Jean Kalenga recalls with visible dejection the day he packed a few of his family belongings and left his village in Rutshuru, Democratic Republic of the Congo (DRC). Thirty-seven-year-old Jean and his wife Neema (31), together with their three children Michelle (10), Emmanuel (8) and Blaise (4), fled for safety following civil strife that rocked eastern DRC earlier this year.
One of the largest refugee-hosting countries in the world, Uganda is making remarkable gains in ensuring that not only its own citizens, but also its refugee population is vaccinated against various diseases.
His family is one of thousands displaced after fighting broke out between the Congolese government and the “March 23 Movement”, known as the M23 rebels. The family are now tented up at the Nyakabende refugee camp, located in Kisoro District in southern Uganda, which serves as a transit camp for arriving and returning refugees and is host to more than 20,000 refugees from DRC.
“Initially we were relieved that we were finally in a safe place, but, later, we realised we were at enormous risk of contracting infectious diseases like COVID-19 and cholera because the sanitation situation here isn’t very pleasant. I worried deeply for my children. We sought vaccination but were turned back because we possess refugee IDs,” laments Kalenga.
Uganda hosts more than 1.5 million refugees, who constitute 3.3% of the country’s population and come from various countries in the region, including Ethiopia, Somalia, Eritrea, Burundi, Rwanda, South Sudan and DRC. Despite being one of the largest refugee-hosting countries in the world, Uganda is making remarkable gains in ensuring that not only its own citizens, but also its refugee population is vaccinated against various diseases.
Jean Pierre Amudu, another Congolese refugee and community leader who arrived in Uganda from the DRC in 2012, tells journalist Evelyn Lirri, “When we received complaints from refugees that they were being denied vaccines, we went to speak to the health workers and realised some were just unaware of the prevailing policy. The refugees are supposed to access the vaccines.”
Annet Dusabe, the assistant District Health Officer in charge of maternal child health and vaccination in Kisoro, acknowledges that Uganda’s refugee policy to relax administrative barriers such as the need to produce an ID to access vaccines has seen a sharp increase in vaccination numbers. According to her, in July 2022 about 500 refugee children were vaccinated against polio and measles, up from the previous monthly average of 120.
This initiative is also backed by the COVAX Humanitarian Buffer, with Gavi as the main funder and supported by UNHCR and UNICEF. The buffer ensures that people in humanitarian settings and conflict areas that can’t be reached by government COVID-19 vaccination campaigns can still access COVID-19 vaccines.
“Our goal is to ensure we vaccinate as many refugees as possible, although vaccine shortages have been our biggest obstacle,” Dusabe explains, further noting that an aggressive vaccination drive against cholera started in April 2022 after 30,000 doses of cholera vaccines were delivered, and has so far reached 7,000 out of more than 17,000 refugees in the camp.
“We are happy our government is making progressive refugee policies such as the 2006 Refugee Act,, through which we have been able to include refugees in our national vaccination plan,” says Uganda’s Health Minister Dr Jane Ruth Aceng.
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Targeted vaccination campaigns
French is the official language of DRC, with other primary languages being Lingala, Kiswahili, Kikongo and Tshiluba, so health workers in Nyakabende have been running targeted vaccination campaign programmes in a language that refugees understand by using interpreters to counter vaccine resistance and communicate other health messages.
“To help them easily understand how vaccines work we, for instance, created an illustration that depicts a stranger suddenly entering your house. You then react by fighting him, until you realise he came to train you how to fight a bigger real imminent enemy coming to harm you. That’s how antibodies work.”
“We had to look inwards to get volunteer interpreters – that is, amongst the refugees themselves. There are those that have been here for a while and can speak most Congolese languages as well as our primary languages here, namely Luganda and English. They have been such great resources for us,” explains Dusabe.
Several kilometres away from Nyakabende is the Kyaka II Refugee Settlement, in Kyegegwa District. Health officials operating in the settlement here hope to vaccinate at least 56,600 adults under the Humanitarian Buffer programme, according to Daphne Namusoke, a Senior Nursing Officer in charge of immunisation in the district.
But she also notes that this wouldn’t be achieved without getting innovative and creative with the messages, simplifying them for all to understand in order for the refugees to voluntarily turn up for the jabs.
“To help them easily understand how vaccines work we, for instance, created an illustration that depicts a stranger suddenly entering your house. You then react by fighting him, until you realise he came to train you how to fight a bigger real imminent enemy coming to harm you. That’s how antibodies work,” Namusoke says.
Many refugees are also doing all it would take to preserve life. At the Itambabiniga Refugee Settlement, 31-year-old pregnant mother Neema Kabirigi, having just received her second COVID-19 jab, says, “My first one (jab) was not a problem, but for the second I was scared because I was pregnant and thought the vaccine could affect my baby. When I saw another woman with a pregnancy bigger than mine get the vaccine, my courage was inspired and I went to get my jab. I am fine.”
Religious leaders in these refugee settlements are also amplifying vaccination messages from the pulpit. Pastor Jean Paul Karimunzira, head of Pentecostal Fathers in Nakivale Settlement admits that at first he was spreading toxic anti-vaccination messages.
“I preached against vaccination. I was telling my ‘flock’ that vaccination was an attempt by the Congolese and Ugandan governments to kill refugees if they didn’t return home. But one health worker changed my perception for good when she showed me pictures of the Ugandan president and other public figures taking the jab. My wife and I took the jab in full view of our congregation and since then, we have been convincing them to get vaccinated,” explains Pastor Karimunzira.