Goma, the capital city of North Kivu. Within a month, the militia seized South Kivu’s capital of Bukavu. In limbo under rebel control, eastern DRC has plunged into a humanitarian crisis with at least 1,157,090 people experiencing displacement in the region since the start of this year. 

Across the border in western Uganda, another catastrophe is beginning to unfold.  

Facing Lake Albert on the border with the DRC, Kyangwali is one of the oldest refugee settlements in Uganda. Established in the 1960s, it became home for people fleeing the Rwandan genocide against the Tutsi. Today, according to the UNHCR, it is home to 151,928 people, with most now coming from South Sudan and the DRC. 

Through humanitarian workers in Kyangwali, FairPlanet has learned that at least 4,153 people have crossed Lake Albert since January to the Sebagaro landing site, from where they are resettled into the village. Instead of being segregated into camps, refugees are integrated into host communities through Uganda’s Comprehensive Refugee Response Framework, a policy implemented in 2017 that recognises refugees’ rights to housing, freedom of movement and work.

Within roughly two weeks of arriving in Kyangwali, they are given a humble home and a small plot of land to farm.

But Kyangwali is under mounting stress. Ugandan media reports the settlement has grown beyond official capacity. In February, the United States suspended USD 950 million of USAID funds to Uganda, leaving over 80 per cent of Uganda’s refugee response currently underfunded. 

Now, the most vulnerable people in Kyangwali are facing starvation.

Surviving in Kyangwali

By May, hundreds of thousands of people assisted by the World Food Programme (WFP) learned that their food rations and cash assistance were cut. These decisions were supposed to be made by triaging people into three categories of vulnerability introduced by the WFP in 2023. Category one includes people who have been in Kyangwali for less than six months, have children, and have severe vulnerabilities, like persons with disabilities. Category two requires three criteria of vulnerability and depends on the household’s size. The rest are in category three. With priority now being given to new arrivals, WFP has cut assistance to categories two and three. 

The WFP told FairPlanet that assistance is now reaching only about 663,000 of the 1.6 million refugees previously receiving aid across Uganda. In Kyangwali, over half the population (85,000 people) have lost assistance.

Gathered in front of a phone screen with a small group of Kyangwali residents in late July, Victoria Asiimwe shared her experience in Swahili through a translator.

Asiimwe, from the DRC, is fifty-one years old and has lived in Kyangwali for over a decade. She explains that she uses crutches and a back brace for support due to a back fracture suffered in an accident. Rebuilding her life in Kyangwali, she finds her family now struggling. Her husband is too weak to work, and both of her children have dropped out of school.

Asiimwe describes her shock at finding out in May that food assistance was cut. Having first heard of it through others, she went to the WFP distribution site as usual, where she learned that she, too, had been cut. Many people who don’t own cellphones found out this way.

Though often needing help to walk the distance to the WFP distribution sites, Asiimwe still came back four times to appeal, insisting that her life depends on food assistance. 

"They told me that it is over, and if you are removed, you will not come back," Asiimwe told FairPlanet.

Needing to take medication every few hours, she describes feeling nauseous on an empty stomach and has turned to neighbours for help. Sometimes people might share a cup of beans. Other times, she said, people insult her and call her a lazy woman.

"I don’t have any family to support me in Kyangwali," she added.

Lazar Kumakech is in his early forties. He fled the DRC in 2018. Translated from Alur, he shared that he still carries anxiety with him from Congo. 

A father of nine, he lives with diplegia, which is a form of paralysis of the lower legs. He uses an adaptive tricycle for which he cannot afford repairs, and describes some difficulty moving around his community due to hills. 

"The cuts were abrupt," he said. All of his children have now dropped out of school because it is unaffordable. He also appealed to the WFP, but received no response. Like Asiimwe, Kumakech was told: "When you are cut off food support, that’s the end of it." When there’s work, he mends shoes. But he is running out of options, and his family is turning to begging for food.

"My neighbour came at night, they kept encouraging me with strengthening words […] to ensure that I’m not so focused on the issue of the food cuts," said Kumakech.

For some, the hunger crisis is exacerbating social isolation. 

Yves, whose name has been changed to protect his identity, has lived in Kyangwali since 2017. He uses a cane and crutches after sustaining a lower back injury from being beaten and tortured in the DRC. In Kinyabwisha, he explained that he now goes a couple of days without eating, just drinking water. 

Though he was shocked to be cut, he said that the small amounts of WFP cash assistance weren’t always useful. Often, people have to choose between food and medicine. 

At twenty-six years old, Yves lives alone and stays at home most of the time. His family members disappeared during the war. What community support there is tends to be clinical; there are mental health practitioners, doctors dispensing medicine and aid workers, he explained.

Yves shared that his neighbours are also struggling. Desperation and ostracism are deepening. People don’t understand why food has been cut. Two people in his community have committed suicide, with many feeling robbed of dignity. They feel like they are 'nobody,' said Yves.

Human Cost of Data Gaps 

As of July, according to the UNHCR’s data portal, 11,489 people with disabilities and 7,105 people with a serious medical condition live in Kyangwali. 

The registration process for refugees is supposed to involve a standardised set of questions known as the Washington Group (WG) set, commonly used by UN agencies and international NGOs to identify persons with disabilities. 

Humanitarian workers describe registration staff in Kyangwali as overwhelmed by an increase in asylum seekers and pressured to rush the process. Questions tend not to be asked properly or at all, and invisible disabilities and temporary conditions are missed entirely. A person can be assessed with a quick glance and placed in a lower priority category.

Though WG sets are commonly used in the humanitarian context, there has been little scrutiny over their efficacy. Emerging studies suggest that the Washington Group questions systematically misclassify disabilities, including severe mobility limitations, deafness and blindness and mental health conditions.

Someone could be registered with a disability upon arrival, but it might not be chronic. Others might have developed a disability after arrival or a condition worsens over time. Some fear disclosing their situations all together because of stigma, prejudice and the higher likelihood of experiencing violence, all of which feed into a vicious feedback loop.

Originally from Burundi, Jean-Marie Nibitanga, who works with Humanity and Inclusion (HI), shared his experience working with psychologists, social workers and physiotherapists serving people with disabilities. He describes food assistance being refused to some of the most vulnerable residents, such as elderly women, people living with HIV and those living with invisible forms of trauma from displacement, rape and massacre.

"You find out that all those things are not considered enough for a person to remain on food assistance," he explained. 

He gave another example of a family being disqualified because the head of household is a man, even if he has a disability and is unable to work, and even if other family members have a disability.

Nibitanga recalled checking up on someone sweating in a physiotherapy session, to find out they hadn’t eaten for over a day. On an empty stomach, some are turning to waragi, he said, which is a type of hard alcohol that, depending on the day, could be an antidepressant or "another way of committing suicide."

People are even asking therapists for food, said Nibitanga. 

In community meetings, humanitarian workers are told to avoid going out at night. Nibitanga explained that some fear doing home visits for medical check-ups. "You fear that you will find the person frustrated," he told FairPlanet. Frustration and desperation can become aggressive.

"When they see us, they think that they are cut off from food, and we are the ones who are benefiting from that money."

Workers with an international humanitarian organisation usually get one meal, maybe some tea from the office, and they don’t eat lunch, said Nibitanga. 

"They can’t understand that we are also facing problems […] we don’t have any power as workers."

Mungurumo Uyergiu, also a community-based rehabilitation worker with Humanity and Inclusion (HI) supporting people using assistive devices such as adaptive tricycles, walkers and canes, sees WFP’s decisions as inconsistent with medical advice.

"When we are treating them, we make recommendations in their medical book," Uyergiu said. But the WFP’s decisions do not reflect medical advice, nor the disability data that should have been collected. "They came up with their own decisions," he added.

By year’s end, Uganda expects to host approximately 2 million more people fleeing war. Since January, the majority of new refugees have been arriving from the Democratic Republic of Congo (DRC). Despite a ceasefire mediated in July, attacks and civilian massacres continued through early August.

As was expressed to FairPlanet, if the militia loses control over key transit corridors out of the DRC, Kyangwali expects an even larger influx of refugees. 

And when they arrive in Kyangwali, the most vulnerable people may be left to fend for themselves.

"This prioritisation exercise was implemented after consulting with key stakeholders, including refugees and their leadership," Lauren Landis, WFP country director for Uganda, wrote through a spokesperson. The WFP relied on data in a registration system administered by the Ugandan government and the UNHCR.

"Households were categorised through a refined model that analysed this data to assign scores and prioritise assistance," she said, without clarifying what the model was.  

According to Landis, cuts were communicated through community leaders, radio, toll-free helpline and help desks at distribution sites. Appeals are being reviewed, and while there are no guarantees, "highly vulnerable cases will be reinstated," she wrote.

Landis did not respond to questions on the Washington Group disability assessment, consultation with medical experts, changes to people’s disability status or preparations for growing refugee arrivals this year.

Left Behind by the Humanitarian Reset

Lilian Kembabazi, a rehabilitation project manager with Humanity and Inclusion (HI) in Kampala, has seen this all play out before. Food rations and cash assistance were cut in 2023, when the WFP introduced the categorisation system.

At the time, people got around three months’ notice, Kembabazi said. This year, there was no time to transition. And even if there were, where are people supposed to go? 

Following the adoption of the New York Declaration for Refugees and Migrants in 2016, Uganda became one of the first countries to implement elements of the Comprehensive Refugee Response Framework (CRRF) for the economic and social integration of refugees that emphasises self-reliance.

Since its official launch in March 2017, the progressive policy has been a point of national pride, promoting open borders, non-camp policies, free integration for refugees and equal access to government-provided social services. 

But despite Kampala’s commitment to a "whole of society approach," Uganda has been unable to transition service delivery away from humanitarian assistance. And donor countries have repeatedly failed to deliver on commitments. 

In 2017, barely a year after UN member states committed to the principles of the New York Declaration, including pledging support to countries that shelter refugees amid devastating humanitarian crises, Uganda was ready to put the CRRF into practice. But with over a million people seeking refuge from war and famine in South Sudan alone, Uganda was hitting a breaking point. Not even half of the country’s funding requirements were met.

Two years later, little had changed. By December 2019, humanitarian experts denounced the chronic underfunding of Uganda’s refugee response and warned of social services shutting down amid the COVID-19 pandemic.

The Norwegian Refugee Council reported starvation in Kyangwali, where people were selling food rations for essential items. By 2021, Uganda was scraping by on 22 per cent of the required assistance and assisting the United States by hosting thousands of refugees from Afghanistan. By 2023, the lack of funding led to the WFP fully rolling out its triage system across Uganda.

Now close to a decade since countries committed to meaningful policy action in solidarity with refugees and host communities, Uganda has one of the most severely underfunded refugee responses in the world as the country struggles to support refugees from the DRC, South Sudan, Sudan, Eritrea and Somalia. And the most vulnerable are bearing a cruel burden. 

"Early in the morning, you’ll see children roaming around asking, Do you have some work for me to do? Can I fetch for you water?" Kembabazi described. "Because back at home, they slept on an empty stomach, so they have to come and look for food."

A survey by HI among 1,280 refugees living in Uganda shows that 35 per cent of respondents with disabilities and 42 per cent of households with children with disabilities have been excluded from WFP food assistance. People are looking for work in the host communities, resorting to begging or selling what few items they may own to survive. Some, including teenage girls, are turning to prostitution and transactional affairs with men, while others are moving to Kampala, traumatised, and facing uncertain futures.

"We don’t know what the scenario may be in the near future," Kembabazi said, emphasising ongoing cuts to mental health services. Across Ugandan settlements, Kembabazi is seeing continued reports of suicides by people who have lost hope.

In Kyangwali, she described the case of a mother of nine who was turned away by the WFP. "She went home and got some rags, put them in a saucepan, and put them on fire. Then she just went behind her small house and hanged herself." 

"There was that general assumption that their [people with disabilities] resilience must be strong, they must have established strong economic ties to sustain themselves. But this is not the case," Kembabazi said, as refugees facing starvation in Kyangwali are unseen, unheard and afraid of being forgotten. 

Image by Richard Ashton.