Think of famine in East Africa and you’ll likely picture desperate people queuing in arid and dusty lands.
Yet behind the drought that has taken hold in the region is an often forgotten and equally pernicious driver of hunger: conflict.
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In South Sudan, it is conflict rather than climate that is causing widespread hunger.
Protracted fighting has forced 3.3 million people to uproot from their homes.
Over 600,000 of them have crossed the border to Uganda in search of sanctuary.
With the start of the rainy season, however, a new threat is emerging.
The risk of cholera and other waterborne diseases is very high given the crowded living conditions and the number of un-immunized children crossing the border.
Cramped conditions for refugees
Red Cross teams in northern Uganda are helping to manage the influx of refugees.
Peter Pearce heads up one of our emergency response teams.
“Outbreaks of disease are what we all fear when you have a lot of people in a confined space,” he said.
Peter is working at the Imvepi camp. It is the newest camp for South Sudanese refugees in Uganda. Opened at the end of February, it’s filling up rapidly.
“The buses are coming in one after the other,” said Peter.
“It’s somewhat overflowing at the reception centre. They are arriving faster than they can be processed. There are 12-14,000 people in a fairly confined area.”
The camp is home to around 33,000 people with thousands more arriving daily. The buses come in from the border and deposit people at Imvepi’s reception centre.
New arrivals take around three days to complete the registration process. Their details are taken, they are fed and sheltered, and immunised against common diseases.
They are then given a small plot of land and some materials to build their own shelter.
Trucking in clean water
“Last night was the first time it rained throughout the night,” said Peter. “It made the situation much worse… It’s always miserable when it’s raining.”
The rainy season brings with it a heightened risk for those arriving at Imvepi.
“We saw a huge need immediately,” Peter continued. “Our role is disease prevention. Of course, the big fear in these situations is cholera.
“There are some cases of diarrhoea, but nothing out of the ordinary for a typical population, nothing that could be identified as an outbreak.”
A steady supply of clean water is vital in keeping the population healthy.
Those already suffering from malnutrition are particularly susceptible to the transmission of waterborne diseases.
As ever, it’s the women, children and older people who are most vulnerable.
10,000-litre water tanks sit in various points in Imvepi. Water from the Nile is trucked in having been cleaned and chlorinated.
Trucking water to all the nearby camps is a complex operation. Each tank is filled more than once a day.
Over time, the team are planning on moving to rainwater harvesting to supply the camp. It will only take one truck to get stuck on the muddy roads for the water supply to dry up.
A toilet of your own
Another important consideration for the team is good hygiene.
To date, our team at Imvepi has recruited 80 ‘hygiene promoters’ from the refugee population.
The volunteers are trained and then tasked with moving between households to check how water is stored, rubbish is disposed of, and much else besides.
The idea is that spreading good hygiene messages will make a disease outbreak less likely.
Toilets are of course another issue at Imvepi.
Peter’s team have already constructed blocks of latrines and showers for people waiting at the reception centre.
The second, more challenging phase comes when people move out of the centre on to their own plot of land.
The Red Cross gives people tarpaulins and blankets. They are also given spades and asked to dig their own latrine pits.
Peter added: “We provide timber beams to cover the pit… They source the rest of the materials themselves. You see some amazing brick structures.”
The latrines ensure that human waste is disposed of safely. Having your own plot of land and your own toilet also gives a little bit of dignity for people who have lost everything.