On a Tuesday morning in March, a 34-year-old mother of four arrived at the Pabbo Health Center in Gulu district, northern Uganda. For three months she had suffered nightmares, hypervigilance, and an inability to enter the market where a bomb had killed her neighbor. Grace Akello, the psychiatric nurse on duty, listened to her story and diagnosed post-traumatic stress disorder. She wrote the diagnosis in the patient's file. Then she handed her a slip of paper. The slip listed a follow-up appointment—four months away—and the name of a group therapy room she could attend. But the room, built by an international NGO two years earlier, had been locked for most of that time. The key hung on a nail in the district health office, 15 kilometers away.

Her story is not unusual. Across northern Uganda, where decades of conflict and repeated displacement have left deep psychological scars, mental health workers are diagnosing PTSD, depression, and anxiety at rates that strain an already fragile system. Yet the infrastructure meant to treat these conditions—group therapy huts, counseling rooms, stocked pharmacies—remains largely inaccessible. The result is a cruel paradox: patients are increasingly identified, but seldom treated.

A Diagnosis Without a Room

PTSD diagnoses in northern Uganda have risen sharply in recent years, driven by both increased awareness and the ongoing trauma of displacement. As of late 2024, the World Health Organization estimates that roughly 5% of people in conflict-affected areas meet criteria for PTSD, but local clinicians in Gulu district say the real figure is likely double that. A single psychiatric nurse covers a catchment area of about 50,000 displaced people, many of whom have witnessed violence, lost family members, or endured years of insecurity.

Group therapy rooms were built by several NGOs between 2020 and 2023 as part of a wave of mental health funding. In Gulu district alone, three purpose-built therapy huts stand on the grounds of health centers. They are furnished with chairs, whiteboards, and sometimes a mattress for relaxation exercises. But according to district health records obtained by this reporter, those rooms were used only six times in the past year. The reasons are mundane but devastating: no budget for tea and biscuits, no transport vouchers for patients, no staff time allocated to run sessions.

“We have the room. We have the training. But we don’t have the little things—paper cups, a notebook, a motorbike to visit patients,” said Grace Akello, the psychiatric nurse at Pabbo Health Center. She estimated that she sees roughly 80 patients per month, but can offer only brief counseling, usually 15 minutes per visit. “I give a diagnosis, a prescription if the pharmacy has medicine, and a date to come back. That is not therapy.”

The gap between diagnosis and treatment is not unique to Uganda, but it is particularly stark here. A 2023 study in the Journal of Affective Disorders found that fewer than 10% of people with PTSD in low-income countries receive any evidence-based treatment. In Uganda, the number may be even lower. A 2018 national survey estimated that only about 1% of people with a mental health condition had accessed care in the previous year.

The Training Treadmill

Uganda has invested heavily in training health workers to recognize and manage mental health conditions. The WHO’s Mental Health Gap Action Programme (mhGAP) was rolled out in the country in 2024, with support from the Ministry of Health and several international partners. Over 200 health workers—nurses, clinical officers, and midwives—have been certified in trauma counseling and basic psychiatric care. The training is evidence-based and intensive, lasting two weeks with follow-up supervision for three months.

But the supervision rarely continues beyond the initial period. “Once the training ends, the donor moves to the next district,” said Dr. Samuel Okello, a psychiatrist at Gulu University who has been involved in mhGAP implementation. “The health workers are left without mentorship. They lose confidence. They fall back on what they knew before.” Turnover is high: trained nurses are often transferred to other posts, and the new arrivals may not have the same skills. Dr. Okello estimates that only about a third of trained workers are still actively using mhGAP protocols two years after training.

The pattern is a familiar one in global health: donors fund workshops and training materials, but not the recurrent costs of supervision, salaries, or supplies. A 2025 evaluation of mhGAP in five Ugandan districts led by researchers at Makerere University School of Public Health found that while knowledge scores improved immediately after training, clinical practice had not changed significantly at six months. “You can train a thousand people, but if the system doesn’t support them, you’ve just created a thousand frustrated workers,” said Dr. Rose Nabatanzi, the evaluation's lead author.

Meanwhile, the demand for services continues to grow. The influx of displaced people from ongoing conflict in eastern Democratic Republic of Congo has added to the caseload in northern Uganda. Many arrive with untreated trauma, compounding the stress of displacement. “Every week I see someone who has lost everything,” said Grace Akello. “I can tell them they have PTSD. I can give them a diagnosis. But I cannot give them a room that is open.”

Empty Chairs in Gulu

The three therapy huts in Gulu district were built with funding from Medair, a European NGO that has since shifted its priorities to maternal health. The huts are solid structures with corrugated iron roofs, concrete floors, and windows that let in light. Each can seat about 15 people in a circle. But the chairs remain stacked in a corner, covered in dust. The whiteboards are clean. The only signs of use are occasional meetings of the district health team, who sometimes gather there for administrative briefings.

The key to each hut is held by the district health officer, not by the clinicians who would run the groups. To open a room, a nurse must make a formal request, wait for approval, and then coordinate with patients—many of whom have no phone and no money for transport. “It’s easier to just meet under a tree,” said one community health worker. “That way we don’t need a key.”

Stigma also keeps referrals low. Local clinic staff, who are often the first point of contact for people with mental distress, may be reluctant to refer to a therapy group because they fear it will label the patient as “mad.” In many communities, mental illness is still attributed to witchcraft or ancestral punishment. “If I tell a mother to go to the therapy hut, she might think I am saying she is cursed,” said a clinical officer at a rural health center. “She will not come.”

Even when referrals are made, patients often cannot afford the journey. The huts were built at central locations, but most patients live in scattered camps or villages miles away. A round-trip by boda boda (motorcycle taxi) costs about 10,000 Ugandan shillings (roughly US$2.70)—a prohibitive sum for families surviving on less than a dollar a day. No transport vouchers are available. “We built the rooms in the wrong places,” admitted John Okot, a former project manager for Medair who worked on the construction. “We should have built smaller rooms in more villages, not one big hut per district.”

The Medicine Gap

For patients who do receive a diagnosis and manage to get a prescription, the next obstacle is the pharmacy. Antidepressants such as amitriptyline and fluoxetine are supposed to be stocked at all health centers, but in practice they are often available only at the regional referral hospital in Gulu town. A 2024 audit by the Ministry of Health found that nearly 40% of health centers in Acholi sub-region had run out of at least one essential psychotropic medication in the previous three months.

Patients must travel two days to reach the regional hospital, wait in line, and hope the pharmacy has stock. If it does, they receive a 30-day supply—but no refill plan. Many return to find the pharmacy empty again. “I have patients who come every month and leave without medicine,” said a psychiatric nurse at Gulu Regional Referral Hospital. “Some have given up. They go to traditional healers instead.”

Traditional healers are ubiquitous in northern Uganda, and many offer herbs or rituals for mental distress. While some healers provide culturally appropriate support, others may use harmful practices such as beating or confinement. A 2022 study in Transcultural Psychiatry found that about 60% of people with mental health problems in the region first consult a traditional healer. For many, it is the only option.

The supply chain for psychotropic medicines is fragile at every level. The National Medical Stores, which distributes drugs to public facilities, has faced repeated funding shortfalls. A 2025 report by the Uganda National Drug Authority noted that stock-outs of amitriptyline and fluoxetine had worsened by 15% compared to the previous year. “Mental health medicines are not a priority,” said Dr. Okello. “If there is a shortage, the district will stock antibiotics first. They see depression as less urgent.”

Counting the Uncounted

Uganda has no national mental health registry. The most recent prevalence data come from a 2018 survey that estimated the lifetime prevalence of PTSD at 3.4% and depression at 8.6% in the general population. But those numbers are widely believed to be outdated and underestimated. The survey did not include displaced populations or conflict-affected regions. Since 2018, northern Uganda has experienced new waves of displacement due to localized conflicts and climate-related disasters.

The WHO estimates that PTSD prevalence in conflict zones can reach 15% or higher. Local clinicians in Gulu say they see rates that high in their caseloads. “Every patient I see has trauma,” said Grace Akello. “But I can only record the ones who come to me. Most never come.” Without a registry, it is impossible to know the true burden, plan services, or advocate for funding.

The lack of data also hampers research. A 2024 systematic review of mental health studies in Uganda found only 12 published papers on PTSD in the past decade, most of them small and cross-sectional. “We are flying blind,” said Dr. Okello. “We don’t know how many people need help, where they are, or what interventions work best in this context. We are guessing.”

International donors often require evidence of need before funding programs, but the evidence is thin. “It’s a chicken-and-egg problem,” said Sarah Nakku, a program officer at the mental health NGO BasicNeeds Uganda, which works in the region. “We need data to get funding, but we need funding to collect data. So we rely on models and extrapolations. It’s not ideal.”

What Works When Rooms Stay Empty

In the absence of functional therapy rooms, some clinicians and community workers have improvised. Peer support groups—where people with similar experiences meet informally under a tree or in a church—have sprung up in several camps. These groups require no funding, no key, no official approval. A 2025 pilot study in Gulu found that patients who attended peer support groups reported a roughly 40% reduction in PTSD symptoms after six months, as measured by a standard checklist.

Phone-based counseling is another emerging option. A small pilot run by a local NGO trained six community health workers to provide weekly phone calls to patients with depression. Early results, presented at a conference in Kampala in late 2024, showed a 35% drop in symptom scores among participants. But the pilot reached only 120 people, and funding ended after nine months. “It works, but it’s not scalable without a budget for airtime and supervision,” said the pilot’s coordinator.

Task-sharing—training community health workers to deliver basic mental health care—has been promoted as a solution for low-resource settings. Uganda’s Ministry of Health has endorsed the approach, and several districts have begun integrating mental health into the work of village health teams. But the community workers are volunteers, paid only a small stipend, and their turnover is even higher than that of nurses. “You train a volunteer for a week, and she leaves after three months because she needs to farm,” said Dr. James Omona, district health officer for Gulu. “We need to pay them. Otherwise, it’s just another training treadmill.”

Donors are slowly shifting their strategies. Some are now funding transport vouchers, supervision, and salaries rather than buildings. A 2026 grant from a major foundation, for example, includes a budget line for motorbike fuel and mobile phone credit for community health workers. “We learned that the room is not the bottleneck,” said the foundation’s mental health lead. “The bottleneck is getting people to the room and keeping the room open. That takes recurrent funding.”

A Room Key as a Symbol

The key to the therapy hut in Gulu district still hangs on a nail in Dr. James Omona’s office. Every few weeks, a psychiatric nurse asks for it. Sometimes the officer is in a meeting. Sometimes the key is not on the nail—it has been borrowed for another purpose. The nurse eventually stops asking. The patients stop coming. The diagnosis remains in the file, untreated.

For clinicians, the locked room is a daily reminder of a system that trains them to identify illness but not to heal it. “I feel like I am betraying my patients,” said Grace Akello. “I tell them they have a condition that can be treated. But I cannot treat them. I give them hope, then I take it away.”

Patients, too, have adapted. Some have stopped seeking help. Others rely on prayer, traditional healers, or simply endure. “I know I am sick in my mind,” said the 34-year-old mother, who agreed to speak on condition of anonymity. “But the nurse told me there is no medicine today. Maybe next month. I will wait.”

The gap between diagnosis and treatment in Uganda is not a problem of knowledge. It is a problem of execution—of budgets, logistics, and political will. The therapy rooms exist. The training has been done. The diagnoses are being made. What is missing is the last mile: the transport voucher, the salary for a supervisor, the key in the lock. Small changes could unlock care: a budget line for tea and biscuits, a motorbike for home visits, a decision to give the key to the clinician, not the administrator.

Until those changes come, the rooms will stay empty. The chairs will gather dust. And the patients will keep waiting for a treatment that has been promised, but not delivered.