Open Borders Strain Arua’s Healthcare Infrastructure

It is the first week of the month of August. Scovia Ponni is up for her routine therapy sessions at River Oli Health center IV in Arua district. 

Ponni, a refugee from South Sudan’s Yei region, left her country at the height of the 2016 conflict between government and rebel forces. She was only 18 at the time. 

Since her arrival in Arua, post-war trauma has troubled the 26-year-old mother of one.

“When I first came, I was living with my aunt but had some problems with her daughter, so I had to leave their home. I had nowhere to go because my parents were far away. I started to live alone,” she narrates. 

Ponni survived on a modest living from doing odd jobs around the city, believing she had overcome her trauma, but a string of poor decisions culminated in an unplanned pregnancy and eventual abandonment by the father of her unborn child. This drove her into another depressive episode. 

“I stayed with him for three months but he left me when he discovered I was pregnant. I tried to reach out to him but he had blocked my number,” she said.   

Ponni’s efforts to reach Obidda Isaac, who was a volunteer at Arua Referral Hospital and the father of her unborn child, were futile. Financial and social constraints presented her with a dilemma of choosing between termination or retention of the pregnancy. 

The social work department at the hospital extended an olive branch to Ponni, through the South Sudanese Refugee Association (SSURA) that enabled her access therapy and mental wellness treatment.

Established as a non-profit organization by refugees, SSURA provides assistance to health centers in Arua and Koboko through collaborations with authorities and local governments.

“We decided to come together and organize our people because they understand us better than some of the implementing partners in the camps,” said Batali Gabriel Modi, one of the founders and program coordinator at SSURA, adding that the organization connects refugees to the public services they need, especially health care, and also supports medical facilities. 

Uganda is home to over one million refugees, ranking it at number five, globally. These refugees seek public health care and other services, but the shortage of staff and medical equipment has created a gap in effective service delivery

At Vurra Health Centre III, about two kilometers from the Uganda – DRC border, medical workers struggle with large number of patients, owed to the open border policy that permits free entry and exit at one’s will . 

“When we do a procurement plan, our supply is constant and we do not usually factor in the issue of the migrants, and so It affects one hand of the health supplies,” says Dr. Obite Harold, the in-charge at Vurra Health Centre III. 

He attributed it to some patients being reluctant to state their actual country of residence or origin.

Organizations like SSURA enable refugees like Ponni to access quality public health services. At River Oli Health Centre IV, one of the facilities supported by SSURA, Ponni received therapy sessions as well as antenatal and postnatal care. 

“They have not let me do it alone, we are still together. And they always check up on me in case of any other issues,” she narrates.

Specioza Asara, the SSURA Program Development Manager, says that mental health and psychosocial support are key for the organization which is currently setting up a trauma healing center at River Oli Health Centre IV with staff and counselors. 

The organization also offers HIV/AIDS awareness and treatment, sexual reproductive health education on top of providing a chemistry machine for testing blood samples as well as. 

“In all our outreaches, we integrate these and offer community health education towards government health programs where we see gaps,” she adds.

Despite the assistance rendered by SSURA, challenges that include lack of access to mental health medicine in health centers, are still present. This is because lower health centers are not permitted to prescribe them. However, the referral hospitals are also under equipped. 

“Most times we make referrals to Arua Hospital but we find when the drugs our patients need are out of stock,” says Asara. 

Paul Bishop Drileba, the District Health Officer (DHO) of Arua City, says that to mitigate these shortcomings, there are partnerships with organizations that facilitate cross-border activity and coordinate health services between the three countries. 

“Some of these partners are across the border, for example UNICEF. They help us not only with health services but also language barriers and ease of access to refugees in the camps,” he says.  

The refugee crisis is an ongoing struggle that may not be managed by authorities in isolation.

SSURA and Ponni are a stark reminder of how much is achievable, when systems partner to work together as a means of contributing to the livelihood of minorities and marginalized groups; a shared global responsibility. 

All over the world, owing to uncertainty, fear and risk, people make one of the most difficult decisions of their lives; leaving their homes in pursuit of a safer and better livelihood. This is what ran through Ponni Scovia’s mind in 2016, as she permanently left South Sudan for Uganda as a homeless refugee.