MSF continues to respond to the medical needs of some of Kenya’s most vulnerable people: inhabitants of slum settlements and refugee camps, patients with HIV/AIDS and tuberculosis (TB) and victims of sexual and gender-based violence.
Dadaab is the world’s largest long-term refugee settlement, made up of five camps, which are home to some 345,000 refugees, mostly Somalis. As a result of an agreement signed by the UNHCR, UN refugee agency, and the governments of Kenya and Somalia in 2013, Somalian refugees are being urged to return home voluntarily. However, very few refugees are making this choice and they remain in Dadaab, where funding for humanitarian assistance continues to decrease. Although MSF has not been able to have a permanent international presence there since 2011 due to insecurity, staff have continued to work in the 100-bed hospital in Dagahaley camp and at four health posts, providing outpatient and mental health consultations, surgery, and antenatal, HIV and TB care. In May, prevailing insecurity caused MSF to evacuate a number of staff and close two of its four health posts. In 2015, teams carried out 182,351 outpatient consultations and admitted 11,560 patients to the hospital.
HIV/AIDS and TB care
In Ndhiwa, western Kenya, an estimated 24 per cent of adults are HIV positive, and the number of people infected has been increasing annually. In mid-2014, MSF began a four-year programme aimed at reducing the number of new HIV infections, treating people living with HIV and reducing mortality rates. In 2015, the programme continued to provide support to local health authorities by improving access to HIV testing, offering voluntary medical male circumcision and preventing mother-to-child transmission. Trained counsellors ensured follow-up of HIV-positive patients to improve treatment adherence.
In December, MSF completed the handover of its long-running HIV and TB programme in Homa Bay hospital to the Kenyan Ministry of Health. By the end of 2015, more than 7,300 people were receiving antiretroviral (ARV) treatment in the programme, 265 of them having been enroled in 2015. MSF had been working in Homa Bay county since 1996, and Homa Bay was the first public hospital to provide ARV treatment free of charge in Kenya.
Providing healthcare in Nairobi
Sexual and gender-based violence is under-reported in Kenya, and it is hard to find dedicated healthcare in public clinics and hospitals. In the Eastlands slums, MSF continued its programme at Lavender House clinic, where victims of sexual and gender-based violence have access to a 24-hour hotline and ambulance pick-ups. They also receive treatment for physical injuries, post-exposure prophylactics to prevent transmission of HIV and sexually transmitted infections, a pregnancy test, when relevant, and psychological counselling. Swabs are taken for legal purposes and referrals for social and legal support are made available. In 2015, more than half of the 2,429 people treated at the clinic were under the age of 18, and a quarter of those were younger than 12. MSF is working with the health ministry to make comprehensive treatment for sexual and gender-based violence available in public health facilities.
MSF also runs the trauma room in Lavender House, managing outpatient medical emergencies and stabilising patients before transporting them to other facilities if necessary. Three ambulances are available and the call centre responded to over 4,200 calls in 2015. MSF supports the emergency department of Mama Lucy Kibaki hospital with additional staff, equipment, training and supervision. In 2015, the emergency department handled 25,481 patient visits. This is the only hospital accessible to Eastlands’ 2.5 million residents.
The team at Green House clinic in Eastlands continues to diagnose and care for patients with drug-resistant TB. In 2015, 30 people with the multidrug-resistant form of the disease received treatment and three patients with extensively drug-resistant TB were initiated on the new drug bedaquiline.
In Kibera, Nairobi’s largest slum, MSF provides comprehensive basic healthcare, as well as treatment for HIV, TB and non-communicable diseases, to the 240,000 inhabitants through two clinics. In 2015, teams carried out 132,500 consultations, and assisted 2,469 deliveries in the maternity ward in Kibera South. Over the past few years the Kenyan government has made general healthcare and HIV and TB treatment more widely available in Kibera, and MSF will hand over these centres to the Ministry of Health in 2017.
Responding to a cholera outbreak
MSF supported the Ministry of Health’s response to a massive cholera outbreak in 2015. In Nairobi, teams set up cholera treatment units (CTUs) and over 570 patients were also treated at a CTU in Dagahaley refugee camp. By the end of the year, MSF had supported 47 facilities in 17 counties and had provided care to more than 8,300 patients.
Garissa university attack
In April, Al Shabab militants stormed a university in northeastern Kenya. Over 100 people were killed in the incident, most of them students. An MSF team treated survivors of the attack, including more than 70 with gunshot and blast wounds, and people who had sustained cuts from shattered glass. MSF provided medical consultations, food and water at Garissa airport, where around 300 evacuated students spent the night.