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Disability and povertyA global challenge$

Arne H. Eide and Benedicte Ingstad

Print publication date: 2011

Print ISBN-13: 9781847428851

Published to Policy Press Scholarship Online: March 2012

DOI: 10.1332/policypress/9781847428851.001.0001

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Displacement, mobility and poverty in northern Uganda

Displacement, mobility and poverty in northern Uganda

(p.119) Six Displacement, mobility and poverty in northern Uganda
Disability and poverty

Herbert Muyinda

Susan R. Whyte

Policy Press

Abstract and Keywords

Shattered livelihoods and entrenched poverty are pressing issues for people with mobility disabilities in displacement locations in northern Uganda. For over two decades there has been a prolonged civil war. To illustrate the experience of poverty and its association with immobility, this chapter compares the life experiences of two polio survivors – one living in a rural internally displaced person (IDP) camp without mobility devices, the other in an urban setting with mobility devices. It shows the linkage between physical mobility and social interaction, resource mobilisation, attraction of socioeconomic support, and poverty.

Keywords:   civil war, socioeconomic support, polio survivors, mobility devices, IDP camp, social interaction, physical mobility

Shattered livelihoods and entrenched poverty are pressing issues for people with mobility disabilities in displacement locations in northern Uganda. For over two decades there has been a prolonged civil war in northern Uganda, covering the whole of Acholiland,1 between the Lord's Resistance Army (LRA) and the Uganda government forces. The LRA war has been characterised by violence and brutality, leading to the displacement of the local population (Finnsrom, 2003; MSF, 2004; Refugee Law Project, 2004; UNICEF, 2004; Allen, 2006). For the period 1996–2004 an estimated 1.2 million people in the region were displaced and in Gulu district alone, over 400,000 people (almost 90% of the population) lived in camps for internally displaced persons (IDPs)2 and temporary settlements in towns (Refugee Law Project, 2004, p 1; UNICEF, 2004, p 5).

The war and displacement has caused massive losses of the means of livelihood. IDPs lost their livestock and were hardly able to access their agricultural land. Market places and agro-processing plants were destroyed or rendered inaccessible; trade was constrained. The number of those of working age was diminished through abduction and deaths; food insecurity and poverty increased (WFP, 2004, p 7; Allen, 2006). The displacement locations lacked not only sources of income but also other basic necessities such as healthcare, education and day-to-day security.3 In the IDP camps people survived mainly on emergency relief handouts intended to save life rather than to support livelihoods or to address poverty. Development, which is about building sustainable systems, promoting equity, building systems of governance and eradicating poverty, was put on hold until the conflict could be resolved. The war and displacement have been found to be the single most important factor responsible for the poverty levels in the Acholi sub-region (World Bank, 1998; CARE, 2002).

In these conditions, where hundreds of thousands of people suffered impoverishment and constraints on their movements, we focus on the consequences for people with mobility disabilities – those unable to move around easily because of impairments to their legs or eyes. Our observation is that poverty and physical immobility reinforce one another. Mobility impairment increases poverty while poverty prevents the social arrangements (including assistive devices) that might improve mobility. Yet this vicious circle is not inevitable nor does it affect every mobility-impaired person equally. We show that the policies of government and non-governmental organisations (NGOs) play a role in the relation between (p.120) mobility and poverty. The nature of the impairment was significant, with those wounded from the war enjoying most support opportunities, and leprosy survivors least. Most of all, we emphasise that the ‘heroes of everyday life’, struggling against huge difficulties, seldom stood alone. Nearly all were embedded in kinship relations and these social resources contributed to enhanced mobility for some.

The sweeping changes accompanying the war and displacement constituted a multifaceted jeopardy in the form of entrenched poverty4 and affected people with disabilities in different ways. Most were unable to access mobility devices and have been unable to develop their livelihoods because it is difficult for them to invest in learning appropriate skills and education, and to effectively participate in activities needed to reduce poverty. The burden is also extended to their families who are forced to divert household expenditure to non-productive expenses such as food purchase, healthcare and extra needs for their family members with disabilities. The few rehabilitation interventions that could be a basis for reducing poverty target certain categories of people with disabilities and not others, benefiting those in urban more than rural settings, men more than women, and those impaired directly by the war rather than by other causes.

To illustrate the experience of poverty and its association with immobility, we compare the life experiences of two polio survivors – one living in a rural IDP camp without mobility devices, the other in an urban setting with mobility devices. From this analysis we show the linkage between physical mobility and social interaction, resource mobilisation, attraction of socioeconomic support and poverty. (p.121)

(p.122) Displacement and poverty

Before the LRA war Acholi men lived in family-based homesteads surrounded by homes of patrilateral relatives, situated on allocated pieces of land that were owned communally. Wives moved to the homes of their husbands and helped cultivate the land around the homesteads for subsistence food production and the sale of some crops. Ox ploughs were used as well as hoes, and the land was fertile. Between farming, livestock breeding and trading, families were largely self-sufficient. People recalled the past as a time of plenty in contrast to the poverty of life as an IDP.

Yet despite these memories of an abundant past, it can be argued that poverty in the North pre-dated the LRA war. Economic development there had long lagged behind growth in the South, even though the first executive prime minister and later president of independent Uganda, Milton Obote, was himself a northerner. Like the rest of Uganda, the North was affected by Idi Amin's regime, especially after the declaration of the economic war in 1972 in which he nationalised the manufacturing sector and sent away the Asians who were the main lifeline of Uganda's private sector. Economic deterioration continued through the 1980–85 Obote II regime, which was characterised by political instability and insecurity. The National Resistance Movement (NRM) assumed power in January 1986 to face a shattered economy and inflation raging at an annual rate in excess of 240% (World Bank, 1990). The NRM government embarked on a stabilisation and structural adjustment programme in 1987 with the aim of restoring macroeconomic stability and bringing down inflation. Inflation went below 10%, (p.123) and economic growth rates averaged 6.4% a year for eight years (UBOS, 2001). While these impressive figures were important in areas without violent conflict, in northern Uganda the poverty situation was continuously deteriorating mainly due to insecurity and displacement. After displacement the rural areas (former villages) became ghost communities. The people were gone, the houses collapsed, the goats, cows, chickens, the food granaries and most domestic property were all gone. Cultivation was also seriously affected since the plough oxen were lost during the war and the government restocking programme had not succeeded.

Especially for the rural populations, the encampment type of settlement organised by the government as part of a military strategy to ‘protect’ the civilian population largely lacked basic facilities and services essential for subsistence (Finnstrom, 2005; Allen, 2006, pp 56–7). The Ugandan government made no advance arrangements for provision of appropriate health services, sanitation and food in any of the designated locations (MSF, 2004; Refugee Law Project, 2004), resulting in new conditions characterised by lack of access to land, spatial congestion, hunger and entrenched poverty. Means of livelihood were completely skewed, lives of the people profoundly affected, and most people survived on relief handouts.

To deal with the worsening situation, the Northern Uganda Reconstruction Project (NURP) was formed in 1992, with the aim of redressing the imbalance in development in the northern districts. NURP was later followed by the Northern Uganda Social Action Fund (NUSAF), aimed at empowering communities in war-torn northern Uganda by enhancing their capacity to systematically identify, prioritise and plan for their needs within their own value systems. The rehabilitation programmes, however, have been generally characterised as ‘too little, too late’. Not enough use was made of NGOs, especially in the rural IDPs, and the programmes fell short of major social rehabilitation reforms (World Bank, 1998). According to the National Household Survey, people in northern Uganda live below the average national household consumption level (UBOS, 2001, 2006).

One of the key constraints in the life of people in the IDP camps was access to land. With the large number of people in one place, it was difficult for people with mobility disabilities to find land within the gazetted 5km around the camp to do any cultivation. Movement to more distant areas was restricted due to rebel threats and the ‘security’ measures put in place by government forces. People were not allowed to leave the camps before 9.00am and they were expected back before 5.00pm. Akello (who had to walk on all fours) explained her experience of the few times she had been to the garden:

‘One had to leave the camp after nine o'clock as the regulations were. It took an hour or two to reach the garden as the fields were far, and by then the sun would already be hot and one could hardly do a good amount of work before walking back in order to reach the camp within the gazetted time (5.00pm). Then, what you manage to (p.124) get is very little, because you work under tension and worried about the distance back.’

Despite all the rules and restrictions, those who did not get a chance to be allocated land around the camps sneaked out to their fields (outside the gazetted 5km radius) to get food, and to carry out many of their other daily activities in a more or less clandestine manner. But most people with mobility disabilities could hardly engage in that kind of venture because of their mode of mobility. This was tough because apart from losing a source of income, many of the people with mobility disabilities could hardly produce enough food for their families and often went without a meal. A few worked in other people's gardens to either get the money to buy food or be given food in kind.

The direct consequence of insecurity, restricted mobility, lack of devices and limited access to land was lack of food. Most people in the IDP camps survived on WFP handouts; the policy of WFP was to provide 40–60% of nutritional requirements on the assumption that people would be able to supplement food rations with crops they grew. However, people with disabilities were given more rations, in principle 98% of their nutritional requirements. Yet the real amount of food they actually got for meals was reported to be inadequate. In the first place, they shared their rations with other members of the household. Moreover, with hardly any sources of income available, disabled people, like others, often sold the WFP food to the ‘food aid black market’ in order to support their families by buying basic necessities such as salt, soap, paraffin, renting some more land for gardening, taking the WFP maize to the grinding mill and keeping their children in school. This considerably reduced the amount of food at their disposal for actually feeding their families and exposed them to persistent food insecurity and hunger. On one of our visits to Akello's home, she informed us that they had done without meals for two days because the WFP handouts had been used up and there was no money to buy food since her husband had spent some days without working because of sickness. She had to send her elder daughter to her paternal aunt to get some millet flour for food.

Another socioeconomic effect of low agricultural production and restricted mobility was loss of linkage between the (rural) IDP camps and the urban areas. Traditionally, the main economic linkage between the rural and urban areas was the buying of agricultural produce by business people in urban areas, from the rural producers. With the lack of marketable products due to lack of meaningful agricultural production, there were limited means through which money could flow to and circulate within the IDP camps. Thus, people in the camps hardly had any ability to buy. The few items that were occasionally marketed were expensive due to the low production and the risks involved in transporting them from the gardens, since they were produced outside the camps. With such low economic dynamism, any activities that people with disabilities or members of their families got involved in could hardly help them earn a reasonable income. Occasionally some people with disabilities marketed foodstuffs, handicrafts and WFP handouts, (p.125) but people in IDP camps had limited capacity to buy, rendering commodities sold by people with disabilities marketless.

Inappropriate planning

Despite the rapidly increasing numbers of disabled people in Gulu town, the issue of disability did not seem to be a priority. Many political leaders and programme managers struggled for something to say when asked about it. Disability was not perceived as a ‘life threatening’ condition, and was considered to be more of a long-term, rehabilitation issue. Politicians and planners gave priority mainly to situations or events that were categorised as emergencies or ‘life threatening’, such as lack of food, water, shelter, clothing and medical services. In the process, work on routine social and economic aspects of life including the extra needs of people with disabilities, domestic violence, AIDS and other health-related problems and household incomes was generally neglected.

On the WFP food distribution day it was common to see people with mobility disabilities together with another person, in most cases a relative, in the queue for food. Akello was always with her seven-year-old daughter. On that day the young girl had to miss school to assist her mother in getting the food and carrying it home. Those with tricycles and wheelchairs, on the other hand, could be seen with sacks of their WFP handouts on the baggage carriers below their seats, wheeling home. Although even those with crutches, sticks, white canes and other forms of mobility devices had difficulties carrying the food home, at least they could lead the way home to whoever volunteered to carry the food for them.

Some planners and programme implementers, including WFP, perceived disability as a homogeneous condition for all the people affected. Disabled people were lumped together as a group perceived to have ‘similar’ problems and needs: basically food, shelter and emergency medical supplies. The catchword in the policy documents was ‘needs’. More specifically, the Ugandan IDP policy document recognises the necessity of attention to the special needs of certain categories of people that it identifies as the most vulnerable – including widows, older people, children and people with disabilities (Office of the Prime Minister, 2004). Such lumping together of the different categories of disabled people ignores bodily differences and leads to standardised approaches to various activities which in many ways theoretically and practically excludes disabled people. Such an understanding also disregards the aspect of multiple disabilities – loss of limbs and loss of sight, loss of limbs and mental health problems, physical disabilities combined with other chronic conditions such as tuberculosis, HIV/AIDS, diabetes and so on – which require extra attention.

The lumping together of the different categories of people with disabilities as one group made it difficult to focus on the particular problems that affect different categories of people with disabilities and to come up with relevant interventions. From our observations, even disabled people's organisations (DPOs) at both grass-roots and national level tended to downplay or even be unaware of the (p.126) diversities that existed among people with disabilities. This has implications not only for how to root out poverty among people with mobility disabilities, but also how specific targeting and planning of interventions involving people with disabilities can be affected. We understand the difficult task of differentiating the various categories of disabilities without accepting some similarities, but at least for the important aspect of reducing poverty, the different forms of mobility needs should be considered as a specific issue.

During violent conflict situations, certain aspects of disability are crucial and should be attended to immediately. Physical mobility is critical for people with disabilities to be able to carry out day-to-day activities including ability to access relief services. Many people with disabilities could not effectively access relief supplies without mobility facilities. Many of those with a visual impairment needed white canes, those who had problems with their limbs needed crutches, wheelchairs, callipers, corsets and so on to be able to access other emergency supplies, and therefore to stay alive. All these could hardly be obtained due to policy inadequacies and poverty, especially in the rural IDP camps.

Lack of mobility devices

In situations of poverty and conflict where services are in short supply, communication technology very poor and traditional social support systems weakened or completely missing, physical mobility is a key determinant and crucial to a person's economic status and survival. In a war situation, people need to be ‘physically fit’, not only to escape danger (running or walking long distances, taking cover in case of shooting, looking for food and staying in undercover hiding for a long time) but also to live a relatively normal life and to fight poverty in such circumstances. This brings into question the nature of mobility technology in protracted conflict situations and displacement locations, the process of accessing it and how all these impact on the livelihood of people with mobility disabilities.

In Gulu town, and to a lesser extent in the IDP camps, one could easily see someone limping, someone missing a limb, a few moving in wheelchairs, walking using crutches or a stick, using a white cane or being guided by a child. Of the 107 people (66 men, 41 women) we interviewed, less than half (44) had any mobility devices, and out of the 37 who lived in the IDP camps, less than a third (only 10) had mobility devices. This was mainly because most of these people could not buy the devices due to lack of reliable sources of income. A wheelchair cost 250,000 Uganda shillings (approximately US$125) and a tricycle was about US$175, which most people with mobility disabilities could hardly afford.

At the same time, most of the NGOs that could assist them had fled, especially from the rural areas, due to the insecure situation. The orthopaedic workshop in Gulu hospital that was being funded by AVSI5 was the only one that produced mobility devices in the whole of the northern region. Although the mobility devices had been considerably subsidised by the NGO and were even free in some instances, most people with mobility disabilities in the rural areas could not (p.127) afford them because of the additional costs on top of what the NGO contributed. Some could not get transport to reach the NGO office in the urban areas, given the insecurity and their modes of movement. Interestingly, many directly linked poverty to their disability since it was because of their immobility that they had failed to address most of their extra needs, in particular improving their livelihood.

In almost all situations, particularly in the IDP camp, the only way that someone could get mobility equipment was through good social connections. Most people accessed them through contacts to an NGO, a church institution or a relative. Margaret got her wheelchair through connections she had with the priest and three others got theirs when we linked them to the district rehabilitation office, at the time of collecting data for this study. In the IDP camps, it could easily be concluded that there were few people with disabilities because they could hardly be seen in public places or moving around.

Apart from the adverse effect on social relationships, the lack of mobility devices influenced the nature of support people with mobility disabilities could get from the community. Most people found it easier to assist those with mobility devices than those without. People helped those in wheelchairs to pump water, pushed them over hills and helped carry something for someone using crutches. However, it seemed difficult to help someone crawling on the ground or a visually impaired person without a white cane. “People just pass as if they don't see me. Maybe it is because I am just on the ground. But they seem to enjoy pushing the wheelchairs of those who have them” (beggar who moved on all fours).

Closely related to mobility and poverty was the difficulty in getting appropriate clothing. With the different modes of physical mobility it was easy to see that the clothes some people with disabilities were putting on were not meant for them. Many could be seen wearing under or oversized clothes and shoes. These were given to the IDPs by relatives, charity organisations and friends without taking appropriate measurements. In some cases this made mobility more uncomfortable for those with a physical disability and the clothes wore out in a relatively short time. Akello often wore an oversize dress, which seemed to have been given to her. Such donations were nevertheless important in the lives of the disabled people because they were some of the very few alternatives available, and could only be obtained by those who had the appropriate social connections.

One of the categories of people who could not access mobility devices due to extreme poverty was that of the disabled former combatants who had left rebel activities without going through the official channels. They did not go through reception centres and they did not have official amnesty (valid documents) and thus missed the accompanying benefits including medical treatment, financial support and mobility devices from the rehabilitation agencies. Many stayed in the rural areas and were ‘hidden’ by their families because they did not have the ‘appropriate papers’ to allow them to freely move around, interact with others and to participate in any activities that could earn them an income. The lack of valid documents also made it difficult for this category of people to be targeted by the intervention agencies since most NGOs feared being labelled collaborators.

(p.128) The poverty levels among the former fighters became more entrenched because of community attitudes toward them. Partly, people feared that the government would term them ‘rebel collaborators’ if they associated with such former fighters. More generally, there was perpetual suspicion of whatever they tried to do; most people would not work with them unless they did not know that they were former combatants. Many did not trust them; they feared doing business with them because they looked at them as dangerous people capable of anything. As one former rebel returnee in the suburbs of Gulu town recounted: “I had started a boda-boda [motorcycle taxi] business but when the owner of the motorcycle learned that I am a formerly abducted returnee, he removed it from me.”

The undercover returnees were anxious about their future and had low self-esteem; they felt discriminated against, and they seemed to struggle in adjusting from their lives as former combatants to fit into a new civilian setting. Their situation was made more complicated by their inability to disguise themselves as non-combatants since they had an impairment that directly connected them to the rebellion and people often asked how and where they got such disabilities. The stigma and their inability to freely interact with others made it difficult for them to acquire mobility devices and/or mobilise and organise themselves to advocate for their other extra needs. They lacked resources to clear their image, which limited their socioeconomic interaction and further perpetuated their poverty.

Sanitation and reduced personhood

Personhood is about the cultural recognition of an individual's social value and dignity. The combination of disability and poverty impinged on personhood in many ways. Not being able to support oneself and provide for others, not being able to get to social functions easily, and for some, not being able to find or keep a spouse diminished their standing in the eyes of others. One of the most overlooked yet deeply felt sources of humiliation was access to latrine facilities. This intimate and fundamental aspect of everyday life was largely perceived as a private and personal problem.

Sanitation facilities were generally poor in the camps. The small grass thatched huts had hardly a metre between them. Due to the large number of people in one place, there were latrine facilities, rubbish collection points and water sources very close to the homesteads. There were not enough latrine facilities for the number of people. Most were built with mud and wattle and many were either open to the elements or had a roof with inadequate grass covering, and therefore leaked. The latrines typically had a bad stench, flies and a wet surrounding, indicating that most were shallow. They consisted of a simple hole in a dirt floor; most did not have concrete slab floors as is recommended. In many cases they were surrounded by faeces, both inside and outside, because some people, especially children, did not use them properly.

Families of people with disabilities lacked resources to build modified latrines suitable for their disabled members; they could not afford to buy slabs to make (p.129)

Displacement, mobility and poverty in northern Uganda

Some latrine facilities in Unyama camp

them more useable, or put up doors and lock them to keep them clean. Some of the latrines were in waterlogged or bushy areas, which were difficult for people with mobility disabilities to reach. People without mobility devices had to move through these contaminated places on their four limbs; others scooted on their buttocks. Sometimes they could not make it by themselves and they had to be physically lifted, especially during the rainy season when most of these places were soaked. Akello's sisters-in-law (the wives of her brother-in-law) physically carried her to the latrine because it was in a waterlogged place. This was in many ways embarrassing and sometimes she had to starve herself to reduce the number of times she had to go to the latrine, or wait for night time when less people would see her being carried:

‘Sometimes I am like a child because people have to lift me to the latrine and wait for me. Can you imagine? But what can I do? I cannot use any latrine; the specific one I can use – the one with a slab – is in a place which I need help to reach, especially when it rains, because it gets waterlogged.’ (Akello)

With no modified seats, accessibility to latrines was very difficult for people with disabilities. Using a latrine, especially those in the camps, needed strong legs that could support someone squatting over a hole for some time. And many of (p.130) the amputees or those with weak limbs had to move long distances to look for appropriate latrines they could actually use.

So, the lack of mobility devices and the failure by the authorities to build appropriate latrine facilities left families and individuals with physical disabilties to deal with an everyday need that was experienced as a source of humiliation. Poverty made it impossible for families to provide decent latrines. Ultimately this meant a reduction in personhood: instead of adults who could manage their private needs, disabled people were reduced to a helpless state, who had to be assisted in going to the latrine.

Stigma and aid policy

Poverty, disability, discrimination and stigma are influenced by policies of government, donors and NGOs. Some categories of people with disabilities were affected by poverty more than others, which forced them into stigmatising conditions. This was a result of selective investment in particular target groups, particularly in the urban areas. A few international agencies, government departments and NGOs launched interventions aimed at reducing the effects of the war and improving the conditions of people with disabilities. Although the official policy was to serve everyone who needed extra assistance regardless of the type of disability, the plans, whether intentionally or unintentionally, favoured particular categories of disability, leaving others in extreme poverty.

Most NGOs and government departments supported mainly people with war-related impairments, leaving out those who were impaired due to other causes. In particular polio and leprosy survivors and those with a visual impairment were hardly targeted. Attention was given mainly to those whose impairments were a direct result of the war: landmine, bullet and bomb blast survivors. The risks they confronted as war victims and the challenges of reintegration faced by (officially processed) abducted returnees and former combatants were of considerable concern to the intervention agencies (AVSI, 2004a; Refugee Law Project, 2004: World Vision, Uganda, 2004).

Of all the categories of people with mobility disabilities leprosy survivors were the most affected by stigma, reflected in the avoidance, fear and outright hostility they suffered in the community even if they were cured of the disease. Discrimination was compounded and reinforced by poverty. The activities in which they could engage to earn an income were limited. They were supposed to avoid certain activities and places because they were prone to injuries through burns and wounds. At the same time, because of stigma, they could only do work that did not require them to be in direct contact with other people (repairing shoes, selling charcoal, digging people's gardens and so on), which limited their levels of income. Therefore, it was difficult for them to acquire the devices and medical treatment they needed and they ended up stuck in a poverty cycle.

(p.131) Forced urban life

Studies in Africa have shown that disabled people are attracted to urban centres because of new livelihood possibilities (Van den Bergh, 1995; Silla, 1998; Whyte and Muyinda, 2007). In the case of northern Uganda, the attraction of towns was reinforced by insecurity in the rural areas. With the destruction of agriculture, which was the main source of income, and because of persistent insecurity in the rural IDP camps, people with disabilities moved to Gulu town for alternative livelihoods and relative safety. Most of those who left their rural homes to stay in Gulu town were men, apart from a few women who were caught up in the urban settings due to the insecure situation and were unable to go back to their villages. Most women were tied to their life in the rural areas mainly because of family obligations of looking after children and/or protecting their marriages. If they went to town and left their partners in the camps, they expected that their husbands would find other women. Most men, on the other hand, had no fear of losing their spouses if they left them in the rural areas; instead, many used this as an opportunity to get some source of income in town to support their families in the rural camps.

Unlike their colleagues in the rural IDP camps, many people with disabilities in urban areas mobilised themselves into organisations to advocate for their needs and to fight poverty by devising ways of improving their lives. In town there was a greater density of people with disabilities, so it was easier to mobilise, and there was easier access to potential sources of aid and support because government offices and donor organisations were located there. All of the informants we talked to in Gulu town, with the exception of the leprosy survivors, were members of disability support organisations through which most of them had acquired mobility devices that facilitated their engagement in income-generating activities and helped them fight poverty. For instance, visually impaired people formed the organisation called Gulu Agriculture and Handicraft for the Blind on their own, without donor support. They staged drama and theatre performances at various locations; these were aimed at encouraging visually impaired people to participate in handicraft making and agriculture activities for improvement of their incomes and life conditions. Another initiative was the formation of the Gulu Disabled Cooperative Society, which specialised in leatherwork, making and repairing shoes and bags. Others, with support from Pact Omega (a US aid-funded NGO), formed the Alokolum Kilombe disabled group in the suburbs of Gulu town and initiated a grinding mill project.

Most of those in the urban settings (more than two thirds of all those interviewed) had mobility devices and they could be seen engaged in various activities: operating sewing machines, petty trade, cleaning vehicles, repairing shoes, making charcoal stoves and small oil lamps and doing casual labour (mainly collecting rubbish in public places such as markets, car parks and along the streets). Thus the poverty levels of people with disabilities in urban settings were lower than those in the rural areas.

(p.132) Some disabled people, however, were not able to get the necessary social contacts to any source of income in their new urban lives. Poverty and hunger forced them to resort to the much-despised economic activity of begging. Many of them, especially the leprosy survivors and those with visual impairments, could be seen at the Holy Rosary Catholic Church in Gulu town, where the priests gave them some food and small amounts of money on Wednesdays. They also begged on the streets, at entrances of restaurants, banks and shops, and from passers-by. On Fridays they went near the mosque to get alms. Many of them knew that the activity they were involved in was disdained by society but said that they had no alternative because they had no one to help them. In Acholi culture begging is seen as a dehumanising activity and a family's integrity could be seriously undermined if one of their members was a beggar. But in the circumstances, staying in the villages would lead to worse life conditions than being a beggar. One of the beggars on the street in Gulu town preferred life in town to that in the village:

‘… yes, here in town I get something although I hate it and everybody hates it. In the village people are very few and it is hard to get kind people that can donate. Here, although most people seem to hate it, they give you money and they tell you not to go to them again. Shopkeepers sometimes hide away from us, you can see them running away the moment they see us going to their shops, and at times they openly tell us that there is no money, but still we can get something for survival.’

Some of the beggars who had mobility devices used them to attract attention by demonstrating the extent of their disability and levels of poverty. Apio parked her ramshackle wheelchair beside her, with its dry grass cushion, pressure-less tyres tied on the wheels with sisal string and wooden back wheel, to attract the attention of people who might give him money. Omac dismantled his prosthesis and waved it to whoever passed him as a way of asking for money.

However, the relatively better livelihoods in the urban areas were undermined by the severe lack of food due to lack of cultivation in the rural areas that had previously fed people in the towns. The situation was made worse by the lack of relief food provision in urban settings. The WFP relief policy was to provide food only in rural IDP camps, excluding people in urban and semi-urban settings. This was mainly because the towns were perceived as relatively secure compared to the rural IDP camps; urban people were expected to earn some income to buy food and to cater for their other needs on their own. However, in Gulu town, the majority of those with mobility disabilities lived in the ‘urban IDP camps’. These were displacement settlements within Gulu town with all the characteristics of an IDP camp, particularly congestion, poor hygiene and lack of livelihood opportunities. Because they were not administratively categorised as ‘camps’, people did not ‘qualify’ for relief services, in particular food from the WFP.

(p.133) The lack of food made life conditions very difficult for people with mobility disabilities in urban areas. They could only get food by having a source of income, which was precarious for many of the leprosy survivors and those with a visual impairment, who often ended up begging. The few who had a source of income spent much of their earnings on food, paying for healthcare, support for their children in school and on household requirements. They hardly had any resources left to meet their other needs, especially maintaining and replacing their mobility devices.


Different people in different situations experience disability differently (Murphy, 1987; French, 1994; Bruun, 1995; Petryna, 2002; Kohrman, 2005). Because of these different experiences, Coleridge (1993, p 28) notes that disability leads to different life pathways, different mindsets, different ways of looking at the world and what life means. One of the ways this manifested itself in northern Uganda was in the form of poverty.

We chose to focus on the relation between poverty and physical mobility among people with disabilities in conflict and post-conflict situations. We did this by examining how people with mobility disabilities are exposed to entrenched poverty through the effects of displacement: inaccessibility of land, lack of basic necessities, forced urban life, lack of mobility devices and poor priority setting by planners and political authorities. We have shown that poverty can be both a cause and a result of physical immobility. Illustrating the relationship between physical mobility and poverty in such circumstances is one of the ways abilities and disabilities of people with disabilities can be analysed, and appropriate interventions developed.

As in the case of Akello, many people with mobility disabilities in the IDP camps were stuck in the mobility–poverty cycle: they were not able to get the mobility devices they needed due to poverty and at the same time they could not engage in any activities to reduce their poverty due to immobility. The lack of resources to acquire mobility devices affected their ability to engage in economic activities and made it difficult for them to advocate for their extra needs. They were often unable to develop their livelihoods because they could not invest in education and in learning appropriate skills.

The effects of poverty were particularly evident in the lives of those left out by the intervention agencies. Most of those whose impairments were not due to the war lacked mobility equipment, did not participate in disability organisations and activities and were not provided with credit facilities to start income-generating activities. The lack of such socioeconomic stimulants forced most of those who were not targeted by intervention agencies to remain in the rural areas, where it was easier for them to be supported by their relatives.

Disability has been given deserved attention in most of the developed countries in the form of favourable policies followed by effective interventions (Ingstad, (p.134) 1995; Barnes et al, 1999; Stiker, 1999). In the developing countries, on the other hand, it is seen as a problem for tomorrow. Since the promulgation of the 1995 constitution, Uganda has tried to improve the welfare of disabled people through a policy of affirmative action, where the representation of people with disabilities is embedded in national sociopolitical structures at all levels. The aim was to improve the welfare of disabled people through active participation in decision making at various levels. Much as these efforts indicate that improvement of the life conditions of disabled people is one of the national priority areas, unlike in developed countries, lack of adequate resources to deal with the more persistent and seemingly overwhelming problems of HIV/AIDS, conflict and political stability make disability a low priority.

Further, disabled people are seen as a minority group that lack the numbers necessary to have a broader political impact beyond choosing their own representative in an election, so politicians, planners and implementers pay negligible attention to their condition. Because of their condition, many are not educated and therefore not employed. They lack the financial and organisational ability to bring pressure for an effective response to their condition, which further perpetuates their poverty.

In general it is difficult to draw a line between poverty and emergency conditions in conflict situations. Poverty and disability should therefore be looked at in terms of balancing relief and rehabilitation concerns in the short term, and development (reducing poverty) in the long term. Focusing on mobility is important because it facilitates specific attention to people with various levels of mobility disabilities and helps avoid lumping them together, which makes it easy to target specific cases with the necessary interventions. Examining the various aspects of mobility also creates a linkage between the objectives of the emergency relief programmes in the short run and the long-term plans aimed at sustainable development and reducing poverty. We have shown that it is easier for a person with mobility devices to benefit from the emergency programmes, which are usually the basis for participating in the long-term development activities.

Therefore, examining how poverty in violent conflict situations makes people with disabilities unable to acquire the necessary mobility devices is central in informing policy on disability. It is important to re-emphasise that provision of mobility devices to those who need them in violent conflict situations should be treated as an emergency, to reduce the short-term effects of immobility and to set a basis for long-term developmental programmes including poverty alleviation among the affected individuals. Focusing on mobility can help restore or strengthen not only ‘physical fitness’, but also the socioeconomic interaction and regard for the personhood of people with mobility disabilities in violent conflict situations.


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(1) The Acholi are situated in the four districts of Gulu, Kitgum, Pader and Amuru, east of the Nile, in northern Uganda, with an estimated population of 1.5 million (Uganda Population and Housing Census Report, 2002).

(p.135) (2) There has been a distinction made between IDPs and refugees. IDPs are those who have been forced to flee their homes as a result of war, natural or man-made disaster or generalised violence, who do not cross an internationally recognised border but remain in their country of origin. Refugees, on the other hand, are those who leave their homes for the same reason, but cross the border and enter another country (United Nations, 1999). Differentiating between the two terms is important because each of the terms define certain identities and entitlements.

(3) The government of Uganda has always argued that the reason for establishing IDP camps since 1996 was to provide security to the civilians. Most people in the camps felt, however, that they were being inadequately protected and there was a very high sense of insecurity in the camps. Some camps were attacked and people were abducted by rebels (Refugee Law Project, 2004, pp 29–30; Finnstrom, 2005, pp 110–11; Allen, 2006, p 54).

(4) Generally, poverty in Uganda (including the northern region) is defined as the ‘lack of basic necessities and services such as food, clothing, beddings, shelter, basic health care, roads, markets, education, information and communication’ (UBOS, 2001).

(5) An Italian organisation that has been doing disability work in northern Uganda since 2000.