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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 (200km) north of Uganda’s capital, Kampala, draws new arrivals every day 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.
Known for its progressive refugee policies, which include granting freedom of movement, land to cultivate, and the right to work and open a bank account, Uganda is home to 2 million refugees – the largest refugee population in Africa – who live in 13 settlements across the country.
But funding shortfalls, compounded by aid cuts, have left the country’s refugee programmes in crisis. This year, the UN’s refugee agency, UNHCR, received only 12% of the $850m (£640m) it needs for Uganda.
The World Food Programme’s (WPF) rations have been slashed – in early 2025 it supported 1.6 million refugees, but this year can help only 663,000 – leading to worsening hunger and malnutrition. Acute malnutrition among under-fives has risen by nearly 50% in a year.
The International Rescue Committee (IRC) says funding cuts have pushed the country’s health system to the brink. In 2025, the IRC’s Uganda health budget was about $18m (£13.6m), the bare minimum to keep critical services running, according to local sources. 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 even more 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 heath system.”
In December, the IRC had to shut the two clinics it supported in Kiryandongo, forcing refugees to walk farther to access medical care. When they get there, they often find stocks of medicines are low or nonexistent.
Suzan Mandera, 30, from South Sudan, regularly attended one of the two clinics that closed, Cluster G health post, to get medicine to treat 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 is struggling to serve the 300,000 people under its care.
Mandera, who left South Sudan in 2014 during the civil war, points at the surrounding 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?”
The cuts are taking their toll on staff too. Dr Nicholas Sabiiti, a medical officer at Panyadole, barely has time to eat as he races between the wards, theatre and outpatients.
“We had to let go of more than half our staff in 2025,” he says. “I rarely have a day off. I am not able to get a proper meal until night-time.”
Sabiiti’s colleague Sarah Birungi, a midwife, says pausing for a break would mean patients giving birth unattended. It is impossible to keep up with demand.
“We are seeing mothers with sepsis returning to hospital because of all these delays,” she says. “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 that while no cases of puerperal sepsis (infection of the reproductive tract after childbirth) were diagnosed in Panyadole before the staff cuts in October, there were at least five cases in January, though they were successfully treated. According to IRC records, newborn deaths at Panyadole rose from 13 in October to 23 in January.
In January, the United Nations Population Fund, UNFPA, identified a critical need for 267 midwives across all of Uganda’s settlements. The persistent funding gap means only 23% of these are in place.
Kristine Blokhus, country representative for the UNFPA 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,” she says.
The struggle to treat everyone adequately is getting harder, despite a drop in the number of patients – from 15,065 in October to 10,926 in January.
Mandera puts the fall in numbers down to a sense of resignation among the refugee population. “One time I called the ambulance driver from Panyadole hospital when a mother was in labour and they said it was not an emergency,” she says. “There is only one ambulance driver for the whole settlement.” The settlement previously had three ambulances.
Fatima Muhammad Ahmed, a Sudanese refugee and volunteer translator adds: “The volunteers who were previously given a modest transport stipend are no longer receiving it and cannot walk many miles every day to Panyadole to help people communicate with health workers.”
The UNFPA says there is a 30% shortage of supplies in at least seven of Uganda’s settlements, including Kiryandongo. This includes the drugs oxytocin, misoprostol and magnesium sulphate, which are all used in obstetric medicine, as well as clean delivery kits, neonatal resuscitation equipment and HIV post-exposure prophylaxis (Pep) kits.
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 and loss to follow up.
The number of village health teams, who are often the first point of contact for refugees, has fallen from 2,517 in 2025 to just 163, weakening health promotion and early response to illnesses such as malaria, pneumonia and diarrhoea.
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,” Annet says. “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,” she says. “Sometimes they just give you a half dose and send you away.”
