How Uganda is Doing More with Less

Geoff Bennett:
The ongoing conflict in the Middle East has drawn attention away from other devastating wars around the world, including in Sudan, where millions of civilians have been displaced and many forced to flee to neighboring countries.
The crisis comes as many donor nations sharply reduce refugee assistance, leaving humanitarian agencies scrambling to adapt.
Special correspondent Fred de Sam Lazaro reports now from Uganda, long one of the region’s leading destinations for refugees.
Fred de Sam Lazaro:
In a world that seems ambivalent, even hostile toward refugees, Uganda stands apart.
Patrick Okello:
One hundred or less.
Fred de Sam Lazaro:
Patrick Okello is commissioner of refugee affairs, overseeing what he readily calls an open door policy.
Patrick Okello:
This is a very small number. Today has been a good day.
Fred de Sam Lazaro:
Every morning, just outside his Kampala offices, hundreds of recent arrivals gather, on this day most from Ethiopia, Eritrea and Somalia. The vast majority are approved for asylum.
Patrick Okello:
In terms of rejection, it’s about 2 percent, which is the lowest number anywhere in the East African region and even in the world.
Fred de Sam Lazaro:
We travel to Kiryandongo, about three hours from Uganda’s capital, where tens of thousands of refugees have settled and where hundreds continue to arrive every week. Uganda has perhaps the world’s most liberal refugee policy, and over the recent decades up to two million people fleeing conflict in surrounding countries have come here.
They’re given work permits, a small plot of land to cultivate, things to start life over. That’s never been easy in a low-resource setting, but after cutbacks in international aid programs in the last couple of years, it’s become exponentially more difficult, and the government’s been forced to make some tough decisions.
Refugees here have come mostly from South Sudan in recent years. That country, carved out of Sudan in 2011 after decades of brutal civil war, has been beset by internal conflict since. Then, about three years ago, Sudan itself became racked by violence, sending waves of Sudanese into a neighborhood now occupied mostly by their former South Sudanese antagonists.
Beatrice Emani arrived here several years ago and settled into this home built with assistance from a nongovernment group and tends a small plot of land.
This used to be yours.
Then a chunk of it was recently taken from her, she says.
Beatrice Emani, South Sudanese Refugee (through interpreter):
They told me they had a lot of Sudanese coming in, so I had to give them some of this land.
Fred de Sam Lazaro:
Food assistance she used to get in commodities, and later cash, that too went away.
Beatrice Emani (through interpreter):
They said they are going to give us food again, but that has not happened. Maybe those people are taking all the support.
Fred de Sam Lazaro:
Resentment and conflict have arisen here and even killings, driven as much by scarcity as old animosity, officials say.
Jason Hepps, Representative, UNHCR:
The stability of the situation in the settlements is something that is extremely worrying.
Fred de Sam Lazaro:
Jason Hepps heads the Uganda office of the U.N. High Commissioner for Refugees. UNHCR has for years provided support to the Ugandan government, but this year it’s raised just 10 percent of the funds it says are needed here.
Jason Hepps:
And so you have to triage.
Fred de Sam Lazaro:
Because they are new here, the Sudanese get priority, but they don’t get much; 37-year-old Aisha Adan Moussa, separated from her soldier husband, fled here from the Darfur region with four small children.
Unlike arrivals in earlier years, there’s no assistance to build her a sturdier home than this tent-like structure. She receives just under $75 in food assistance, which must stretch for two months.
Aisha Adan Moussa, Sudanese Refugee (through interpreter):
I get some maize, yams, cooking oil. Sometimes, I can buy tomatoes. I go to the market and around the neighborhood to collect clothes to wash so I can get something extra. I can make porridge with sugar for the kids.
Fred de Sam Lazaro:
Her children will not likely see a school any time soon.
Jason Hepps:
This year, tens of thousands, if not hundreds of thousands of children, will just not — it will be a lost year for them.
Fred de Sam Lazaro:
There’s simply no money, he says, as most donor nations have reduced their assistance budgets. The U.S., by far the largest donor, cut its global humanitarian assistance to one-third of what it was two years ago.
Hepps says health care funding has fallen through the floor.
Jason Hepps:
We had about, all told, $30 million. That was ’24. In ’25, that was reduced to about 15, and this year, we started the year with about $2 million.
Fred de Sam Lazaro:
At the Panyadoli Health Center, serving some 300,000 people in the area, the staff has been trimmed from 133 two years ago to about 50 today, among them just two doctors.
Dr. Alex Tezita, Panyadoli Health Center:
I’m delivering 85 to 90 women per week.
Fred de Sam Lazaro:
One of them is Alex Tezita.
And 45 beds to accommodate these women. And the rule, you say, is, if you have a normal delivery, you’re on the floor. If you have a C-section, you have first dibs on a bed.
Dr. Alex Tezita:
Yes, to try to prevent complications, infections and so on.
Fred de Sam Lazaro:
Caesarean sections are common among the Sudanese patients, he says, due to the practice of female genital cutting.
Dr. Alex Tezita:
Out of five, you will find that three by C-section.
Fred de Sam Lazaro:
Wow, three out of five.
Dr. Alex Tezita:
Yes.
Fred de Sam Lazaro:
As we spoke, I had to quickly duck out of the way, as the family of a patient just behind us sought the doctor’s attention. The patient had just delivered, and her blood pressure was spiking.
Dr. Alex Tezita:
Let me first bring my gloves.
Last year, I didn’t lose a mother, but I have lost babies. I lost around 67 babies.
Fred de Sam Lazaro:
Sixty-seven babies. How many of these would have been preventable if you had the amenities that you would need?
Dr. Alex Tezita:
Around 50 of them would be preventable.
Fred de Sam Lazaro:
He’s worked to better the odds for babies, landing donations of incubators and improvising, this contraption with three naked lightbulbs, for example.
Dr. Alex Tezita:
That thing was my phototherapy, for babies that have jaundice, yellowing of the eyes and the skin.
Fred de Sam Lazaro:
Yes, yes, yes.
(Crosstalk)
Fred de Sam Lazaro:
Overall, the survival rate of newborns here climbed from 90 to 96 percent between May 2024 and May 2025.
Mothers and babies are just one part of the workload here. On any given day, there are hundreds of patients with HIV, T.B. and malaria, with hypertension, diabetes and heart disease. Dr. Tezita says he hasn’t taken a vacation since at least 2024, and he’s been awake most of the time.
How many hours do you sleep?
Dr. Alex Tezita:
A maximum of three, sometimes two. Yesterday, I left this place at 3:00.
Fred de Sam Lazaro:
You left this place at 3:00 a.m.
Dr. Alex Tezita:
A.m.
Fred de Sam Lazaro:
And woke up?
Dr. Alex Tezita:
Six-thirty, I was here.
Fred de Sam Lazaro:
In response to U.N. appeals, the United States recently announced a $2 billion grant for humanitarian assistance worldwide. The funds are to kick in later this year, with Uganda’s share at $75 million.
Jason Hepps:
That will cover a lot of the humanitarian immediate lifesaving needs for health workers, for medicine, in what we are calling a bridge.
Fred de Sam Lazaro:
A bridge that will span only a part of a sea of humanitarian need, he says, in a region where conflict seems unrelenting.
Patrick Okello:
Hosting refugees is a global shared responsibility. It should not be left entirely to Uganda alone. We have given land, but the refugees need shelter. We have given land. The refugees need food. We have given land. Children have to go to school. Children need health services. The women need to deliver children in decent hospital environment.
Fred de Sam Lazaro:
For the “PBS News Hour,” I’m Fred de Sam Lazaro in the Kiryandongo refugee settlement, Uganda.