Karamoja: Bringing life-saving services closer to communities

Uganda is facing a worsening humanitarian crisis driven by climate shocks, large-scale refugee displacement, food insecurity, and increasing vulnerability among refugees and host communities, particularly in Karamoja and West Nile. In response, a US$75 million allocation from the United States to the Uganda Humanitarian Fund (UHF) has been distributed among three UN agencies and six international NGOs to deliver prioritized, lifesaving assistance in areas with the greatest needs. 

The allocation is coordinated by the United Nations Resident Coordinator's Office (RCO) and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), with a focus on addressing malnutrition in Karamoja and supporting refugees and host communities in the Western and Northern regions and Kampala. The funding is supporting critical sectors including food security, health, nutrition, protection, shelter, and WASH, while also advancing the Humanitarian Reset through more coordinated, efficient, accountable, multisectoral, and locally driven action to maximize the impact of limited resources.

From 9–20 August, the OCHA Uganda-Kenya team, as well as the RCO, held a monitoring mission in Karamoja and West Nile, monitoring the impact of the Uganda Humanitarian Fund (UHF) on projects in the area. The Karamoja leg of the monitoring mission took the team through Moroto, Kotido and Kaabong, visiting WFP food stores, district leaders, health facilities and community outreach sites to see how humanitarian support is reaching communities facing food insecurity, malnutrition, climate shocks and insecurity. Partners including WFP, UNICEF and AFI are working alongside government health teams to deliver essential services to some of the region’s hardest-to-reach communities.

Moroto – 10 August

WFP Warehouse

At the WFP warehouse in Moroto, supplies were being prepared for distribution to health facilities and outreach posts. Ready-to-use supplementary food (RUSF) and other nutrition commodities are planned and dispatched to reach communities as close to the last mile as possible. The system allows health teams to request additional supplies when cases are identified, with deliveries planned in advance to ensure that children enrolled in treatment do not run out of essential nutrition commodities. Staff reported that they had not experienced a situation where these commodities were unavailable.

Moroto District Health Office

At the district health office, Dr. James Lemukol, the District Health Officer, described food insecurity, environmental and economic shocks and climate change as major drivers of malnutrition. The response has focused on rapidly expanding life-saving health and nutrition interventions, including door-to-door screening and outreach services. Since April, UNICEF, WFP, the Ministry of Health and district teams have worked together to train health workers and Village Health Teams, map outreach sites and strengthen data collection and monitoring. Five rounds of nutrition screening and outreach were carried out, reaching more children than initially targeted. But while the immediate response is helping children recover, health workers warned that the underlying conditions at household level remain a major concern.

 “Children may improve while they are in the programme, but when they are discharged they fall back to the same circumstances,” Dr. Lemukol said. “The cycle could easily repeat again.” For families, food insecurity is closely linked to livelihoods. Local leaders said many households are struggling to find enough food, while drought and erratic weather have made farming increasingly difficult. Some families turn to mining and other forms of casual labour because they have few alternatives.

Loputuk Health Center III

At Loputuk Health Center III, Sister Lucy, who has worked at the facility for 36 years, described the challenges facing families in the surrounding communities. The lack of rain has left fields scorched and reduced food production. Acute malnutrition has traditionally peaked between November and May but changing weather patterns are making it harder to predict when families will face the greatest shortages.

The health centre receives ready-to-use therapeutic food (RUTF), supports community outreach and screens children for malnutrition. It serves 12 outreach sites, including hard-to-reach communities. Between April and July 2026, the facility participated in three mass-screening cycles, reaching 4,923 children under five. The screenings identified children with moderate and severe acute malnutrition and connected them to treatment and supplementary feeding programmes.

Over the same period, the prevalence of acute malnutrition in Loputuk sub-county fell from 18.1 per cent in the first round to 6.8 per cent in the fifth. But the health centre itself faces constraints, including limited space and storage. Staff also highlighted the need for greater support to community volunteers who play a critical role in reaching families beyond the facility.

Lorikokwa Outreach Site

At Lorikokwa, health services are brought directly to the community. Supported by UNICEF, WFP and AFI, the outreach team provides nutrition screening and treatment alongside health education on nutrition, malaria prevention, sanitation and hygiene. Community members are also shown how to prepare nutritious foods using locally available ingredients.

Women attending the outreach site shared that malnutrition is inseparable from the wider struggle to put food on the table. Many households rely on casual work, selling firewood or charcoal, collecting water, cleaning houses, washing dishes or carrying bricks. Others try to grow sorghum, beans, maize, pumpkin and other crops, but unreliable rainfall can destroy the harvest. Some families eat only once a day when food is scarce. Others said that although food is available in markets, they do not have enough money to buy it.

Women also described sharing specialized nutrition products with other children in the household when there is nothing else to eat.

Kaabong – 11 August

Kopoth Health Center III

In Kaabong, the same pressures are evident. At Kopoth Health Centre III, health workers described a deteriorating food security situation, with some families increasingly relying on gold mining to survive. The community is also affected by prolonged drought, crop failure, cattle raiding and insecurity. These challenges are closely connected to other risks facing children, including school dropout and child labour. Health workers stressed the importance of timely humanitarian support and continued investment in nutrition services.

Nakatapan Outpost – Lolelia South

Further into Lolelia South, the team visited Nakatapan health outpost, serving 18 villages and more than 9,500 people. Here, health workers provide a range of services, from nutrition screening and immunization to malaria prevention, sanitation and hygiene education. Families are taught practical measures such as safe food preparation, drying food on racks and improving hygiene in the home.

The outreach team also demonstrated locally produced supplementary foods. Andre Foods International (AFI) is developing a biscuit made from locally available ingredients as an alternative way of supporting children with moderate acute malnutrition. Yet families still face major barriers to accessing services. Some travel for hours to reach the health post, while others have to walk long distances to collect water.

Community dialogue with women receiving nutrition support

During a discussion with women enrolled in the supplementary feeding programme, participants described the difficult choices families make when food runs out. Some women said they leave home early in the morning and walk for several hours to reach the health facility. Others said they rely on mining to earn money for food, sometimes taking their children with them. At home, many had planted beans, cassava, groundnuts, sorghum, sesame and vegetables, but much of the harvest had wilted because of the lack of rain. One of the most immediate concerns was simply what the family would eat that evening. Water is another major challenge. Some families reported spending up to two hours walking to collect it. Communities said they wanted health and water services closer to where they live, as well as better access to schools and maternity services.

Looking beyond the immediate response

The Karamoja mission ended with a debrief highlighting both the gains made and the work still needed. Outreach services have expanded access to life-saving nutrition screening, treatment and immunization, and essential nutrition commodities have remained available. But the needs on the ground remain greater than the current response.

One concern is that children can relapse after completing treatment if their families return to the same conditions of food insecurity. There is therefore a need to look beyond treating malnutrition and address the household and community factors that cause it. Water, sanitation and hygiene also remain critical gaps, alongside the need for better communication with communities, stronger follow-up and continued support for Village Health Teams.

For Douglas Lubowa, UNICEF Social and Behaviour Change Officer covering Kaabong and Moroto, the region needs solutions that go beyond responding to each new crisis. “We keep coming back to this place, we make progress, and then climate change sets communities back again. We need to find sustainable ways to help people build livelihoods and become more resilient.” That resilience is what communities themselves are asking for: reliable access to food and water, better roads and health services, sustainable livelihoods and opportunities for children to remain in school.

The humanitarian response is helping save lives today. The longer-term challenge is to make sure those gains endure, and that communities in Karamoja have the resources, services and opportunities they need to withstand the next shock.