On Friday, December 19, 2025, a doctoral defence at Makerere University School of Public Health (MakSPH) made visible how knowledge transcends across generations. Dr. Henry Komakech, who first trained at the School for his Master’s in Health Services Research (MHSR) between 2008 and 2010 and has served as a Research Associate in the Department of Community Health and Behavioural Sciences (CHBS) since 2014, defended his PhD titled Effects of the Repatriation of Refugees on the Health Services of the Host Populations in the West Nile Districts of Arua, Moyo, and Adjumani. The thesis examined what happens after refugees begin to return home and humanitarian partners withdraw, leaving district health systems to absorb the transition.

Just over two months later, on February 25, 2026, MakSPH took its place in the 76^th Congregation of Makerere University at Freedom Square, presenting 231 graduands. The four-day ceremony, held from February 24 to 27, saw the University confer degrees and diplomas on 9,295 graduands across nine colleges and two schools, including 213 PhDs. Of the seven doctoral degrees presented by MakSPH, four came from the Department of Community Health and Behavioural Sciences, where Komakech’s work was supervised and examined. The defence in December had tested the scholarship; the congregation in February formally admitted it into the University’s record.

The scholarship itself engaged a structural public health question shaped by Uganda’s refugee experience. By mid-2025, the United Nations High Commissioner for Refugees (UNHCR) estimated that 117.3 million people were forcibly displaced worldwide due to conflict, persecution, or violence. Of these, 42.5 million were refugees, 67.8 million internally displaced persons, and 8.4 million asylum seekers, with 87 per cent of refugees hosted in low- and middle-income countries, including Uganda.

The country today remains one of the key actors responding to this humanitarian crisis, hosting close to two million refugees and asylum seekers and implementing one of the world’s most progressive refugee policies, which integrates displaced populations into national systems of service delivery under the Refugees Act of 2006 and the Refugees Regulations of 2010.

According to UNHCR, refugee repatriation is the return of refugees to their country of origin, ideally voluntarily, safely, and with dignity when conditions allow. It is one of the most preferred and recognised durable solutions to displacement, alongside local integration in the host country and resettlement to a third country, and is typically organised through tripartite agreements between the country of origin, the host country, and the UN refugee agency.

Yet when repatriation occurs, and sometimes this happens rapidly, numbers in host areas decline, affecting financing, staffing, drug supply, infrastructure, and district planning. In this case, repatriation, as Komakech investigates it, is therefore not simply demographic change due to sudden withdrawal but a health systems transition with governance and fiscal consequences.

“This work emerged from observations I made during earlier studies in Northern Uganda, a region that has hosted large refugee populations for many years,” Komakech observed. 

He added, “I noticed that the presence of refugees had varied effects on health services, affecting both refugee and host communities. Yet despite this reality, there was limited research examining how health systems function during periods of transition, particularly as refugee populations move in and out of host districts. This raised an important question: Do districts and aid agencies design health services in ways that can accommodate both incoming and outgoing refugee populations, and what does this mean for service delivery for everyone involved? That question ultimately shaped my study.”

Komakech holds that repatriation matters in humanitarian action and public health emergencies because it offers closure for displaced populations while allowing host countries to reorganise health and social systems as displacement pressures change. 

The question that shaped his doctoral research did not emerge in isolation, though. It developed within a field built over decades by Prof. Christopher Garimoi Orach, Professor of Community Health at Makerere University and Komakech’s principal supervisor, an author of more than 100 peer-reviewed publications in high-impact journals whose work has anchored refugee health and public health in complex emergencies within Uganda’s academic and policy landscape while also contributing to global scholarship in the field. 

If Komakech examined what happens when humanitarian support withdraws, Orach’s earlier scholarship focused on how health systems respond when displacement arrives. The progression reflects an intellectual continuity grounded in history.

“My work has enabled me to mentor many graduate students in disaster risk reduction and refugee health. About ten PhDs have completed under my supervision in this area,” Prof. Orach said, speaking with the benefit of hindsight after decades of academic mentorship and leadership at MakSPH. “Dr. Komakech’s work is extremely unique. His study examines how repatriation affects health systems in hosting districts, a question rarely studied at this depth, especially at PhD level.”

Uganda’s integrated refugee policy makes the study even more important. Unlike the parallel model, where refugee services operate separately from national systems, Uganda uses an integrated model where refugees and host populations share health services. Therefore, when refugees leave, the health system itself experiences a transition. His findings show the need for preparedness and sustainability planning, since humanitarian funding declines when refugee numbers decrease, Prof. Orach argued.

The field before the student

Orach’s entry into refugee health was not theoretical. After earning his Bachelor of Medicine and Bachelor of Surgery from Makerere University in 1988, he completed his internship at St. Francis Hospital, Nsambya, before being posted to West Nile as a Medical Officer at Maracha Hospital in Arua District in 1989. By 1990, he had become Medical Superintendent of the same hospital, serving in a region shaped by displacement from South Sudan and northern Uganda. Decades later, it would be the same West Nile districts where Komakech conducted his doctoral research.

In that environment, displacement was not a policy concept but a clinical reality. Hospital registers reflected migration patterns. Drug shortages, referral pressures, and fluctuating patient volumes were part of daily management. Refugee health was not yet an academic specialisation, Orach recalls. It was a lived service delivery, observed through overcrowded wards, strained supply chains, and district health systems adjusting in real time to population movements.

Those experiences gradually shifted his attention toward population health. Orach returned to Makerere University for postgraduate training in public health, completing the Diploma in Public Health in 1994, with the programme culminating in the Master of Medicine in Public Health in 1996. His master’s research examined maternal mortality in Gulu District using the Sisterhood methodology, a community-based study that earned him the Community Health Research Award from the World Health Organisation (WHO) Regional Office for Africa in 1997.

The recognition marked an early indication of the policy relevance of Prof. Garimoi Orach’s work. During this period, he also undertook specialised training in refugee studies at Oxford University in 1996 and later in large-scale emergency health response through the International Committee of the Red Cross (ICRC)–WHO Health Emergencies in Large Populations programme in 1997. The academic trajectory was beginning to align with what he had already encountered in practice in West Nile.

In 1999, after completing his master’s training, he intended to return to district service from where it all began. A senior academic intervened. “Professor Gilbert Bukenya asked me where I intended to work,” Orach recalls. “I told him I wanted to return to the district. He said, ‘Chris, you are not going anywhere. You will stay here at the university.’” That decision redirected his career toward academic public health. Between 1996 and 2002, he served as a Research Fellow at MakSPH, at the time called the Institute of Public Health (IPH), combining teaching, research, and field engagement.

International collaboration soon expanded the scope of Orach’s work. Through a European Union–supported partnership linking Makerere University, Oxford University, the Institute of Tropical Medicine in Antwerp, and Moi University in Kenya, he deepened research into refugee welfare policy and emergency public health systems. The collaboration also opened further academic pathways. He pursued additional training at the Institute of Tropical Medicine in Antwerp, completing a second Master of Public Health in 2000, before later earning a PhD in Public Health from Vrije Universiteit Brussel in 2006.

His doctoral research examined reproductive health services for refugee and host populations in Uganda and the policy implications of integrating those services within national health systems. The work, published in The Lancet, which is one of the world’s oldest and most prestigious peer-reviewed general medical journals, informed policy reforms on refugee health at a time when Uganda was strengthening its legal and institutional framework for refugee protection, culminating in the Refugees Act of 2006 and the Refugees Regulations of 2010. Decades later, Komakech would revisit the same policy landscape from another angle, examining what happens to those integrated health systems when refugee populations begin to leave host districts, and humanitarian support recedes.

Orach’s academic career at Makerere subsequently progressed through successive ranks from being appointed Assistant Lecturer in 2003, Lecturer in 2006, Senior Lecturer in 2009, Associate Professor in 2012, and a full Professor of Public Health in 2015. Alongside teaching and research, he also served diligently as Head of the Department of Community Health and Behavioural Sciences from 2010 to 2019 and as Deputy Dean of the School of Public Health from 2012 to 2020. Over these years, he supervised postgraduate scholars and helped consolidate refugee health and public health in complex emergencies into an institutionalised field of teaching and research.

Emergency response gradually became a curriculum. What began as field-informed training, including a short course in Public Health in Complex Emergencies (PHCE) that started in 1999, evolved into formal postgraduate programmes. 

In 2014, the School established the Master of Public Health in Disaster Management, drawing on earlier emergency health initiatives and international collaborations. Refugee health systems, disaster preparedness, and post-disaster recovery had entered formal academic training within the institution. By the time Komakech embarked on his doctoral study three years later in 2017, the intellectual infrastructure for the questions he was asking had already been built, with the strong contribution to the field by front-runners like Orach. The scholar who would later examine the system at its point of transition had also grown within that very environment.

“Dr. Komakech’s journey mirrors mine. During my PhD, my supervisor’s illness delayed my completion. In his case, he suffered a severe road traffic accident that required multiple surgeries and interrupted his doctoral studies for several years,” Prof. Orach said, reflecting on the life-threatening accident that forced his student to withdraw from the programme before returning to defend his thesis in December 2025. “Despite this, he continued publishing and remained academically active. When he submitted his thesis draft, its quality surprised us greatly. His perseverance demonstrates true resilience, an essential quality in doctoral training.”

The student within the field

Komakech’s formation shows a long relationship with Makerere University and with the public health questions that would later shape his doctoral work. He first trained at Makerere’s Faculty of Social Sciences, earning a Bachelor of Arts in Social Sciences in 2005 before entering development and humanitarian work. Between 2006 and 2008, he worked with CARE International and the Charity for Peace Foundation, supporting communities affected by displacement and gender-based violence.

The work exposed him to the social and institutional pressures that accompany conflict and forced migration. Seeking stronger analytical tools to understand how health and social systems respond to those pressures, he later enrolled at Makerere University School of Public Health, completing a Master of Health Services Research in 2010.

It was during this period that Komakech first met Prof. Garimoi Orach, beginning an academic relationship that would later shape his doctoral journey. Over more than a decade at the School now, he has served as a Research Associate, contributing to teaching, supervision, and the design and implementation of health systems research. 

His work has spanned disaster resilience, refugee integration into national health systems, and the governance of health services in fragile settings, combining field research, project coordination, policy engagement, and academic publication. The doctoral study he defended in 2025 built directly on this sustained engagement with displacement, humanitarian response, and the capacity of public systems to adapt to changing pressures.

The question that emerges when people leave

Komakech’s doctoral study examined the large-scale repatriation of South Sudanese refugees between 2006 and 2009 in the West Nile districts of Arua, Moyo, and Adjumani. Conducted between 2017 and 2019, the research used a mixed-methods design to analyse how district health systems adjust when refugee populations begin to decline.

The study investigated three related questions of how the repatriation process unfolded in the districts, how health services were reorganised once refugees left, and whether those services remained sustainable after humanitarian actors scaled down operations. Evidence was drawn from policy and programme documents alongside 81 key informant interviews with government officials, district health managers, humanitarian agencies, and community stakeholders.

The results from the study confirm that the repatriation process itself within the areas was highly structured and collaborative. In this process, national and district governments worked with UN agencies, humanitarian organisations, and refugee communities to organise voluntary return. Information campaigns, confidence-building visits to areas of origin, health screening, and reintegration support helped prepare refugees for departure and reduce uncertainty about conditions back home. Through this coordinated system, nearly 95,000 South Sudanese refugees were repatriated from settlements across the West Nile districts between 2005 and 2009.

The departure of refugees, however, was found to reshape local health systems within host communities. Dr. Komakech’s thesis reports that during periods of influx, humanitarian agencies expanded district capacity by providing essential medicines, health workers, infrastructure, and logistical support. Once repatriation began and aid organisations withdrew, district health teams assumed responsibility for facilities and services previously supported by humanitarian partners.

Although Uganda’s integrated refugee policy enables these services to be absorbed into the national health system, the study reports, districts often face persistent shortages of medicines, personnel, and operational funding. Many facilities established for emergency response were found to remain in place but lacked sustainable financing for routine service delivery.

In earnest, the study characterises repatriation as a health systems shock, affecting governance, financing, and service sustainability. Its author cogently states that humanitarian resources tend to decline rapidly when refugee numbers fall, while government allocations adjust more slowly through national budget cycles. Consequently, he notes, district health systems in the areas inherit expanded responsibilities without equivalent continuity of resources;

“Districts do not experience relief when NGOs leave,” Komakech explained. “They transition from supported service delivery to unfunded responsibility.” The research also reveals variation across districts. In Arua, earlier integration of partner-supported services into district structures helped cushion the transition, suggesting that governance choices and early planning indeed influence how systems absorb the shift from humanitarian response to routine service delivery.

The evidence in his study points to the need to treat repatriation as a planned health systems transition rather than a simple population movement. Dr. Komakech, in his recommendations, calls for humanitarian agencies to align exit strategies with district health planning, urges the government to integrate refugee-supported services into national systems early, and highlights the need for sustained investment by both government and development partners to ensure that district health services remain functional as humanitarian support declines.

For his mentor and principal supervisor, Prof. Orach, the study confirms Komakech’s growing authority in the field, following his graduation with a PhD in Public Health from Makerere University on February 25, 2026. 

“I now consider Dr. Komakech a health systems expert in refugee health. Having worked in this field for nearly a decade now, he is well-positioned to advance research on health systems in emergency settings. His work demonstrates how governments, NGOs, and communities can collaborate to sustain healthcare during repatriation. He is an important asset to the university and will likely be sought after by humanitarian organisations. I hope he remains in academia to continue advancing this developing field.”

Mentorship and the reproduction of scholarship

Mentorship was at the heart of the bond between Prof. Orach and Dr. Komakech, built on trust, mutual respect, and a shared commitment to advancing public health scholarship and research at Makerere University School of Public Health. For Orach, supervising a PhD was never only about research guidance; it meant nurturing a scholar, shaping independent thinking, and opening paths for leadership in the field. 

“My mentorship philosophy is simple,” Orach explained. “I see students as future scholars who should surpass me. I guide them toward unexplored areas where they can lead. Knowledge must be shared openly, and students should always have direct access to their mentors. Silence concerns me. Active engagement is essential.”

The philosophy prioritises intellectual independence. Rather than directing students toward his own research agenda, Prof. Orach encourages them to pursue critical questions that expand the boundaries of public health scholarship. Dr. Henry Komakech’s own doctoral work exemplified this approach. “Prof. Orach played a critical role throughout my PhD journey, offering guidance beyond academics, shaping study design, methodological rigour, theoretical grounding, and policy relevance. His mentorship helped me navigate difficult phases of fieldwork, analysis, and writing while encouraging independence and critical thinking,” Komakech reflected.

Mentorship remains a cornerstone of MakSPH’s scholarly culture, reflected in the Department of Community Health and Behavioural Sciences, chaired by Assoc. Prof. Christine Nalwadda, since March 2020 Dr. Nalwadda praised Komakech’s contribution to advancing the School’s mission, noting: “As a School, we are proud of the work of our scholars and the impact it has on the University and the communities we serve. Dr. Komakech’s research addresses a matter of national and regional importance. Uganda hosts nearly two million refugees, the largest refugee population in Africa, and understanding how health systems adjust when populations move is critical. His work provides vital evidence to guide planning and ensure health services remain responsive during these transitions.”

She said her department now has 12 faculty members, 11 holding doctoral degrees, with the remaining colleague progressing through their doctoral training. This concentration of expertise reflects a culture where mentorship and scholarly development are central. Within this environment, the mentor-student relationship between Orach and Komakech represents more than individual achievement. Orach’s scholarship established refugee health and public health in complex emergencies as an institutionalised area of study at the School, and Komakech’s research extends this trajectory, examining how health systems endure once humanitarian intensity declines.

Looking ahead, Dr. Henry Komakech wants to consolidate this emerging field, mentor younger scholars, and ensure research evidence informs policy and practice for refugee and displaced populations. For Prof. Christopher Garimoi Orach, this progression represents the deeper purpose of doctoral training. “Public health must lead in fragile and humanitarian settings,” he asserts. “We must train highly skilled professionals like Komakech in disaster and humanitarian response who can operate within strong governance and funding structures. My greatest satisfaction is producing more PhDs equipped to lead in these contexts. I am confident our efforts are bearing fruit, though much work remains.”

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