Dr Jessica Hawkins  reflects on Uganda’s early response to COVID-19 in conversation with Humanitarianism and Conflict Response MA alumni and Director of Communications for USAID’s Better Outcomes for Children and Youth, Sarah Lagot Odwong.

On the 13th of March, the World Health Organisation declared that every African state had a case of COVID-19. The news followed warnings from the WHO that as many as 190,000 could die on the continent within the pandemic’s first year.[3] Uganda, a country that has experienced crises from various threats, including those related to conflict and global health, has received praise from those within and outside the country for its quick action in response to the pandemic, much earlier than some European states.
In this regard, there is much that countries such as the UK can learn from Uganda’s fast action. For Uganda, a country formed solely on colonial lines, an unusual form of unity has emerged due to lockdown, which is usually only seen during national sporting moments. However, as the successful lockdown starts to ease, structural inequalities are re-emerging, threatening the newly formed Ugandan national feeling.

Uganda’s quick lockdown – lessons for the West

Uganda is no stranger to outbreaks of deadly viruses. In 2007, Western Uganda experienced a large Ebola virus (Towner et al. 2008). Even earlier in 2001, the war-torn Acholi region registered 224 deaths due to Ebola, while most of the population were forcibly held in Internally Displaced People camps (Hewlett & Amola 2003). In addition to Ebola, the country has had to act quickly against outbreaks of measles, Yellow fever, and Crimean Congo Hemorrhagic Fever regularly. Correspondingly, it has been necessary for Uganda to develop prevention methods in response to pandemics. According to WHO Africa, on 18th March, Uganda’s preparedness went hand-in-hand with a comprehensive response plan, admired by both donors and its population.[4]

Press releases and Government of Uganda reports show that as early as 5th February, President Museveni was meeting with government officials to discuss their preparedness for the threat of Coronavirus; this was followed two days later when the Ugandan Ministry of Health issued a notification, using WHO recommendations, to encourage people to increase handwashing with soap and to avoid shaking hands. However, these were just the official communications. Even in late December and January, when the true extent of what was happening in Wuhan started to emerge, precautionary measures were being put in place in Uganda. Teams of public health officials, epidemiologists, and surveillance monitoring started to have discussions behind closed doors on how to respond to the virus. Thus when the President announced the lockdown on 19th March, which restricted movement, closed schools, and halted public gatherings,[5] border points were already active and ready to respond, and informal messaging to communities had already started to sensitise the public about the virus. The first case of COVID-19 was recorded on 21st March.

This proactive response, when compared with the UK, demonstrates Uganda’s preparedness. In contrast, despite the confirmation of the first case in the UK on 29th January, the lockdown was not announced until 23rd March, and although the British lockdown was more stringent (people were told to work from home where possible) than the Ugandan version, 335 people had already died by this point. By 9th June, Uganda has registered only 775 cases and was remarkably only one of five African countries with no deaths by this date.[6] In both countries, the numbers may not be exact, but the figures show that lockdown has slowed Uganda’s rate of infection (with the restrictions on international travel being the most significant for halting the spread).

Many media outlets have described the UK’s current situation as unprecedented; that may be the case for the average citizen who is trying to navigate the complexities of the lockdown. However, just like the Ugandan one, the British government had plenty of time to prepare for a pandemic. Since 2007, every British government has been aware that a pandemic was the biggest threat to life, registering a level 5 impact (a terrorist attack is classified as level 3).[7] In this regard, there was plenty of time to prepare for a response to meet the impact of this risk. The Ugandan government acted promptly, while the British government took an alternative path.

Unity in lockdown

The most remarkable aspect of Uganda’s lockdown was how it changed understandings of “being Ugandan”. Usually, Ugandans’ identity is foremost tied to their regions, such as Buganda or Acholiland. However, the lockdown has created a sense of Ugandanness. Each community has seen support from the national government on a par with its neighbours. In the past, regions such as the South-West where the President comes from, are perceived to receive more government funds than the much poorer northern region. Within each community, the Local Councils Level 1 became the custodians of the Covid-19 response, and through this, everyone in the community came together to follow the lockdown rules and support one another. Those who could, donated to the Covid-19 response.

Further, the government’s test, track, and trace initiative is also seeing local level support. Even traditional weddings, known to be large affairs, were toned down to smaller numbers with social distancing adhered to. Lockdown created a new community spirit that is very Ugandan.

The veil of lockdown

Despite this seemingly proactive response in Uganda, it cannot be seen solely in a positive light. A recent blog post from LSE has highlighted the economic and social impact on Ugandans, outlining the detrimental effect the lockdown has on those living from hand to mouth without any form of relief package. What about those who have experienced years of conflict and violence and already rely heavily upon relief and reconstruction initiatives and have significantly poor access to health care? The northern region, specifically, Acholiland, saw twenty years of war during the Lord’s Resistance Army conflict. Many here are farmers who have had to battle with the state to access land, which was sold or taken from them during the conflict. Lockdown has meant that they could not travel to these often distant farmlands and has meant they have missed vital steps in the farming cycle, denying them crops not only for future income but also for their own family’s subsistence. This is a severe blow for a region that is on the periphery of Uganda’s economic development.

Further, the number of refugees in the north is now estimated by UNHCR to be just over 800,000.[8] As travel restrictions are relaxed, there are concerns that the virus’s rate of infection will increase dramatically. Uganda’s refugees are often transitory, moving between their official refugee camp and their social networks elsewhere in the country for employment purposes. Further outbreaks of Ebola and increased conflict in the DRC could increase the numbers entering the country again, placing further demands on health services, particularly as the COVID-19 funds are reduced.

There are also huge concerns as the region sees a resurgence of gender-based sexual violence and an increase in mental health issues. These were two of the biggest demands on the health services in this post-conflict region before lockdown. Lockdown has helped hide these issues; much work will need to be done to ensure they receive the support and response they deserve.

Finally, government accountability is being questioned. It has emerged that government co-ordinated food distribution is prioritising government favoured areas.[9] When other agencies and individuals (including opposition MPs) have offered to co-ordinate to ensure parity, the government has responded with military action.[10] Also, it emerged that money for constituency COVID-19 response was paid directly into MPs’ accounts, much of which has not been accounted for.[11] Further, the most recent scandal relates to the President’s own family members, who not only received preferential quarantine when they returned to Uganda from a trip at the beginning of lockdown, but they have also been allowed to leave the country, in spite of continued travel restrictions for the rest of the population. As the 2021 elections loom, so has the emergence of Corona-politics.

In sum, Uganda’s COVID-19 response should be studied and researched in more detail to understand how it managed such a prompt and seemingly successful response. The lockdown created a temporary new form of Ugandan nationalism that has never existed before and perhaps will not again. Yet, as lockdown eases, Uganda’s structural inequalities, which were ever-present before Coronavirus, are emerging; no notion of national unity can disguise what could be critical areas for campaigns as the country nears its Presidential elections.

Acholi poster – https://www.afro.who.int/sites/default/files/2020-04/Acholi%20-%20Coronavirus%20-%20Poster.pdf

[1] Lecturer in Humanitarian Studies at HCRI, University of Manchester.

[2] Communications Director for USAID Better Outcomes for Children and Youth Program and communications advisor for the Ministry of Health’s “Heroes in Health” Campaign and Covid-19 response.

[3]  https://www.bbc.co.uk/news/world-africa-52587408

[4]  https://www.afro.who.int/news/uganda-uses-recent-outbreak-experience-prepare-coronavirus

[5] https://www.health.go.ug/2020/03/19/guidelines-on-avoiding-the-corona-virus-pandemic/

[6] https://apps.who.int/iris/bitstream/handle/10665/332321/SITREP_COVID-19_WHOAFRO_20200610-eng.pdf

[7] https://www.newstatesman.com/politics/uk/2020/03/why-weren-t-we-ready see also p.5 of the National Risk Register https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/61934/national_risk_register.pdf

[8]  https://data2.unhcr.org/en/country/uga

[9] https://oxfamblogs.org/fp2p/surviving-the-covid-19-pandemic-the-view-from-a-ugandan-surgeon-and-epidemiologist/#comments-wrapper

[10] https://blogs.lse.ac.uk/africaatlse/2020/06/15/food-distribution-coronapolitics-uganda-lockdown-elections-kampala/

[11] https://www.theeastafrican.co.ke/news/ea/Uganda-executive-MPs-in-tussle-over-use-of-Covid19-funds/4552908-5554338-m963anz/index.html

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