The policy of prioritisation is having devastating consequences for refugees in Uganda, write Costanza Torre and Charlotte Brown.
Uganda hosts more refugees than any other country in Africa under a much-praised self-reliance model. This policy approach grants refugees the right to move and work within Uganda and allocates them plots of land for shelter and cultivation. Faced with widespread funding cuts, the Ugandan refugee response has recently adopted a new strategy of allocation of resources based on prioritisation. In this new prioritisation strategy, refugee households are categorised according to levels of vulnerability and assigned different amounts of monthly assistance accordingly, with some refugees being cut off entirely.
The prioritisation is predicated on two implicit assumptions. The first, that the self-reliance model is so solid that refugees can draw on its strengths to make do in the face of reductions in food availability. The second, that food is but one component of a multidimensional policy and that with the land allocation intact refugees will still be self-sufficient.
However, poor quality land that is isolated from centres of economic activity has left many refugees relying on insufficient humanitarian assistance rather than being self-reliant. Most refugees in Uganda’s thirty settlements are dependent on the monthly rations provided by the World Food Programme. In this context, the consequences of cuts to monthly assistance have been profound and unsettling. It has reshaped nearly every aspect of daily life for refugees. As households prioritise their income to provide a minimum diet, the possibility of self-reliance has never seemed so out of reach.
Increased insecurity
Food insecurity is at the heart of the crisis. Even before the latest rounds of cuts, malnutrition among refugee children was alarmingly high. Now, reports indicate sharp increases in acute malnutrition and stunting. This has devastating implications for cognitive development, academic performance, long-term health outcomes, and earning potential in adulthood. For many households, the prioritisation framework has meant impossible choices: mothers often skip meals to ensure their children eat, families are rationing already insufficient portions, and children drop out of school, either to contribute to the household search for an income or because they are too hungry to focus.
There has been a rise in casual labour in direct response to the prioritisation changes. Increasing numbers of refugees, desperate for income, turn to leja-leja – unstable, low-paid, and often exploitative agricultural work, which usually involves digging or weeding vegetable gardens, predominantly owned by Ugandans. Leja-leja is physically exhausting, socially stigmatised, and extremely time-intensive, preventing refugees from pursuing sustainable income-generating opportunities. Crucially, it offers little in the way of economic mobility, offering meagre wages of UGX 2,000 (£0.42) per task. The working conditions and poor pay heighten refugee’s exposure to abuse and sexual violence. Women and children have been particularly affected. Many women face the risks of exploitation and abuse while seeking work. Children who are increasingly engaged in labour to support their families face disrupted education and development. Younger children are often left unsupervised as caregivers work long hours, exacerbating the risks of malnutrition and other forms of harm.
Health outcomes have also been deeply impacted by prioritisation. Malnutrition further weakens immune systems and increases vulnerability to infections. A growing number of refugees struggle to adhere to medical treatments, particularly for chronic conditions like HIV and tuberculosis, which require consistent nutrition for effectiveness. Meanwhile, mental health concerns have also surged. Depression diagnoses have seen huge increases, overtaking epilepsy as the leading mental health concern in some settlements. In extreme cases, hunger and economic despair have driven a marked rise in suicide rates.
Education has not been spared either. Families that once supplemented school-related costs (such as meals, uniforms, and exam fees) by selling small portions of their aid rations now find themselves unable to keep children in school at all. Dropout rates have increased, particularly among children from prioritisation’s lower-priority households, which will reinforce cycles of deprivation. Child labour has risen in response to food insecurity, further limiting educational opportunities. Those who manage to remain enrolled struggle to focus, with teachers reporting that hunger and exhaustion are tangible obstacles in the classroom. Reports of gender-based violence, family abandonment, and transactional sex have increased as families adopt desperate coping mechanisms. Meanwhile, overwhelmed and underfunded caseworkers struggle to address the growing protection concerns, with a case worker-to-children-at-risk ratio of 1:229 as of March 2024.
Consequences
As livelihoods in Uganda become untenable, mobility patterns are shifting. Many refugees are adopting dangerous coping strategies. Some are attempting to return to South Sudan to look for work, despite warnings from humanitarian agencies that conditions remain dire. Within Uganda, economic precarity has driven some refugees to sell off their limited assets, further diminishing their future prospects. High urban living costs have prevented significant migration to cities, leaving many trapped in increasingly unsustainable settlement conditions.
At its core, the crisis of prioritisation is a crisis of the self-reliance model itself. Built on the premise that refugees, given access to land and minimal assistance, would gradually sustain themselves, the model has not accounted for structural constraints such as poor soil quality, limited market integration, and the unpredictability of external shocks. The expectation that reduced aid would nudge refugees toward economic independence ignores the reality that assistance was never a surplus; it was, and remains, a vital lifeline.
Uganda’s prioritisation strategy highlights the difficulty of balancing limited resources with vast humanitarian needs. But if the experience of Uganda’s refugees tells us anything, it is that prioritisation does not create resilience. In practice, prioritisation has led to increased vulnerabilities, exploitation, and long-term damage to self-reliance efforts. If international actors are serious about long-term solutions, the conversation must shift. Rather than managing decline, there must be a push for systemic reform: for better funding mechanisms, accountability in implementation, and strategies co-created with refugee communities. Without urgent reforms, prioritisation risks deepening the very vulnerabilities it seeks to address.
This article is part of the #prioritisation blog series, which builds on the SSHAP policy brief on Food Assistance Prioritisation in Uganda and its Impacts