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Uganda: Transport ban causes casualties among children and women during COVID-19

Movement restriction imposed to curb COVID-19 spread but critics say it left no realistic provision for emergency care.

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Sitting outside her grass-thatched house, in a lush part of the northern Ugandan countryside, Jeanette Aromorach described how her son became a victim of the coronavirus pandemic – even though he had never contracted the pathogen.

Stewart Rubamga-Kwo, who was small for his 12 years, had an enlarged spleen and needed regular blood transfusions. On the morning of March 31, he started feeling unwell, though was still conscious and chatting. Accompanied by his father and another relative, he walked some of the roughly 2km (1.2 miles) from his village to a local clinic at nearby Awoonyim Junction, and was carried the rest.

Once there, a nurse called local authorities for help to transport the boy to a hospital in the area but was told all vehicles were busy.

The nurse then appealed to boda boda motorbike taxi drivers, but they were frightened about breaking the law. The day before, the government had imposed a nationwide transport ban as part of a series of measures aimed at stopping the spread of COVID-19, the highly infectious respiratory disease caused by the new coronavirus.

Nyapeya village is just 20km (12 miles) from Gulu regional referral hospital, though the dirt roads leading there are bumpy and slow to navigate. The total journey takes about an hour.

As the day went on, Stewart’s condition deteriorated as he became incontinent and started having convulsions. When an ambulance was finally sent and the boy reached Gulu hospital, eight hours later, he passed away almost immediately. The exact cause of his death was not clear and no post-mortem was carried out.

“If there was a means of transport, the boy might have survived,” Aromorach almost whispered, picking at grasses on the ground. Her son’s newly dug grave was just metres away.

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The grave of Stewart Rubamga-Kwo near the family’s grass-thatched house.

Needless deaths

Stewart’s death has been just one of many. At least 11 pregnant women have died preventable deaths since the transport ban came into effect, according to the Women’s Probono Initiative, a rights group based in the capital, Kampala. Several children have also died, as reportedby local media.

The full death toll may never be known. Meanwhile, Uganda has not registered any fatalities among its 56 confirmed COVID-19 cases to date.

While ambulances are given permits to drive, as are vehicles driven by local authorities or people working in essential services, critics complain the travel ban has left no realistic provision for emergency medical care. People must call local authorities, which have a limited number of vehicles and problems paying for fuel. Phones often go unanswered. Anyone driving anywhere without express permission can be arrested and their vehicle impounded.

“I think the government is responsible,” said Primah Kwagala, a lawyer and the CEO of the Women’s Probono Initiative. “This is leading to so many deaths [but] I think it’s something they are taking lightly. No woman should have to die the way they are dying, needlessly. The government has to be held responsible for their actions.”

According to official statistics cited by the rights group, there was already an increase in the number of maternal deaths nationwide this year, with a rise from eight deaths in the fifth week of 2020 to 76 in the 12th week. The coronavirus lockdown has complicated the situation, with some women miscarrying or bleeding to death trying to reach hospitals on foot in the wake of the transport ban.

When approached for comment, the Ministry of Health first asked for more evidence of deaths related to the restrictions, and then stopped answering calls and emails altogether.

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A drug store in Gulu district, northern Uganda.

In early April, the coronavirus taskforce in Gulu said they only had five vehicles for an area home to hundreds of thousands of people. These had to be used for spreading awareness about COVID-19, as well as investigating cases, tracing contacts and responding to calls from those who needed emergency healthcare, members said.

“[The president] got us unprepared,” said Opwonya John, a senior clinical officer and the Gulu district HIV/AIDS officer. While he approved of restrictions, John said there had been no time to make provision for people who needed medical care. “What about those patients with chronic diseases?” he asked.

Outside the office of the resident district commissioner in Gulu, where locals can apply for special travel permits, one man last week explained he had cycled to ask for permission to bring his sick son for an operation. When he arrived, no one was there. “I just need permission for one day,” he said, plaintively.

In a televised speech on April 14, President Yoweri Museveni addressed complaints that patients were not reaching hospital on time.

“It seems our people are not used to manning this type of emergency centre,” he said, suggesting local authorities make sure someone is always available to answer the phone and organise vehicles. “You can call it [a] call centre, you can call it [an] operations room, but people are on duty in shifts,” he said.

On April 19, Museveni said visibly pregnant women should be allowed travel without permits, while joking that anyone caught stuffing their stomachs with blankets will be arrested.

For Stewart’s family, any change will come too late.

The young boy loved playing football, he was bright at school and in a drama group, his mother said. Lately, he had started fishing in the river banks around his home.

“There might have been something which could have been done to help the child,” said Stewart’s father, Hillary Daniel Lagen.

“He had improved, he was doing well. My main words are to the government officials, if there is a way you can coordinate with the local leaders to transfer severely ill patients to the hospital … that would be very, very good.”

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Jeanette Aromorach and Hillary Daniel Lagen, the parents of Stewart.

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