Alice Nyadeng had been sitting inside Kyangwali HC III children's ward on a bench since 7am by the time we arrived at the health facility at around 11am recently. Nyadeng looked exhausted.
According to Nyadeng, 32, she had an appointment with the doctor three days ago but had not been able to see any; every time she got an appointment, it was cancelled because the doctor had to see other patients in 'critical' condition.
"My daughter has unending cough, yellow eyes and sweats a lot; so, nurses at Maratatu HC II referred me here last week but I have not been able to see the doctor. Sometimes I think they treat me like this because I'm a refugee," she said through an interpreter.
When you walk through the gate, you notice that the outpatient department is typically crowded, the antenatal, postnatal and the wards are equally crowded. As for Beata who has just delivered, there is not much help and she does not know when she will leave. She had delivered the previous night but had not seen a doctor.
"I did not have any complications but the nurse [midwife] advised that I see the doctor, the challenge is that I have waited; I want to leave but they have kept me here," she said.
Nyadeng and Beata are among the many locals and refugees who fail to see doctors at the facility. Some locals say things are made worse by the increasing number of sick refugees arriving at Kyangwali Refugee Camp in Hoima district.
Omuhereza Rwemera Mazirane, the LC III chairman, says his people are suffering more because the health centre which does not have enough staff, let alone infrastructure and medicines; now has to contend with rising numbers of refugees. He also said doctors are shunning the facility because of poor working conditions, remoteness of the area and are overworked.
"With this population, we want a hospital, not a health centre; we don't have doctors, ambulances; my people are suffering. Hoima regional referral hospital is 90km from here," he said.
"Since the 1960s, we have been good neighbours with the refugees, the challenge is that refugees and UPDF are grabbing our land; as nationals, we have become beggars."
He said refugees with identification cards can easily get land and other services faster than the locals.
Dr Justus Timbigamba, the in-charge of Kyangwali, admitted that what patients are saying is true but there is nothing he can do. He also told diplomats from the European Union and Norwegian ambassador Susan Eckey who were visiting that Kyangwali Health Centre III has a catchment population of 57,700 people, of whom 30 per cent are refugees.
"We are incapacitated. The facility has only one government doctor, although partners like United Nations High Commissioner for Refugees (UNHCR) and other organisations have helped us recruit, the doctors are overwhelmed," he said.
The diplomats were in Hoima district for a three-day retreat to assess the needs of the health facility; they also visited Kyangwali Refugee Settlement and interacted with refugees.
According to Hugo Verbist, the Belgian ambassador in Uganda, the new EU humanitarian aid for 2018 prioritizes the provision of rapid and good-quality emergency assistance including medical services to newly arrived refugees, especially those from South Sudan and DR Congo.
In 2017, the EU allocated €65 million in humanitarian assistance and €20 million to build the self-reliance of refugees. Timbigamba explained that Kyangwali HC III is supposed to serve 10,000 people but handles up to 57,272 patients annually. The facility handles about 2,100 on a monthly basis, according to the managers; at least 80 patients receive treatment daily.
"We have only three doctors and what pains mostly is that they sleep three in one house, something that is very inconveniencing to them. Patients are not spared either; males and females share wards at times," he said.
"Doctors that are posted here feel humiliated; a whole degree holder to sleep three in a room is an abuse, so they go."
Timbigamba said NGOs recruit doctors who leave once their contracts are up.
"We have seen cases where NGOs recruit doctors for a contract of three months, most of them don't renew but just go to Kampala; so, we go for the second or third best," he said.
The health facility also faces other challenges. Timbigamba said the ministry of Health sends a mere Shs 1.2 million every quarter which cannot run the facility for two weeks. According to him, with 60 per cent of the patients in the wards being refugees, the administrators believe there should also be planning for the refugees.
Daniel Muhairwe, the MP for Buhaguzi county, admitted that the area is a catchment but explained that refugees are also human beings and the Ugandan government is responsible for them.
"It's a commitment as a country to take care of them; our biggest challenge here is space. Kyangwali sub-county alone has 170,000 people; remember this is a HC III in books but on the ground it's a hospital; so, we should upgrade it," he said.
Dr Nicholas Kwikiriza, the acting district health officer, said the only option is to upgrade the facility. William Carlos, the ambassador of Ireland in Uganda, acknowledged the need to commit more resources. Other ambassadors were outraged at the shameful state of the health centre.
"The EU gives large amounts of money to get the refugees a livelihood because if they are able to sustain themselves, it's better since they will be more responsible for themselves," Dr Albrecht Conze, the ambassador of Germany, said.
"We are shocked by the state of the health centre in Kyangwali; it is below Ugandan standards; doctors need support to treat people, not manage hospitals, there should be a clear-cut [distinction] between management and treating."
According to Conze, doctors should not be running around doing paperwork but concentrate on their core business which is treating the patients. He also said the unhygienic situation needs to be worked on.
"We are going to have a meeting with the Office of the Prime Minister staff and even the prime minster, we should find a way of dealing with this," he said.