The skies are gloomy over the wattle-and-mud houses of Kiryandongo refugee settlement, home to more than 167,000 people. Spread across an undulating plateau, the crowded camp, 120 miles north of Kampala, draws new arrivals daily as conflicts in Sudan and South Sudan add to the displacement toll. Of nearly 50,000 refugees who have arrived in Uganda since January, more than 1,000 have come to Kiryandongo.
Funding shortfalls cripple refugee programmes
Uganda, known for its progressive refugee policies including freedom of movement, land to cultivate, and the right to work, hosts 2 million refugees – the largest refugee population in Africa – across 13 settlements. But funding shortfalls, compounded by aid cuts, have left programmes in crisis. This year, the UN refugee agency UNHCR received only 12% of the $850m it needs for Uganda.
The World Food Programme has slashed rations: in early 2025 it supported 1.6 million refugees, but this year can help only 663,000, worsening hunger and malnutrition. Acute malnutrition among under-fives has risen by nearly 50% in a year.
Health system on the brink
The International Rescue Committee (IRC) says funding cuts have pushed the health system to the brink. In 2025, the IRC’s Uganda health budget was about $18m, the bare minimum to keep critical services running. In January, it fell to $4m, forcing the IRC to close health clinics in 11 refugee settlements and lay off about 80% of its staff, leaving people vulnerable to diseases such as cholera, measles and mpox.
“Two million lives are at stake here. Without a response, I worry the refugee health systems will collapse,” says Elijah Okeyo, the IRC’s country director. “We risk reversing all the work that has gone into the humanitarian health system.”
In December, the IRC shut two clinics it supported in Kiryandongo, forcing refugees to walk farther for medical care. When they get there, they often find medicines are low or nonexistent.
Refugees turn to traditional remedies
Suzan Mandera, 30, from South Sudan, regularly attended one of the closed clinics to get medicine for her children’s malaria or typhoid, and pain relief for her chronic back pain. Now she walks nearly 9 miles to the government-run Panyadole health centre, but it too is operating under severe strain after losing 58 of its 130 staff in December and struggling to serve 300,000 people.
Mandera, who left South Sudan in 2014 during the civil war, points at guava, mango and eucalyptus trees and says: “That is now my medicine. I mix the leaves in a pot, boil them all and drink until I become dizzy with sleep. I don’t think it is a good idea, but what can I do?”
Staff overwhelmed as patient load rises
Dr Nicholas Sabiiti, a medical officer at Panyadole, barely has time to eat as he races between wards, theatre and outpatients. “We had to let go of more than half our staff in 2025. I rarely have a day off. I am not able to get a proper meal until night-time,” he says.
Midwife Sarah Birungi says pausing for a break would mean patients giving birth unattended. “We are seeing mothers with sepsis returning to hospital because of all these delays. It’s either they delay getting to us because of long journeys and queues, or we are delayed attending to them, which was never the case before we lost all these staff.”
She says while no cases of puerperal sepsis were diagnosed before staff cuts in October, there were at least five cases in January, though successfully treated. According to IRC records, newborn deaths at Panyadole rose from 13 in October to 23 in January.
Critical shortage of midwives and supplies
In January, the United Nations Population Fund (UNFPA) identified a critical need for 267 midwives across all Uganda’s settlements. The persistent funding gap means only 23% are in place. Kristine Blokhus, UNFPA country representative in Uganda, says: “Camp, fuel and salary cuts have largely grounded our mobile midwife teams. When women in remote zones cannot access a mobile team or afford transport to a clinic, they are forced to give birth at home, dramatically increasing the risk of maternal death.”
The UNFPA says there is a 30% shortage of supplies in at least seven settlements, including Kiryandongo. This includes drugs like oxytocin, misoprostol and magnesium sulphate used in obstetric medicine, as well as clean delivery kits, neonatal resuscitation equipment and HIV post-exposure prophylaxis kits.
Malnutrition and outreach services decline
When targeted projects aimed at curbing malnutrition were shut down due to funding losses, the prevalence of acute malnutrition rose from 5.4% to 7.8% in Uganda’s settlements. A recent $5.4m boost to the Ugandan ministry of health from Unicef and UNHCR is expected to improve the situation.
Still, community outreach, mental health services, neonatal and post-operative care and laboratory services have been scaled back or suspended in many locations. HIV and tuberculosis services continue but with reduced consultation time, increasing the risk of treatment interruption. The number of village health teams has fallen from 2,517 in 2025 to just 163, weakening health promotion and early response to illnesses such as malaria, pneumonia and diarrhoea.
Refugees struggle to access basic care
Outside Panyadole health centre, Mandera’s friend Poni Annet, 32, also from South Sudan, points at her 16-year-old daughter’s itchy, dry skin and sighs. The girl, Evelyn, has what looks like a bad case of eczema. “Sometimes I get paid for digging the gardens of residents in the host communities and can afford a tube [of cream] from the pharmacy, but most times I cannot. But even malaria treatment is a problem for us [now], so how can I get treatment for her skin?”
“I can’t afford the money for tests that clinics need and I know even if I go to Panyadole, I will stay in line for hours, even the next day or two, and yet they will still ask me to go and buy medicine elsewhere. Sometimes they just give you a half dose and send you away,” she says.
