The Impact of Leaving Camps on Well‐being of Internally Displaced Persons in Northern Uganda

• Author: Barbara McPake,Ijeoma Edoka,Fu‐Min Tseng
• DOI: http://doi.org/10.1111/saje.12241
• Date: 01 March 2020
• Published date: 01 March 2020

© 2019 Economic Society of South Africa

South African Journal of Economics Vol. 88:1 March 2020

doi: 10.1111/saje.12241

21

THE IMPACT OF LEAVING CAMPS ON WELL-BEING

OF INTERNALLY DISPLACED PERSONS IN NORTHERN

UGANDA

FU-MIN TSENG†,* , BARBARA MCPAKE‡ AND IJEOMA EDOKA§

Abstract

The armed conflict in Northern Uganda led to a large number of internally displaced persons

(IDPs). After the government announced the declaration of free movement on 30 October 2006,

a large number of IDPs left camps. Transition from camp life to post-camp life has important

implications for population well-being. This paper uses the Ugandan National Household

Survey conducted in 2005-2006 and 2009-2010 and a difference-in-differences method to

estimate changes in IDPs’ well-being measured by self-reported heath as well as household food

consumption. We do not find a significant effect of leaving camps on self-reported illness and

household food consumption but we find a significant effect on the choice of healthcare providers

utilised. The postcamp effect was estimated to increase the use of non-free health providers, an

effect composed of more visits to informal providers and greater choice of formal private providers,

when formal providers are utilised. Those findings shed light on policy-relevant issues in the areas

of land rights, recovery of public health systems and gender inequalities in well-being.

JEL Classification: I10, I31

Keywords: IDPs, Well-being, Post-camp period, Uganda

1. INTRODUCTION

Armed conflict is a human-created disaster with lasting adverse effects on communities

particularly those in poor settings (Stewart and Fitzgerald, 2001a, 2001b; Fearon and

Latin, 2003). It is associated with a variety of direct and indirect effects strongly affecting

living conditions of households during and after conflict (Justino, 2011). The directly

observable consequences can be catastrophic, the impact felt years after the end of conflict

and often borne unequally across the population (Hoeffler and Reynal-Querol, 2003;

Justine, 2005; Murthy and Lakshminarayana, 2006; Lai, 2007; Blattman and Miguel,

2010; Buvinic et al., 2012; León, 2012; Kecmanovic, 2012; Ali, 2013).

Armed conflict creates major challenges for public health and health systems in low-in-

come countries, further exacerbated by the diversion of scarce resources to military ac-

tivities (Sidel and Levy, 2009; Devkota and van Teijlingen, 2010). High mortality rates,

* Corresponding author: Department of Economics, National Chung Cheng University,

Minhsiung, Taiwan. E-mail: ftseng@ccu.edu.tw, ftseng14@gmail.com

† Department of Economics, National Chung Cheng University

‡ Nossal Institute for Global Health, University of Melbourne

§ SAMRC Centre for Health Economics and Decision Science – PRICELESS SA, School of

Public Health, Faculty of Health Sciences, University of the Witwatersrand

South African Journal

of Economics

22 South African Journal of Economics Vol. 88:1 March 2020

© 2019 Economic Society of South Africa

disability and prevalence of infectious and chronic diseases leading to reductions in life

expectancy are the major consequences of armed conflicts affecting the long-term health

and well-being of the affected population (Murray et al., 2002; Ghobarah et al., 2004;

Gayer et al., 2007; Akresh et al., 2012; Doocy et al., 2012; Price and Bohara, 2013).

The conflict between the Lord’s Resistance Army (LRA) and the Government of

Uganda in northern Uganda broke out in the early 1990s and mainly took place in Lira,

Pader, Kitgum and Gulu districts (Raleigh et al., 2010).1 As part of military strategy to

quell insecurity, designated urban centres and camps were constructed within the affected

districts to house internally displaced persons (IDPs) (Global IDP Database, 2005;

Rugadya et al., 2008). At the peak of conflict in 2005, the number of IDPs reached ap-

proximately two million, consisting of over 90% of Acholi population, 33% of Lango

population, 12.7% of Teso population and 41,000 in West Nile, (Gelsdorf et al., 2012).

In late 2006, the number of IDPs significantly dropped following the free movement

declaration announced by the Ugandan government on 30 October. By 2009, the num-

ber of IDPs had fallen to 446,300 (UNHCR, 2009; 2012).2

As IDPs returned home from camps their well-being could have been affected by mul-

tiple and often conflicting factors. Situations common in most IDP camps including

over-crowding, poverty, inadequate infrastructure and services such as sanitation, clean

water supply and specialist healthcare have important implications for the well-being of

IDPs (Ministry of Health, 2005; Checchi, 2006; Horn, 2009). Conversely, on returning

home the health of IDPs can be compromised by limited access to services and infrastruc-

ture that would have been destroyed during the conflict. Therefore, the positive effect of

escaping crowded IDP camps can be counteracted by the negative effect of insufficient

infrastructure in places of return (Bozzoli and Brück, 2010). Furthermore, the need to

re-establish livelihoods, planting cycles, housing and land rights may affect household

recovery and resettlement post-conflict (Kruse et al., 2009).

This study uses the Uganda National Household Survey (UNHS) to investigate changes

in well-being measured as health-related outcomes of IDPs and food consumption of IDP

households in the primary conflict-affected districts (Lira, Gulu, Kitgum, and Pader). We

attempt to answer three questions. First, whether the average health status of IDPs in the

post-camp period changed significantly. Second, whether the frequency and pattern of

healthcare utilisation for IDPs changed in the post-camp period. Third, whether the level

of food consumption for IDP households improved in the post-camp period. Rebuilding

a society that has been in long-term armed conflict requires enormous inputs of resources,

which is a huge burden for poor countries. Those questions provide insights into the urgent

needs in progress made towards rebuilding household livelihoods and welfare post-conflict.

This study does not find a significant effect of leaving camps on self-reported illness

and household food consumption but we find a significant effect on changes in health-

care utilisation. The post-camp effect was estimated to increase the use of non-free health-

care services, an effect composed of more visits to informal providers and greater choice

1 The number of conflict events in which the Lord’s Resistance Army has been involved since

1997 is 107 in Lira, 151 in Pader, 266 in Kitgum, and 284 in Gulu (source: Armed Conflict

Location & Event Data).

2 Since the second half of 2004, approximately 350,000 IDPs in Lango and Teso sub-regions had

been encouraged to move out of IDP camps.