How Climate Migration is Reshaping Health Service Delivery in Uganda
Authors: Crispus Mwemaho and Anena Melisha
Climate change is not some distant threat; it’s remaking where and how Ugandans live, and it’s fundamentally reshaping how health care is delivered. Nowhere is this clearer than in Kasese District, where flood-displaced communities and collapsing health infrastructure paint a stark picture of climate-driven disruption.
In this blog, we share two case studies, Muhokya Health Center III and Kilembe Regional Referral Hospital, that show how climate-induced migration is altering health service delivery at both the community and regional levels, with ripple effects felt far beyond Kasese.
Muhokya Health Center III: A Rural Facility Under Immense Pressure
When River Nyamwamba flooded in 2020, over 2,000 people were displaced to Muhokya camp. The nearby Health Center III, a facility originally built to serve a smaller rural population, suddenly became the main provider for both its district and the new camp community.
Health workers here report a surge in patient numbers, especially outpatient consultations, maternal care, and childhood immunization. The displacement disrupted livelihoods and access to clean water, triggering spikes in malaria, diarrheal diseases, and malnutrition. Crowded camp conditions also elevated the risk of communicable diseases, from measles to COVID-19.
Yet, the health facility itself did not grow. Staff workloads ballooned without proportional increases in staffing or supplies. Drug stockouts became more frequent, particularly for antimalarials, oral rehydration salts, and HIV commodities. Chronic care, such as TB and HIV treatment, faced interruptions as displaced persons struggled to keep appointments or moved again in search of safer ground.
For Muhokya Health Center III, climate migration has transformed what was once a steady rural health workload into a volatile and unpredictable frontline of crisis response.
Kilembe Hospital: When a Regional Referral is Wiped Off the Map
Kilembe Hospital was the district’s referral hub, renowned for excellent orthopedic services and serving over 100,000 people. But the 2020 floods demolished the facility, forcing relocation to a much smaller structure that was once merely a trading centre.
Specialized services like orthopedics and surgery dropped sharply. Patients were forced to travel farther to Fort Portal, Bushenyi, or as far as Kampala, journeys that are costly and often impossible for rural families. Referral networks collapsed overnight, destabilizing regional health planning.
The loss of Kilembe highlights how climate disasters can erase decades of investment in health infrastructure overnight, leaving entire regions underserved (Uganda Radio Network, 2023).
Climate Migration and Rural–Urban Shift: A Growing Pressure on Urban Systems
Kasese’s stories mirror a broader shift in Uganda: climate shocks are driving rural families toward urban centers. Cities like Kampala, Gulu, and Hoima are absorbing displaced populations, often into informal settlements without adequate services.
This migration creates new health service hotspots in informal settlements where infrastructure lags behind population growth. Urban clinics and hospitals face surges in outpatient visits, maternal care, and child health services, while also contending with urban burdens such as NCDs, accidents, and respiratory illnesses.
At the same time, rural facilities left behind may experience shrinking patient numbers but growing vulnerability, as those who remain are often the poorest and least mobile, elderly persons, people with disabilities, and subsistence farmers.
What National Assessments Tell Us: VAA and H-NAP Findings
Uganda’s 2023 Vulnerability and Adaptation Assessment (VAA) reviewed over 700 health facilities and found widespread exposure to climate hazards. Nearly half were exposed to drought, 40% to floods, 31% to storms, and 12% to rising water levels and landslides (Makerere University School of Public Health, 2023). Many facilities lacked water safety plans, drainage, or infrastructure to manage stormwater.
Workforce preparedness was weak: 58% of staff had not participated in drought planning, and many facilities lacked training, hydration, or sun-protection protocols for heat exposure (WHO Africa, 2023). Kilembe Hospital itself was highlighted as an example of infrastructure already lost to climate impacts (Insight Post Uganda, 2023).
In response, Uganda launched its Health National Adaptation Plan (H-NAP) 2025–2030 in 2024. It emphasizes climate-transformative governance, a climate-smart workforce, resilient infrastructure, and integration of climate and health data into systems like DHIS2 (Makerere University News, 2024; The Rockefeller Foundation, 2024). These measures aim to protect facilities like Muhokya and prevent further losses like Kilembe.
Lessons from Kasese Linked to National Strategy
Linking Muhokya, Kilembe, and national findings:
Floods and disasters can overwhelm and destroy health infrastructure. Kilembe Hospital’s loss shows how quickly investment vanishes when facilities aren’t climate-proof.
Smaller rural facilities bear the brunt—like Muhokya Health Center III, often lacking infrastructure, supplies, and planning even as demand skyrockets.
Data and workforce aren’t prepared for mobility and shocks. Routine data systems don’t account for displaced populations, and staff aren’t trained for extreme conditions or outbreak surges.
National policy is catching up, but action must reach the ground. H-NAP’s framework is strong, but hotspots like Kasese need climate-proofed facilities, mobile clinics, and integrated response systems.
Call to Action
Climate-proof health infrastructure. Renovate or relocate facilities in flood- and landslide-prone areas.
Design for mobility. Develop surge-ready plans and deploy mobile clinics when camps or informal settlements form.
Support workforce resilience. Train staff on climate health risks, provide sun-protection and hydration, and incorporate mental health support.
Upgrade data systems. Integrate climate variables into DHIS2 and include indicators on displacement.
Scale collaboration. Use H-NAP’s frameworks to unlock funding and ensure localized adaptation in high-risk districts.
Conclusion
Climate migration is reshaping health in Uganda, from the overwhelmed corridors of Muhokya Health Center III to the demolished walls of Kilembe Hospital. National assessments like the VAA and H-NAP offer the knowledge to respond, but Kasese provides the urgent, human ground-truth we can’t ignore.
Uganda’s health system can, and must, adapt. With climate-smart planning, resilient infrastructure, and flexible services, we can deliver care that keeps pace with a moving population and a changing climate.
References
Insight Post Uganda. (2023, October 24). Climate change vulnerability assessment validated to develop the National Health Adaptation Plan. Insight Post Uganda. https://insightpostug.com/climate-change-vulnerability-assessment-validated-to-develop-health-national-adaptation-plan/
Makerere University News. (2024, August 23). Inside Uganda’s National Health Adaptation Plan to combat climate change. Makerere University. https://news.mak.ac.ug/2024/08/inside-ugandas-national-health-adaptation-plan-to-combat-climate-change/
Uganda Radio Network. (2023, October 24). MoH validates climate change vulnerability adaptation assessment. Uganda Radio Network. https://www.ugandaradionetwork.net/story/moh-validates-climate-change-vulnerability-adaptation-assessment-
World Health Organization Regional Office for Africa (WHO Africa). (2023). Uganda country climate and health vulnerability and adaptation assessment. WHO Africa. https://www.afro.who.int/countries/uganda