Adaptations in Management for Ensuring Security and Quality of Care in a Ugandan Refugee Camp

Over 600,000 Kenyans were displaced during the post-election violence in 2008. The Uganda Red Cross established health care for a refugee camp of 2,014 Kenyans located along the Uganda-Kenya border. Given the renewed tribal tensions across Kenya and eastern Uganda, the Red Cross strategically attempted to minimize exposure to outside violence while maintaining quality of care.

A retrospective, descriptive study of the refugee patient population (n=484; >99% Kikuyu ethnicity) was performed via patient registries. A violence risk analysis based on health delivery location was completed. Each location – camp, Ugandan clinic, Kenyan hospital – was graded in risk of violence during transport and/or clinical care based on documented incidents. Then, the frequencies of patient exposure to the varying levels of potential violence or discrimination were recorded and analyzed.

During the camp's initial nine days, 100% (n= 27) of patients were referred to Ugandan health facilities (“moderate” exposure level). The arrival of a volunteer student permitted establishment of a diagnostic record system, which resulted in strategic coordination of NGOs to provide on-site health resources, including educators, medicine, mosquito nets, and HIV active-case finding. The following twelve days resulted in 10.7% (n=52) of patients exposed to moderate levels of potential violence and 0.4% (n=2) exposed to high levels (Kenyan hospital). However, the camp would be relocated further interior into Uganda due to increasing regional instability and violence.

Despite pervasive tribalism, the Uganda Red Cross reduced exposure to violence through innovative coordination as a means of maintaining quality of care.