Neck-deep in a tight trench, Jackson Wani swats away buzzing flies as he shovels soil. The stench is strong from the collapsed wall of the latrine he is shoring up, a dozen paces from his family’s makeshift home.
More than a million refugees ― a population twice the size of Miami ― have arrived in Uganda since civil war broke out in South Sudan in 2013. Last year, the conflict spiraled into a man-made famine, and the United Nations warned that the situation was “fertile ground” for genocide.
Around the world ― from regions as varied as the Middle East, Southeast Asia and Central Africa ― staggering numbers of people have fled their homes in recent years to escape war, persecution, or political instability. Over 2.6 million of them live in officially recognized refugee camps, according to the U.N.
Tens of thousands have been killed in over four years of South Sudan’s war. But researchers who have studied conflict worldwide suggest that the number of indirect deaths could be 15 times higher than those who died in actual fighting, and disease and sickness are a core part of that. (There are no precise figures for the number of deaths in Bidi Bidi due to disease.)
Why The U.S., One Of The World's Richest Countries, Struggles With Diseases Of Poverty Victims Of This Disfiguring Disease 'Feel So Much Pain And Shame' Meet The Americans Who Live With Open Sewers In Their Yard “With a large number of displaced people living in close proximity, with poor water, sanitation and hygiene conditions, it leads to a risk of waterborne diseases,” said Lisa Nelson, the Uganda country director for the U.S. Centers for Disease Control and Prevention, which is supporting efforts to monitor health in the camps scattered across the forests and farmlands of northern Uganda.
Aid agencies are trying to encourage households to maintain their own toilets and latrines. But it can take weeks to get new arrivals set up with a waste system that functions properly.
In this sprawling settlement, cholera, hepatitis and typhoid fever ― all associated with exposure to human fecal matter ― are big risks. With large numbers of children together, measles is also a worry. And about a third of the cases seen by camp doctors involve malaria, which is spread by mosquitoes who breed in standing water.
The health care system in South Sudan was already in ruins from its decades-long war of independence from Sudan, but the new nation’s civil war has made things worse. Almost all of the major neglected tropical diseases recognized by the WHO are found in South Sudan. These frequently misunderstood illnesses tend to strike the poorest, most marginalized populations with the least access to health services. They include blinding trachoma, certain types of intestinal worms, and the ferocious visceral leishmaniasis fever. In recent weeks, South Sudan has declared an outbreak of Rift Valley fever, a viral disease that can cross from animals to humans, and reported suspected cases of meningitis.
For example, refugees fleeing Syria last year struggled with an outbreak of cutaneous leishmaniasis, a parasitic disease spread by sandflies that causes boils and lesions.
Muzaffar Salman/Reuters A doctor treats a child showing symptoms of leishmaniasis at a hospital in Aleppo, Syria, on Feb. 11, 2013 Soon after the South Sudanese refugees arrived, the Ugandan government handed out plots of land to each family in Bidi Bidi and the surrounding camps. The scrubland was enough to build a small hut and carve out a patch to plant crops.
Water and sanitation experts are trying to help the people who live in these settlements. Red Cross volunteers advise on the best way to construct latrines to withstand Uganda’s heavy rainy season and offer practical guides to installing handwashing stations and digging pits for trash. Yet overstretched doctors can barely cope with the flood of patients who come in every day.
“You have to make do with what you have,” Daniel said, waving at his clinic, a wooden frame with plastic sheeting for the roof and walls. On the other side of the flimsy structure, a baby with a malaria fever wails as a nurse slides a needle into his arm.
This article is part of HuffPost’s Project Zero campaign, a series on neglected tropical diseases and efforts to fight them.