Doctors Without Borders

Dadaab Briefing Paper: Back to Square One

In the Dadaab camps of northerastern Kenya, which collectively form the largest refugee camp in the world, life is becoming more difficult every day and hundreds of thousands of refugees are facing a humanitarian emergency. Their health is at risk of deteriorating rapidly but humanitarian aid agencies are struggling to provide meaningful assistance on an ongoing basis.

The relocation of families to the newly opened camps of Ifo 2 West and Ifo 2 East continues, but work to ensure sufficient services has been slow to restart. Today, a limited number of people remain on the outskirts of the camps in so-called “self-settled areas,” where living conditions are still extremely poor. Such conditions have profound consequences for the health of these refugees, as confirmed in a detailed survey conducted by MSF’s epidemiological branch, Epicentre, in September 2011. The health situation in Dadaab is alarming, with recent outbreaks of measles, acute watery diarrhea, and cholera.

MSF continues to run its hospital and four health posts in Dadaab’s Dagahaley camp. At the height of the emergency, from October 2011 to January 2012, the 300-bed hospital in Dagahaley was operating beyond its capacity, reaching a peak of more than 350 patients in the first week of January. Today the situation has improved and medical activities have been restored in Ifo 2 [Somali refugee camp]. However, the number of severely malnourished children requiring hospitalization is still high compared to the same period last year, with nearly 100 children being admitted to the intensive therapeutic feeding center every week.

MSF is constantly adapting to the exceptionally difficult humanitarian and security challenges in the camps. Despite limited international presence in the camp due to security concerns, MSF staff are still providing high quality medical care.

Photo:Kenya 2011 © Brendan Bannon - Somali refugees settle at the edge of Dadaab, the world’s largest refugee camp.

Somali Survivor Seeks to Give Back

Civil war destroyed Hussein Magale’s home in Somalia in 1992, when he was around two years old. Forced to flee, he spent the next 16 years in a Kenyan refugee camp.

“I was born in Somalia, raised up in Kenya, now I’m switching over to being an American,” he said.

“(People) live in an open prison, far away from justice and humanity,” Magale said. “They speak, but their voices are never heard.”

Doctors Without Borders eventually came to his camp. So Magale, who speaks three languages, began translating for them.“If they (doctors) were not like that, I wouldn’t have survived,” he said. “Working with them … I understood the power of a medical education.”

Now, he’s a biochemistry sophomore and an aspiring doctor. He translates for the University of Arizona Medical Center’s doctors and assists the Arizona Refugee Connection, which helps people worldwide.

He still has a lot of work ahead of him and medical school is some time away, but his goals for the future are very clear. “When I become a doctor,” he said, ”I’m planning to not only help Somalia or Somali refugees, but anyone who needs it most.”

Learn more on the work of Doctors Without Borders with Somali Refugees.

I am a Kenya[n] currently studying in Canada. When my mother was first diagnosed with HIV/Aids in 2002, we all went into denial. The stigma and discrimination was rampant and the ARV’s were too expensive for us.

Thanks to MSF, my mother is alive, beautiful, strong, how can I best describe it! Alive and Kicking. There was not only the treatment, there was the nutrition and support group services.

My mother is now a community health worker in Mathare slum. MSF runs a clinic near this slum called the Blue House clinic, and yes, you thought right, it is painted blue.

The end, in some circumstances, justifies the end.

Happy 40th anniversary MSF.

Wairimu Gitau
from Ottawa

A comment left on the WNYC Leonard Lopate Show website earlier this week from an interview with Michael Neuman. The interview was regarding the new MSF book, Humanitarian Negotiations Revealed: The MSF Experience.

Listen to the archived Leonard Lopate Show interview with Michael Neuman on the WNYC website.

This mother and child—and this part of Mogadishu—show the toll of the overlapping political, security, and public health crises in Somalia, which have put an immense burden on women and children.

Years marked by conflict, drought, and a profound lack of governance culminated in a massive humanitarian crisis in the second half of 2011, to which MSF responded by expanding its programs in Somalia and for the huge numbers of Somali refugees who sought aid in Kenya and Ethiopia.

Photo: Somalia © Lynsey Addario/VII

MSF Condemns Attacks On Aid Workers And Calls For Release Of Abducted Colleagues in Somalia

One week ago, a gunman killed Phillipe Havet and Andrias Karel Keiluhuo, two Doctors Without Borders/Médecins Sans Frontières (MSF) aid workers, while they were implementing emergency assistance projects in Somalia’s capital, Mogadishu. Three months ago, MSF staff members Montserrat Serra and Blanca Thiebaut were abducted in the Dadaab refugee camp in northern Kenya while providing emergency assistance for the Somali population there.

These attacks on aid workers must be condemned in the strongest terms, MSF said today. They jeopardize life-saving medical projects that are already far from adequate in addressing the vast medical needs of the Somali population.

MSF is confronting the difficult dilemma of working in a context like Somalia, where the needs are not only extremely great, but the risks are exceptionally high for the safety and security of all staff. As we consider this dilemma, MSF is requesting that all people—especially the authorities in control of areas in Somalia where our kidnapped colleagues are being detained—do everything possible to facilitate the safe release of Blanca and Montserrat.

Five kilometres southwest of downtown Nairobi in Kenya, the sprawling Kibera slum is a sea of mud and corrugated iron shacks with small, narrow rooms that house entire families.

More than 60 percent of diseases among Kibera patients are linked to hygiene and sanitation conditions. People most commonly come to MSF clinics in Kibera for pneumonia, respiratory diseases, diarrhoeal diseases, skin diseases and worms. These are all diseases with clear connections to poor hygiene, poor sanitation and overcrowded living conditions where diseases are easily transmitted. There are far too few toilets, the homes are small and congested, clean water is scarce, and access to free or affordable quality healthcare is critically limited.

Urban Survivors is a multimedia project by Doctors Without Borders/ Médecins Sans Frontières (MSF) in collaboration with the NOOR photo agency and Darjeeling Productions, highlighting the critical humanitarian and medical needs that exist in slums the world over.

Photo: Nairobi, Kenya © Francesco Zizola/NOOR

Five kilometres southwest of downtown Nairobi, the sprawling Kibera slum is a sea of mud and corrugated iron shacks with small, narrow rooms that house entire families.

Kibera is severely overcrowded and suffers from a grave and dangerous lack of sanitation. Most houses do not have toilets, so people must seek out public ones during the day. At night, however, these are unsafe or unreachable, forcing people to defecate in bags that they then throw outside. The high population density, the deplorable hygiene, and lack of clean water and sanitation significantly increase the risk of diseases spreading in the slum.

The people of Kibera have very limited access to free or affordable health care. The government has historically considered it an “informal settlement,” which renders slum residents “invisible” to the authorities and the rest of the society. As a result, there has been no government-sponsored development inside the slum- no provision of public water, sanitation, education, infrastructure or health care.

Urban Survivors is a multimedia project by Doctors Without Borders/ Médecins Sans Frontières (MSF) in collaboration with the NOOR photo agency and Darjeeling Productions, highlighting the critical humanitarian and medical needs that exist in slums the world over.

Photo: © Francesco Zizola/Noor

Catherine Atieno is HIV positive and the mother of four children. She lives in Kibera, a slum on the edges of the Kenyan capital, Nairobi, where she works in the local MSF clinic.

Shortly after Catherine started antiretroviral treatment, she discovered she was pregnant with her fourth child. She feared that she would pass on her HIV infection to her child. Three years earlier, her elder daughter Joanne was born with the virus when Catherine did not know she was HIV-positive.

Catherine confided her fears to a friend who worked in one of MSF’s clinics in Kibera. As a result, Catherine enrolled in the Prevention of Mother-to-Child Transmission programme (PMTCT) at the clinic. Catherine was already taking antiretroviral drugs for her own health. And during delivery of her baby, the child was also given medication.

“Lucky is a healthy girl,” she said. “When I was pregnant, the doctor said maybe either I will die or she will be born HIV positive. But when she came out, she was just normal – that’s why I decided to call her Lucky.”

Nine in ten of the 2.5 million children living with HIV acquired the virus from their mother either during pregnancy, birth or the breastfeeding period. But these infections are entirely preventable, by putting the mother on HIV treatment, as well as the baby on prophylaxis at birth and during breastfeeding. In wealthy countries paediatric HIV has almost been eliminated with the risk of transmission cut to 2%. Expanding prevention of mother-to-child transmission (PMTCT) services could ensure that many other women, like Catherine Atieno from Kenya, are able to protect their families from HIV.

“5 Lives” tells the stories of people who MSF works with every day, people whose lives often hinge on whether or not they can gain access to a simple medical intervention. These are situations that could be avoided with proper and sustainable funding and investment in public health. That’s why MSF supports calls to permanently allocate a small portion of a new financial transaction tax (FTT), which has been proposed by some governments, to support global health needs. A regular stream of funding would help provide some of the resources needed to address unchecked health crises around the world.

Photo: © Sven Torfinn

Somali refugees stand outside a reception center in Dagahaley camp, Dadaab, Kenya. Since the kidnapping of two MSF employees on Oct. 13, MSF has continued to treat severely malnourished children and others in the Dagahaley camp hospital. Teams plan to reopen four health posts inside the camp and to restart other medical activities in the coming days. Read more

Photo: Kenya 2011 © Michael Goldfarb/MSF

Boys in a remote village in the Turkana region of northwestern Kenya play next to an MSF food distribution site. People in the Turkana desert rely almost exclusively on livestock and they have seen many of their cattle and goats die due to the drought this year. See more photos

“There are millions of children suffering from malnutrition today–out of view from journalists and TV cameras. Why should they have to wait to be caught up in the middle of a war or a food crisis in order to receive the kinds of high-value foods that will help them grow healthy and strong and reach their potential?”

- Dr. Susan Shepherd, MSF Nutrition Advisor