Médecins Sans Frontières MSF (Doctors Without Borders) is reinforcing its work in East Africa due to alarmingly high rates of malnutrition among Somali refugees settling on the outskirts of the refugee camps of Dadaab in north-eastern Kenya.
Waves of people continue to arrive every day at the sprawling Dadaab refugee camp in eastern Kenya.
© Yahya Dahiye/MSF
Day after day, thousands fleeing the conflict in Somalia continue to arrive at the overcrowded camps of Dadaab. Their situation has been made even worse by the drought affecting their country and Kenya.
The region is suffering from a severe drought after two failed rainy seasons.
The refugees - exhausted after days, and sometimes weeks, of travelling - are receiving inadequate assistance on their arrival at the overcrowded camps.
World's largest refugee camp
Dadaab is made up of three camps, called Ifo, Hagadera and Dagahaley. Together they make up the largest refugee camp in the world. Set up 20 years ago to house 90,000 people, the camps are now home to more than 370,000 people, and the numbers keep on growing.
With the camps already full, new arrivals are having to settle in makeshift shelters in the desert on the camps' outskirts. Despite the fact that MSF has repeatedly asked for a solution to decongest the Dadaab camps, there has been no response.
MSF medical care
MSF has been the sole provider of medical care in Dagahaley camp since 2008. Dagahaley camp has a population of more than 113,000, but this is constantly increasing, with an average of 500 new arrivals a day.
About 25,000 people are currently living in the desert outside Dagahley camp.
MSF teams have also been providing assistance in past months to newly-arrived refugees on the outskirts of Ifo camp, while waiting for the opening of Ifo 2 - an extension camp that has room for 40,000 people. Its opening will enable MSF to scale up its activities further.
Extremely high malnutrition rates
A new reception centre in Dagahaley, managed by the Kenyan Authorities and the UN's agency for refugees, the UNHCR, opened in June, with the aim of improving assistance for the new arrivals.
An MSF team assesses the health of people arriving at the centre each day. The team has been carrying out systematic nutritional screening of babies and children under five years old, using MUAC bands, which measure children's middle upper arm circumference. Alarming malnutrition rates have been found.
As a result, MSF carried out a 'rapid nutritional assessment' in the new arrivals' area in mid-June. The results exceeded the team's worst fears.
Dire living conditions
As part of the procedure to detect malnutrition in MSF-run health posts in Dadaab refugee camp, Kenya, children have their height measured.
© Serene Assir/MSF
Refugees are having to cope with extremely difficult living conditions, including intense heat, very little water and poor sanitation. In addition, there are long delays before they are registered by the UNHCR and provided with food rations.
During MSF's three-day rapid nutritional assessment in mid-June, some 500 children between six months and five years old were measured and weighed.
As many as 37.7 percent were suffering from global acute malnutrition. Of these, 17.5 had severe acute malnutrition, which means they are so malnourished they are at risk of dying. Children up to 10 years old were also showing elevated rates of malnutrition.
“There is a high level of malnutrition. We are extremely concerned," said Monica Rull, head of MSF projects in Kenya and Somalia.
"Catastrophic situation..."
"I expected to find a difficult situation but not a catastrophic one," explained Anita Sackl, who coordinated the nutritional assessment.
"The majority of new arrivals actually fled because they had nothing to eat, not just because their country has been at war for decades," she added.
Because of these worrying results in the new arrivals area, MSF is now including children over five years old in their nutritional programmes in Dagahaley camp.
Humanitarian aid too slow
The delay in providing humanitarian aid is causing serious difficulties for refugees. New arrivals have to wait up to 40 days before being officially registered by the UNHCR and receiving a card entitling them to regular food rations.
In the meantime, they received a ration of food sufficient for just two days, and a five-litre plastic container for storing water.
"It was totally unacceptable," said Monica Rull.
In the past two weeks, there have been some small improvements, which Monica Rull welcomes: "Since the beginning of July, newly arrived refugees at least receive food for 15 days. However, it is still not enough. The World Food Programme (WFP) must ensure more regular food distributions. A nutritional survey for all the Dadaab camps needs to be done. Children up to ten years old should also be included in order to confirm malnutrition rates in older children and thus adapt the nutritional programmes."
MSF is also calling for the registration procedure to be speeded up. Currently, there is only one registration centre for the entire Dadaab complex, situated in Ifo camp, which is 10 km from where most new refugees are settling.
Critical water shortage
There is a critical shortage of water in and around the camps. MSF has found that in some areas outside Dagahaley camp, refugees are receiving less than three litres of water per day. While three litres is just sufficient for a person's daily water intake in a hot climate, it means that people have absolutely no water left for cooking or washing, making it impossible to ensure even a minimal level of hygiene.
Increasing the water supply is absolutely vital. MSF teams are currently distributing more than 100 cubic metres of water by truck every day to newly-arrived refugees outside Dagahaley.
Dagahaley hospital and health posts
Pressure is mounting in the MSF-run Dagahaley hospital, and at MSF's six health posts in Dadaab.
In the inpatient therapeutic feeding centre, 130 children are being treated for severe acute malnutrition with medical complications, and there are an average of 107 new admissions each week. A new 60-bed ward has been opened to accommodate them all. A further 2,292 children with severe acute malnutrition are being treated as outpatients.
Most of these children have been referred from two newly opened health posts located outside the camps, in the areas where the newcomers are settling.
There are 700 new admissions each week, on average, to the supplementary feeding programme, for children with moderate acute malnutrition. Altogether, 10,000 children and adults are receiving extra food in MSF's supplementary feeding programme to prevent them from developing malnutrition.
MSF reiterates the need for all organisations working in the camp to scale up their activities in order to provide appropriate assistance to the refugees. This includes immediate assistance for refugees as soon as they cross the Somalia-Kenya border, as well as finding acceptable solutions to ease overcrowding in the existing camps.
MSF has been providing medical care in Kenya since 1992, and has worked in the Dadaab camps for a total of 14 years.
Since 2009, MSF has been the sole provider of medical services in Dagahaley camp, where it runs a 170-bed general hospital and six health posts to supply healthcare to the camp’s more than 113,000 residents.