SUBSTANDARD LIVING CONDITIONS FOR REFUGEES IN KAMPALA
Introduction: Why Refugees Come to Kampala
Many refugees arrive directly to Kampala after fleeing persecution in their countries of origin. Although analysis of the root causes of refugee flight to Uganda is beyond the scope of this report, Human Rights Watch and other organizations have documented the problems of political repression, armed conflict and other human rights abuses in Burundi,211 the DRC,212 Ethiopia,213 Rwanda,214 Somalia,215 and Sudan216 which often give rise to refugee flight.
Of the refugees in Kampala, many have come there directly, before they even learn about or consider going to one of the refugee camps located in the north of the country. The rationale is both a function of the forms of transport selected-truckers and buses are headed for Kampala and not for remote villages where camps are located; and of geography-especially for Great Lakes refugees, Kampala is the first city they reach. However, even Sudanese refugees sometimes come directly to Kampala without ever stopping in one of the camps closer to the Ugandan-Sudanese border. Although many refugees living in Uganda's camps never consider moving on to Kampala, and many find the more rural nature of camps, and the possibility to grow food, both preferable and more familiar, others do go to refugee camps first, and then subsequently leave. Refugees leave camps for one or a combination of several reasons (discussed in more detail in Part III), including: inadequate humanitarian assistance, general insecurity and attacks, or insecurity for particular individuals.
Once they arrive in Kampala, asylum seekers and refugees have few places to turn to meet their basic needs. UNHCR is, of course, the main organization responsible, but the agency only provided assistance to 274 refugees in 2001.217 InterAid, a Ugandan organization that serves as UNHCR's main implementing partner, provides intake counseling for asylum seekers and refugees, some medical care, and income-generating initiatives for a small number of refugees. InterAid reported 10,315 "visits" by refugees and asylum seekers during 2001.218 A few NGOs and faith-based organizations provide assistance only when asylum seekers are waiting for their status to be assessed. Once recognized as refugees, most must sign an agreement verifying that they will be "self-sufficient" in Kampala. Keeping this promise is very difficult for refugees, given that they are living in a city where Ugandan citizens themselves are suffering from unemployment and poverty.
Inadequate Food and Material Assistance
In Kampala, newly arrived asylum seekers sleep and spend their days near the Old Kampala Police Station. This is the police station where their first interviews occur, and it is located just around the corner from InterAid, the main implementing partner of UNHCR in Uganda. The newest arrivals are allowed to share the once-a-day food rations of the prisoners jailed at the police station. Each adult refugee gets one portion of the total amount intended for the prisoners, which is donated by charitable agencies in Kampala.219 Mothers must share their portion with their children.
One international NGO in Kampala provides housing and food assistance to some asylum seekers. Although the Kampala program was closed for several months in late 2001 and early 2002, by April 2002 it was assisting over three hundred very needy asylum seekers. The assistance is cut off once an asylum seeker is recognized as a refugee, or after six months, whichever comes first. This policy is strictly enforced by the NGO, although persons still in dire need may obtain ongoing assistance after a home assessment visit from the NGO's staff. Matthew K., a forty-one year old Sudanese man, although very grateful for this assistance since it had helped his six-year-old son, said, "My son became anemic in the camp. UNHCR would not respond to his needs. I brought him here to Kampala and the only rescue we received for food came from [the NGO]. My child got a bit better but now my child is remaining without support. There is no longer money from them to help us."220
Elizabeth N., a thirty-year-old woman from Lumule, Sudan, fled with her fourteen-year-old son to Kampala when her husband was killed during the war and all but one of her children died from hunger. They arrived in Kampala in February 2002 and were part of a group of new arrivals sleeping outside in the Old Kampala neighborhood. She said, "I am having so many stomach problems, and now I am also hungry. I have to eat the `food to deceive the stomach' [a starchy, filling porridge] when I can find it. I have to sleep outside at InterAid and when it rains it comes on to me. I have nowhere to go.... Sometimes we get food from the police."221
Sara L., a Sudanese refugee living in the Kabowa neighborhood of Kampala said, "I can't steal or work to get food. I am looking for a way to go back to Sudan. My child is always hungry."222 Another refugee woman living in the Wankulukuku neighborhood told a Human Rights Watch researcher that she had coped at first in Kampala by cooking and selling street food. Then she ran out of money for this business. She explained, "When I first came here I went looking for UNHCR, but I found no help from them.... [Now that she cannot sell food on the street anymore], our problems are food and where to sleep. We have no covers and no good place to sleep. My girl does not even go to school. I cannot even get her food to eat."223
Since newly arriving asylum seekers often come without money or other support networks, their first concern is to find a safe place to sleep at night. Some are lucky and find shelter with friends or family, or with one of the two church leaders who give refugees shelter on church property. Others decide that since they need to be in Old Kampala to seek asylum or obtain services, they will sleep outside near the Old Kampala police station and InterAid.224 Several refugees explained that prior to the time of Human Rights Watch's visit they had been allowed to sleep inside a broken-down school bus that had been parked near the Old Kampala police station. Several spoke longingly about the shelter and warmth the bus had provided. However, the bus had been allegedly towed away after journalists planned to write a story about it.225
Once an individual obtains refugee status in Kampala, UNHCR assists a very small portion of them with a subsistence allowance for accommodation. Many others must rely on charity to meet their needs. One female human rights activist interviewed by a Human Rights Watch researcher explained that she had a place to sleep when she first arrived because a Congolese family took her in. They had since left, but had paid the rent for her three months in advance so she would have time to find another place.226
Finding money to pay rent is a daily struggle for refugees in Kampala. Monthly rent for a room is commonly between Ush.9,000 - 30,000 (U.S.$5 - $17).227 In Kampala, most refugees live in crowded rectangular rooms made out of cement blocks. One neighborhood a Human Rights Watch researcher visited was the Kisenyi-Mengo neighborhood, where many Somali refugees live. In one cement room that measured approximately thirty-by-thirty feet, there were ten foam mattresses on the floor, and a few had been pulled into the street outside for airing. Each mattress belonged to one family. One man with ten children explained that they had to take turns sleeping on their one mattress.228
Elsewhere, Mulumba T., a Congolese refugee, explained his struggle to find rent, "I have to find rent money... but I have no options. Also, my wife is pregnant. She is just about to give birth, and I don't know what to do with her and the medical costs we will have. Our rent is Ush.35,000 [U.S.$19] and we cannot pay it. The landlord will send us out soon. I cannot sleep outside with my pregnant wife. There are so many other refugees with the same problems."229
Some refugees, usually women and girls, obtain shelter by working as domestics. Usually they work only for room and board, without a salary. They are vulnerable to sexual and other exploitation. Zola R., a twenty-year-old Congolese refugee woman explained,
I found a job working as a domestic for an Algerian woman. She had four children and no husband. She gave me food and a place to sleep. I worked from five in the morning until midnight every day. I had to do a lot of work for her. I didn't receive any pay, but food and a sleeping place. But she had to switch her jobs and she left on April 5, 2002. Even though that was so difficult, I would like to find a new job like that. Right now I am sleeping with other Congolese. We only have one small room where five people have to sleep together.230
UNHCR is reluctant to continue assisting even the small number of refugees it helps in Kampala. Human Rights Watch attended a press conference in Kampala where UNHCR made its policy preferences quite clear. Mr. Saihou Saidy, the UNHCR Representative in Kampala told the press, "It is easier for HCR to deal with refugees in the camp setting. At some point we have to stop paying the rent of refugees. We recommend to refugees that they should go to the settlements."231
Inadequate Medical Care
Asylum seekers in Kampala are not eligible for medical assistance from NGOs. Asylum seekers normally must go to Mulago Hospital, one of Kampala's public hospitals, to try to get treatment. Some asylum seekers go to independent clinics, where treatment is more immediately available and where medicines can be purchased. Others have to ask Ugandans to help. Doris K., a young woman who had been a student activist in the DRC fell sick with malaria immediately after arriving in Uganda. A Ugandan helped her and paid for the medical costs.232 However, most forgo treatment because they simply cannot afford it.
Once a refugee's status has been recognized in Kampala, she can receive some triage care from InterAid's offices, which is officially tasked with providing medical care to refugees. InterAid has a small clinic, which was visited by Human Rights Watch, where sick refugees are seen on Tuesdays and Thursdays. Funding for drugs is provided by the German organization, Gesellschaft für Technische Zusammenarbeit (GTZ). Emergency or more complex care must be obtained at Mulago Hospital. If a refugee requires treatment that has to be paid for, a referral to Mulago must be made by InterAid, which is sometimes difficult to obtain.233
Each part of this system is fraught with problems. First, most refugees interviewed by Human Rights Watch explained that they did not receive care at InterAid's clinic either because no one on staff spoke their language, or because they were told that they should be self sufficient or that they should be in the camps. This latter reason was a common complaint amongst Sudanese. A twenty-eight-year-old Sudanese refugee woman, Inas M. said, "I have an internal bleeding problem with my menstruation cycle. I have gone to their offices at InterAid and they do not help me. They tell me, `you go back to the border where you come from.' I am sick and I am losing weight."234
Others complained that the medical care offered at InterAid was inadequate. For example, Fidèle D., a Rwandan refugee had typhus and malaria just prior to Human Rights Watch's visit. When he had typhus he went to a medical center and was treated. When he had malaria he went to InterAid. He found them very badly equipped. He said:
They did not do the malaria test. They gave me about five injections, during five days. I did not stay there, but came back every day. When it did not get any better, I went to Nsambya hospital. It was very serious. They admitted me immediately and gave me several infusions. The first night I was so sick I had no idea where I was, I was not clear in my head. They told me afterwards I had a very high fever.... Getting treated there [at InterAid] is really hopeless. ("Se faire soigner la-bas, c'est vraiment sans espoir").235
When Fidèle went to InterAid afterwards they refused to pay the bills, saying that he should not have gone to the hospital without their reference if he wanted reimbursement. He was unusually lucky because eventually he found an NGO that paid the bills for him.
Finally, since so many medical cases wind up in one of Kampala's hospitals, the government of Uganda would like to receive more help from UNHCR. One government official explained that he felt the agency was not doing its job for medical cases,
Normally, UNHCR doesn't listen to our referrals on... medical grounds. For example, we recently referred a case that required urgent medical attention to UNHCR. They wrote a letter back to us stating that the individual concerned should seek care at Mulago hospital. The letter [seen by a Human Rights Watch researcher] stated that "the only referrals we will receive are those regarding individuals in need of resettlement."236
Lack of Medical Care: Victims of Sexual Violence and Other Forms of Torture
Torture victims are not receiving adequate care in Kampala, a particularly egregious fact, since it is in contradiction to UNHCR's own guidelines237 and the agency's recognition that "the personal, social, and economic costs of failing to identify and intervene with [victims of extreme violence] are devastating."238 When Human Rights Watch enquired about the counseling available at InterAid, we were told that UNHCR and InterAid give counseling to asylum seekers and refugees about the pros and cons of remaining in Kampala versus going to the refugee camps. Refugees are "counseled" about how difficult it is to be self-sufficient and about "the need for them to go to settlements, especially to receive education for their children."239
When Human Rights Watch enquired later about counseling for sexual violence or torture victims, UNHCR explained that they do have a system of referrals for refugees (not for asylum seekers) to an NGO called the Transcultural Psychosocial Organization (TPO).240 However, in a telephone interview with Human Rights Watch, the Director of TPO explained that TPO does not provide any psychotherapeutic counseling for torture victims in Kampala, only in Uganda's refugee camps.241
Vincent A., a Congolese refugee living in Kampala showed a Human Rights Watch researcher deep scars ringing his shoulders, indicating that large cuts had been made all the way around the shoulder joints of both of his arms. He had been living in North Kivu and on July 9 and 10, 2000, his village had been attacked. 242 He said,
They killed so many in that situation. They killed many of the displaced. They wanted to exterminate the civilian population. But we weren't the aggressors.... They... subjected me to the "vest system"-the objective was to cut both of my arms off. They didn't manage to cut through the bones, but they made these two long cuts at my shoulders.243
Vincent had not received any medical or psychotherapeutic treatment for his torture.
Raphael S., a Congolese refugee living in Kampala who had been a pharmacist in Goma, eastern DRC, was tortured by security agents of the rebel force controlling his area, the Congolese Rally for Democracy (RCD-Goma).244 He was accused of unfairly raising the price of products for an RCD soldier.245 He told a Human Rights Watch researcher about the torture he had suffered in a Goma jail, and what medical care he had received since arriving in Uganda:
I fell unconscious from the beatings and so they brought me to the hospital at about 11:00 p.m. I spent eleven days in the intensive care unit. The tests showed that [as a result of the torture] my kidneys had been crushed, and I also had a broken clavicle. [After becoming a refugee in Uganda], except for the first two months I was here I have received nothing. I have to find rent money and there is inappropriate medical care. I know that the care at InterAid is terrible. They give people inappropriate medicine without doing the necessary examinations and checks. Because of my injuries I need proper care, including urinary tract treatment, but I have no options.246
Aaron H., a Rwandan refugee who told a Human Rights Watch researcher that he had been detained and tortured in Kampala by agents of the Rwandan government, was too afraid to tell his story to InterAid in order to ask for counseling assistance. He was only receiving legal counseling because the NGO that offered it was the "only place I feel safe."247 UNHCR recognizes that "it is essential that...victim[s] receive counseling as early as possible;"248 and yet, of eight victims of sexual violence or other forms of torture, not a single victim interviewed by Human Rights Watch in Kampala received psychotherapeutic counseling, and only half received medical treatment from UNHCR or its implementing partner, InterAid.
Responsibility for Refugees' Living Conditions in Kampala
Refugees living in Kampala are partly suffering from the poverty and violence that is afflicting many Ugandan nationals. While the Ugandan government does allow some refugees to work and provides them with access to its public hospital, the government could do more. For example, the government's opposition to the presence of Sudanese refugees in the capital has meant that their access to assistance has been even more restricted than other refugees.
For its part, UNHCR has not challenged the government's strict policy requiring that refugees be "self-sufficient" if they live in the city. NGO and UNHCR assistance for recognized refugees is extremely limited.
211 See note 45, above.
212 See note 46, above.
213 See note 47, above.
214 See note 48, above.
215 See note 49, above.
216 See note 50, above.
217 See UNHCR, Uganda Community Services Report, 2001 (on file with Human Rights Watch).
218 See InterAid Uganda, "Data Showing Visits By Refugees and Asylum Seekers During the Period January to December 2001," (on file with Human Rights Watch).
219 Human Rights Watch interview with Deputy Officer Thomas at Old Kampala Police Station, Kampala, Uganda, April 9, 2002.
220 Human Rights Watch interview with refugee, Kampala, Uganda, April 15, 2002.
221 Human Rights Watch interview with refugee, Old Kampala, Uganda, April 12, 2002.
222 Human Rights Watch interview with refugee, Kampala, Uganda, April 15, 2002.
223 Human Rights Watch interview with refugee, Kamapla, Uganda, April 15, 2002.
224 In March 2002, several newly arrived asylum seekers had begun sleeping in the gated courtyard outside of InterAid. Pierre T., a Congolese refugee, explained that the large group was mostly made up of new arrivals, coming from the DRC and Burundi. He estimated there to have been at least forty people in the group, although UNHCR insisted that there were fewer people sleeping outside. Human Rights Watch obtained a copy of the correspondence sent by InterAid to the police, requesting that the asylum seekers be rounded up on the night of March 12, 2001. Addressed to the District Police Commander at Old Kampala Police Station, the request explained that "for about a month now many people claiming to be refugees and asylum seekers sleep at InterAid offices.... Even some of those who have been explained to what procedures to follow have insisted on staying around. To make matters worse, we get reports that some of them drink and fight here, not to mention the fact that they soil the whole compound which now is very dirty and smelly, something we fear may cause an epidemic here." Letter from Mr. David Obot, Executive Director of Interaid to the District Police Commander, Old Kampala Police Station, March 12, 2002 (on file with Human Rights Watch). The next morning, Pierre T. went to InterAid to find out what happened and found the refugees dispersed in different locations. The group then walked the long distance to UNHCR by foot to protest this treatment and demand a solution. A UNHCR staff member took the refugees back to InterAid and sent two families to UNHCR houses in Kampala. The others were taken to the police. Some left from the police station for the camps and others continue to stay at InterAid, or right next to InterAid. Human Rights Watch interview with refugee, Kampala, Uganda, April 16, 2002.
225 Human Rights Watch interview with refugee, Kampala, Uganda, April 9, 2002.
226 Human Rights Watch interview with refugee, Kampala, Uganda, April 10, 2002.
227 Throughout this report, the exchange rate used was 1,795 Ugandan shillings to the dollar.
228 Human Rights Watch interview with refugee, Kampala, Uganda, April 16, 2002.
229 Human Rights Watch interview with refugee, Kampala, Uganda, April 10, 2002.
230 Human Rights Watch interview with refugee, Kampala, Uganda, April 15, 2002.
231 UNHCR Uganda Representative (speaking at a UNHCR/Human Rights Watch Press Conference), Kampala, Uganda, April 16, 2002.
232 Human Rights Watch interview with refugee, Kampala, Uganda, April 10, 2002.
233 Human Rights Watch interview with NGO representative, Kampala, Uganda, April 9, 2002.
234 Human Rights Watch interview with refugee, Old Kampala, Uganda, April 15, 2002.
235 Human Rights Watch interview with refugee, Kampala, Uganda, April 9, 2002.
236 Human Rights Watch interview with senior Ugandan government official, Kampala, Uganda, April 8, 2002.
237 See UNHCR, Guidelines on the Protection of Refugee Women, 1991, p. 54 (suggesting that UNHCR should "institute counseling and mental health services for refugee women, particularly for victims of torture, rape, and other physical and sexual abuse.").
238 See UNHCR, Training Module: Interviewing Applicants for Refugee Status, 1995, p. 89.
239 Human Rights Watch interview with UNHCR Community Services staff member, Kampala, Uganda, April 8, 2002.
240 TPO is an NGO founded in 1995 and based in Amsterdam, The Netherlands. TPO collaborates with the World Health Organization to assist refugees and others traumatized by war, human rights violations and other atrocities. Staff train local workers in affected locations as well as provide experts in the field when governments or aid agencies request their assistance. TPO is active in Algeria, Bosnia-Herzegovina, Cambodia, the DRC, Ethiopia, Gaza, India (among Tibetans), Mozambique, Namibia, Nepal, Sri Lanka and Uganda and is primarily financed by the Netherlands Ministry of Foreign Affairs. See TPO website, http://www.xs4all.nl/~tpo/.
241 Human Rights Watch telephone interview with Director of TPO, New York, September 20, 2002.
242 North Kivu has been the site of ongoing fighting, death, and displacement. According to UN estimates there were approximately 450,000 displaced people in the region during the period of this refugee's flight. See IRIN, "Tension in North Kivu," July 28, 2000. The fighting in the region between various militia groups and the Rwandan-backed rebels is the main reason for the continued displacement. On July 10, 2000 Sake village was attacked. Twenty-nine civilians were killed and several more wounded when unidentified attackers entered the village, burning huts and attacking occupants with knives and machetes. See Reuters, "Attackers Kill Twenty-nine Civilians in Rebel-held Congo," July 10, 2000; IRIN, "Feature on Tension in North Kivu," July 28, 2000.
243 Human Rights Watch interview with refugee, Kampala, Uganda, April 10, 2002.
244 The RCD launched a rebellion against the government headed by Laurent Kabila in August 1998. They vowed to restore democracy and respect for human rights within the DRC but the RCD-Goma and its Rwandan allies as well as the other parties to the conflict in the Kivus have regularly slaughtered civilians in massacres and extrajudicial executions. See "Eastern Congo Ravaged: Killing Civilians and Silencing Protest," Human Rights Watch/Africa, May 2000, Vol. 12, No. 3(A). See also Human Rights Watch/Africa, The War Within the War: Sexual Violence Against Women and Girls in Eastern Congo, June 20, 2002; ; Human Rights Watch/Africa, War Crimes in Kisangani: The Response of the Rwandan-backed Rebels to the May 2002 Mutiny, Vol. 14, No. 6(A), August 2002.
245 In September 1999, the DRC government ordered all exchange bureau closed and declared that it would be illegal for Congolese to hoard foreign exchange. This decree caused a large fluctuation in the national currency, and the government blamed a number of companies for attacking the Congolese franc and causing the depreciation. In response to the plummeting value of the currency, the government put in place price controls on many products. See Agence France-Presse, "DR Congo Forbids Foreign Cash Holdings, Closes Money Change Bureaux," September 18, 1999; AP, "Congo Under Kabila Looks a lot Like the Mobutu Era," March 6, 2000.
246 Human Rights Watch interview with refugee, Kampala, Uganda, April 10, 2002.
247 Human Rights Watch interview with refugee, Kampala, Uganda, April 11, 2002.
248 See UNHCR, Guidelines on Prevention and Response to Sexual Violence Against Refugees, 1995, p. 50.