Health challenges facing marginalised groups in Kaabong

The health situation among the Ik, an ethnic minority in the Karamoja sub-region, is dire. With the nearest health centres located miles away, access to basic medical care is almost impossible for most residents. The Ik inhabit the farthest reaches of Kaabong District, straddling Uganda’s borders with South Sudan and Kenya. Administratively, Ik County comprises the three sub-counties of Timu, Murungole, and Kamion. However, only Kamion sub-county is served by a Health Centre III, while the other two make do with lower-tier facilities, which are scattered and under-resourced. Reaching any of these health facilities often requires residents to walk between 10 and 20 kilometres. Those who can afford to, use bodabodas which charge Shs60,000 to and from the health centre. However, arranging for a boda boda can take hours.

Locals report that countless deaths occur quietly within people’s homes. Data from the Uganda Bureau of Statistics (UBOS) indicates that more than 3,000 Iks remain largely invisible in national frameworks, barely acknowledged within Uganda’s legal or policy structures. It is no exaggeration to describe the constituency’s health system as broken. Bosco Ezra Ocan, a teacher at Timu Primary School in Timu sub-county, recounts the overwhelming challenges. He says the nearest health facility is Timu Health Centre II, which has only a nurse and a midwife.

“Critically ill patients can only receive reliable treatment at Kaabong General Hospital, which is 50 kilometres away. On many occasions, the health centre faces drug stockouts. The best the health workers can do is to give you a referral letter. People fall sick and remain at home. In the end, they die,” he says. The health centre is located on a mountainside and some members of the community have to walk 12 kilometres to access it. 

Esther Nangole, a resident of Kololo Village has faced the tragedy of poor access to healthcare and health information. Her sister died seven months after giving birth, leaving her with the baby. She suffered a stroke after giving birth, an ailment the family neither recognised nor understood. Although the new mother remained ill for months, she was never taken to a health facility. “Shortly after my sister’s death, her oldest child fell ill with pneumonia. She died on the journey to Timu Health Centre II. The baby lacks proper feeding. I tried to breastfeed her but she needs more food,” she says. Now, Nangole, herself pregnant, has placed the toddler with her grandmother.

Yet poverty is so deep-rooted that even the grandmother struggles to provide the basic needs. The household frequently endures hunger. Such tragic patterns are common in Ik County, where several children have been orphaned after their parents died of preventable or treatable diseases. While Kaabong District leaders acknowledge the gravity of the healthcare crisis, they argue that cultural attitudes also play a significant role. Many Iks, they note, still place unwavering trust in local herbs and traditional remedies, avoiding formal medical care even when gravely ill. Many of them believe that raw honey can cure any ailment. 

Limping structures

The problem extends beyond Ik County, though. According to Ministry of Health guidelines, every sub-county should have a Level Three facility. Dr Sharif Nalibe, Kaabong District’s health officer, says out of 19 sub-counties, only eight have Health Centre IIIs. “Of the remaining eleven sub-counties, two do not have a single health facility. These sub-counties have been operational for more than five years but due to inadequate funding, we are unable to put up health structures. We hope that by the next financial year, we will have established something in one of them,” he says. The district has one general hospital but does not have a health centre IV. However, the government is in the process of elevating Kalapata Health Centre III to a health centre IV. “The government received funds from the Italian government to improve infrastructure in the Karamoja sub-region.

A theatre and staff houses will be constructed at Kalapata Health Centre III,” Dr Nalibe explains. Kaabong General Hospital is grappling with a shortage of medical personnel, which has severely compromised the delivery of timely patient care and treatment. Established in 1982 as a level-two facility following a cholera outbreak, today, the hospital serves a catchment area of 25,000 people. Since it is a referral, the hospital sometimes surpasses its catchment population. Dr John Baptist Omutogor, the medical superintendent of Kaabong General Hospital, says there are only five doctors, none of them specialist. However, two of them are away on study leave, while one is away on annual leave. This has left the hospital with only two doctors. “I have been working day and night for almost two weeks. Every day, we deal with 200-500 patients in the outpatient department (OPD).

Sometimes, there are drug stockouts in the lower facilities so all the patients come here. The doctor-to-patient ratio is quite low but we have to offer the services,” he says. Although the 150-bed hospital boasts an ultrasound machine, there is no specialist to man it. The hospital has a well-equipped and functional operating theatre but does not have enough manpower to manage it. “We are in the process of acquiring a new X-ray but we do not have a radiographer. Whoever needs those services has to travel to Kotido town, 70 kilometres away. We have run several adverts for radiographers but no one applies,” Dr Omutogor explains. No one responds to the adverts probably because Kaabong is considered a hard-to-reach area. Last year, the hospital sent one of its staff for training in radiography. However, as the hospital was in the process of recruiting him, he was hired by Abim General Hospital. Kaabong Hospital has one anesthetist officer. When he goes on his annual leave, the theater stops functioning. There is also a shortage of nurses, laboratory personnel, and midwives. 

Dilapidated physical structures

The hospital has four wards: surgical, medical, paediatric, and maternity. According to Dr Omutogor, overcrowding is most severe in the paediatric and maternity wards, particularly during the rainy season when malaria cases surge. The physical infrastructure of the hospital also raises serious concerns. Several buildings are cracked and at risk of collapse, endangering both patients and staff, according to Joseph Lokut Mukasa, the vice chairperson of Kaabong District. “Under the USAID Uganda Health Activity (UHA), in December 2024, we commenced the construction of a laboratory at the hospital, at Shs1.5 billion. However, when President Donald Trump issued his executive orders in January this year, all operations under UHA were suspended,” he explains. The construction works, which had reached the window level, were stopped in February and there has been no communication from the donors. 

“This is a huge project that the district is unable to take over. If the funding is stopped, then the Ministry of Health will have to take on the project,” Lokut adds. Kaabong District is made up of three counties; Dodoth North, Dodoth East, and Ik, each with an ambulance. Among the Ik, the structural challenges the district is facing in its healthcare service delivery are compounded by the language barrier. The Ik speak a language that is different from the Dodoth and when they visit the hospital, they are often unable to describe their symptoms. Due to this barrier, they are forced to return to traditional herbs. The Ik’s battle for survival is not just a health crisis; it is a sobering reflection of how distance, poverty, cultural beliefs, and government neglect combine to push an entire people to the brink. Without urgent and sustained intervention, the Ik risk remaining locked in a tragic cycle where preventable deaths continue unchecked, simply because help lies just too far away.

What they say

I have been working day and night for almost two weeks. Every day, we deal with 200-500 patients in the outpatient department (OPD). Sometimes, there are drug stockouts in the lower facilities, so all the patients come here. The doctor-to-patient ratio is quite low, but we have to offer the services. We are in the process of acquiring a new X-ray, but we do not have a radiographer. Whoever needs those services has to travel to Kotido Town, 70 kilometres away. We have run several adverts for radiographers, but no one applies,” says Dr John Baptist Omutogor, the medical superintendent of Kaabong General Hospital.

Under the USAID Uganda Health Activity (UHA), in December 2024, we commenced the construction of a laboratory at the hospital, at Shs1.5 billion. However, when President Donald Trump issued his executive orders in January this year, all operations under UHA were suspended. This is a huge project that the district is unable to take over. If the funding is stopped, then the Ministry of Health will have to take on the project,” says Joseph Lokut Mukasa, the vice chairperson of Kaabong District.

Of the remaining eleven sub-counties, two do not have a single health facility. These sub-counties have been operational for more than five years, but due to inadequate funding, we are unable to put up health structures. We hope that by the next financial year, we will have established something in one of them,” says Dr Sharif Nalibe, Kaabong District’s health officer.