Children Survivors of Displacment and War in Northern Uganda: A Cohort Study of the Itinerant “Night Commuters” and the Importance of Shelter and Security
Rohan Radhakrishna’s study on Uganda’s “night commuters” was one of the winners of the first annual The Lancet-GHEC 2008 prize. An abstract of Rohan’s study - which will be presented at the 2008 GHEC conference - is provided below.
Context: An ongoing 22 year civil war has devastated Northern Uganda’s health infrastructure and caused the displacement of 1.8 million civilians. The displaced itinerant children in war-affected Northern Uganda known as the “night commuters” are a group who flee their villages and IDP (internally displaced person) camps at night for fear of rebel abduction and come into the town center for shelter and security. However, they have never been studied using randomized sampling, control groups, or mixed methods yet numerous policies have been implementing to improve their wellbeing. I arrived in Northern Uganda as a medical and public health student in 2006 working as a consultant for UNICEF and Caritas to conduct a needs assessment of the “night commuters” however the governor of Kitgum Province decided to abruptly close the 13 shelters were 4,500 children were finding sanctuary.
Objectives: To reveal the demographics of the “night commuters,” to understand their motivations for secondary displacement, and to promote evidence-based decision making by government, non-government organizations (NGOs), and humanitarian organizations through including the views of the populations they serve. My goal was also to use our research findings to convince the governor to not abruptly close the shelters and instead to slowly phase out the shelters using a case management approach for the extremely vulnerable children who weren’t able to return home immediately (AIDS orphans, disabled, child-headed households, formerly abducted children, children in congested homes etc.).
Design, Setting, and Participants: A retrospective cohort study of 720 “night commuter” children (aged 7-17) in 13 shelters in 1 district using stratified random sampling and a control group of 410 non-night commuting children (aged 7-17) in villages and camps for IDPS in the same district selected through random cluster sampling during July and August of 2006. Follow-up through an evaluation and prospective cohort study of 120 former “night commuters” in villages and camps in August of 2007. Quantitative surveys were administered in addition to qualitative methodologies using grounded theory: direct observation, key informant interviews (n=45), focus groups in 2006 (n=20) and focus groups in 2007 (n=8).
Main Outcome Measures: Sociodemographic information, housing situation, self-reported health indicators, sense of security, and motivations for displacement.
Results*: Night commuters were more likely to be partial or total orphans than non-night commuters. Lack of accommodation (44% p <.01) was found to be a greater reason for secondary displacement than lack of security (41% p<.01). Respondents cited other causes of insecurity after the rebels had left (thugs and local defense units). Over a dozen push and pull factors influencing their displacement were elucidated.
Conclusions: Respondents cited lack of accommodation and insecurity from non-rebel sources (e.g. thugs and local defense units) as major contributors to their secondary displacement which was not adequately considered by the government or humanitarian groups. Results helped construct a 10 Point Plan for responsible shelter closure adopted in consensus by stakeholders which led the governor to change his policy. I wrote 3 reports from my research leading to increased funding for health centers, schools, and shelter. This study revealed the need for developing minimum standards in population based research for displaced populations during complex humanitarian emergencies to promote more robust research, more representative sampling, and more locally informed decision-making.
*Full results available upon request. Some statistical tests are pending and a manuscript is being submitted.
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