Why are we there?
- Endemic/epidemic disease
- Healthcare exclusion
Latest Links
- Kenya: Help needed for people displaced by flooding
- Kenya: The mental scars of violence in the Tana Delta
- Kenya: Refugee influx worsens dire situation in Dadaab
Historical
Latest Activity Report (2011)
For more than two decades, Médecins Sans Frontières/Doctors Without Borders (MSF) has been providing medical care in Kenya. In 2011, MSF assisted both local people and the large Somali refugee population.
Drought in the Horn of Africa aggravated the already dire situation of refugees in the overcrowded camps around Dadaab, in eastern Kenya. A surge of people fleeing Somalia in search of safety, food, healthcare and shelter in the three camps of Ifo, Dagahaley and Hagadera resulted in a humanitarian emergency.
Dadaab refugee camp
The camps, which had been built for 90,000, swelled to a total population of nearly half a million, making the Dadaab area the third-largest city in Kenya. At the height of the crisis in July, malnutrition levels were well above the emergency threshold. Aid agencies struggled to cope.
Two new camps were opened – Ifo 2 and Kambioos. However, at the end of the year, some 5,000 refugees were living outside Dagahaley, unable to find a place to stay in any of the camps. Inside Dagahaley, MSF was the main provider of healthcare for nearly 125,000 registered refugees, and also catered for the needs of refugees referred to its hospital from other camps.
The team tripled capacity, setting up an emergency nutrition centre with more than 200 beds, while maintaining a 100-bed hospital for maternal care, paediatrics, emergencies and general medical assistance.
MSF conducted more than 170,000 consultations in its hospital and health posts in Dagahaley camp, over 4,000 more per month than planned. Admissions for nutritional support averaged at 350 per month.
Over 11,500 patients were admitted to the outpatient nutrition programme during the year. As most of the refugees from Somalia had had little or no access to healthcare for two decades, outbreak of disease was a major concern, and MSF launched a measles vaccination campaign.
Kidnapping
After protracted negotiations with the government of Kenya and local communities, MSF began working in Ifo 2 camp in July. However, just three months later, in October, two staff members were abducted by a group of armed men, forcing MSF to reduce health activities in the camp.
As insecurity grew, refugee registration was closed. Refugees were no longer being transported to Dadaab or relocated elsewhere. There was a general reduction in non-lifesaving activities, which threatened to reverse the gains achieved during the year.
Liboi, 80 kilometres from Dadaab, is one of the primary crossing points between Somalia and Kenya. When the flow of new arrivals was at its peak, MSF worked in a health centre there, providing care for both Kenyans and Somalis.
Further south, in Ijaara district, MSF assisted Ministry of Health staff in the provision of maternal and child healthcare. In March, fighting in the Somali town of Bula Hawa drove approximately 15,000 refugees and 5,000 displaced people to the Kenyan border town of Mandera.
MSF supported the district hospital and conducted over 1,500 outpatient consultations.
The drought in the Horn of Africa also affected other parts of Kenya. In April, MSF organised mobile clinics and ensured access to water for nomadic pastoralists in Ijaara district. In addition, the team offered reproductive healthcare and saw an increase in the number of women seeking medical assistance during childbirth.
In June, MSF launched an emergency nutrition programme in the Lapur and Kibish subdistricts of Turkana, in northwestern Kenya.
Kala azar
In 2011, the Kenyan government, with the help of MSF, launched the first ever national strategic plan to control neglected tropical diseases, including kala azar (visceral leishmaniasis). Kala azar, which is transmitted by the bite of a sandfly, is almost always fatal if not treated.
MSF has worked with kala azar patients in Pokot, western Kenya since 2006, and in 2011 concluded a validation study of rapid diagnostic tests (RDTs) for the disease.
The results of this study contributed to the government’s decision to approve the tests as a first-line diagnostic tool. An RDT is ideal for use in resource-poor settings, and allows a greater number of people to be screened for the disease, thereby improving access to treatment.
A new combination treatment for kala azar, which takes just 17 instead of 30 days, was introduced, and MSF also gave training to local medical staff working in districts where kala azar is endemic.
HIV and tuberculosis
Around 1.3 million people are living with HIV in Kenya, but only an estimated 550,000 are receiving antiretroviral (ARV) treatment.
MSF has been providing HIV and tuberculosis (TB) treatment for over a decade, and is currently treating more than 17,000 people living with HIV/AIDS and TB in urban areas and rural communities in Nairobi and Nyanza provinces.
In September, MSF detected quality problems with one ARV medicine, Zidolam-N. The drugs were confirmed to be falsified versions of World Health Organization quality-assured medicines that were purchased via a distributor certified by the Kenya Pharmacy and Poisons Board.
MSF took immediate measures to trace and inform patients, replace the affected drugs and provide medical follow-up.
In 2011, MSF completed the switch from d4T-based first-line treatment to a TDF/AZT-regime, which has fewer side effects. All new patients are put on TDF/AZT.
New TB diagnostic machine have been introduced in Nairobi, which are faster and more sensitive. MSF also expanded its TB programme in Mathare, Nairobi, to the predominantly Somali neighbourhood of Eastleigh, where only limited TB treatment services were available.
Some 900 patients with chronic diseases other than HIV also received treatment at MSF health centres in Nairobi. Due to be completed in 2012, MSF is building a new health centre on the outskirts of Kibera slum. It will at first be run jointly by MSF and the Ministry of Health, then gradually handed over to the ministry.
Sexual violence
In the slums of Kibera and Mathare, MSF continues to focus on treating victims of sexual violence. In both areas, the number of child victims is very high – 65 per cent of patients in Mathare are under 18.
MSF provided medical assistance to over 1,000 new patients, offering post-exposure prophylaxis – treatment to reduce the risk of infection with HIV and other sexually transmitted diseases – as well as counselling and social support.
At the end of 2011, MSF had 798 staff in Kenya. MSF has worked in the country since 1987.
Patient Story
Mahmoud*, 39 years old, from Somalia
“I arrived in Dagahaley last night. I came here with my mother, my wife Fadullah and our five children. The journey, which cost us US$250, took nine days, travelling in overcrowded minibuses.
"In Somalia, where we were farmers, all of our animals died because of the drought. I couldn’t pay the taxes I was asked for, so we realised we had to leave.
“I was terrified of an armed group stopping us on the journey and preventing us from crossing into Kenya. On the way, we had to hide. Now I’m here, I feel safer.
“We are staying with my sister, and her family of eight, while we wait to find our own place to live. At the moment we are relying on my sister’s family for everything.
"They are sharing their rations with us so that we can eat. My only plans for the future are for my children to get an education, and for me to find a job so that at least I can earn my own living.”
*The patient’s name has been changed.
