Key medical figures:
• 415,700 outpatient consultations
• 13,200 patients on first-line ARV treatment
• 2,000 patients treated after incidents of sexual violence
Médecins Sans Frontières (MSF) continued to fight HIV and tuberculosis (TB), and in the camps growing insecurity affected healthcare access for refugees.
In the Dadaab refugee camps, home to over 340,000 Somalis, the general level of security has steadily deteriorated since the end of 2011. This has reduced access for aid workers, and MSF is unable to maintain a permanent presence of international staff in its hospital in Dagahaley. Many aid organisations have experienced a decrease in funding, leading to an overall reduction in assistance for refugees in Dadaab. The impact is visible: there is a lack of maintenance and investment in camp hygiene and shelter, which raises major health concerns and increases the risk of epidemics. MSF manages a 100-bed hospital in Dagahaley, providing adult and paediatric care, maternity services, emergency surgery and treatment for HIV/AIDS and TB. Antenatal care, surgical dressings and mental health support are available through four health posts. Each month in 2013, on average, 18,000 outpatient consultations were carried out and over 700 people were admitted to hospital. More than 2,580 babies were delivered and some 4,100 children received treatment through outpatient and inpatient feeding programmes. Over 10,800 mental health consultations were also conducted. In November, a Tripartite Agreement was signed by the UN refugee agency and the Kenyan and Somali governments, outlining practical and legal procedures for the voluntary return of hundreds of thousands of refugees to Somalia. An assessment conducted by MSF among patients in its medical facilities in Dagahaley camp in August found that four out of five people would choose not to return to Somalia given the current climate of insecurity.
Free healthcare in slum settlements
Three MSF clinics continued to provide free basic healthcare in the Kibera slum in Nairobi, as well as integrated treatment of HIV/AIDS, TB and chronic non-communicable diseases. More than 330
people sought assistance at MSF’s 24-hour clinic for victims of sexual violence. Services included post-exposure prophylaxis, psychological support and medical treatment. In 2013, teams working in Kibera completed more than 142,000 outpatient consultations, and provided antiretroviral (ARV) treatment to over 4,300 HIV patients. In February, MSF opened a new clinic in Kibera South that has been set up with the aim of gradually handing over management to the Ministry of Health over a period of five years. It is equipped to provide esidents with basic healthcare and maternity services. There is an inpatient maternity ward, and an ambulance service for obstetric and other emergencies. Integrated management of chronic diseases such as HIV, and any other illnesses, makes it a one-stop service, thus easing patients’ access to medical care and facilitating early diagnosis, treatment and follow-up. Health education sessions, counselling and social support are also offered to empower patients to manage their own health. More than 60 per cent of all consultations at MSF’s Kibera clinics were for respiratory infections and diarrhoeal or skin diseases, a result of the poor hygiene and sanitation. The Eastlands area of Nairobi, composed of poor suburbs and informal settlements, is home to a population of about two million. An average of 150 people who had been the victims of sexual violence came to the MSF clinic each month for medical and psychological aftercare. A team also treated around 476 patients with TB and 40 with drug-resistant TB. An MSF team carried out a health assessment in Eastlands to evaluate other needs and to explore the extent of sexual violence in the area. A proposal to expand the programme will be completed in 2014. The Blue House clinic, where MSF has been providing HIV care since 2001, was handed over to the AIDS Healthcare Foundation.
Addressing the HIV epidemic in Homa Bay
MSF continued the handover of the HIV programme at Homa Bay to the Ministry of Health and its partners, and expects to complete the process by 2015. Some 25,000 people have received care in the programme since 2001. However, as a result of MSF’s HIV impact in population survey in Ndhiwa, Homa Bay – which found one of the highest incidences of HIV in the world – MSF set up a new programme in 2013 to increase the response to this epidemic. It will open in the first half of 2014. Emergency interventions An MSF emergency intervention had been underway in the Tana River delta region since the beginning of the year assisting victims of intercommunal violence, but the response was expanded when the area was subject to heavy flooding in April and many communities were displaced. Teams provided medical and mental health support to people from both the Orma and Pokomo communities. More than 4,900 health consultations and 160 individual and family mental health consultations were carried out. Staff also organised more than 830 community activities within the camps for displaced people, such as latrine construction, distribution of relief items, water treatment and sanitation services. There was sporadic violence throughout the year in the Rahmu area of Mandera county, and during intense clashes between local armed militias in May, houses were destroyed and looted. An MSF team distributed relief items to the people affected and donated drugs and medical material to Rahmu hospital, where several wounded were treated. MSF facilitated referrals and also conducted training for Ministry of Health staff. This emergency aid was completed in August.
43 years old
I felt hopeless after having been diagnosed with HIV in 2003. This was when stigma and discrimination was very high. Before MSF came, all I thought I could do was hide and wait to die just like I had witnessed my friends and neighbours fade away. I am now a family man with one wife and a pretty five-year-old girl. ARV treatment gave hope to the hopeless and I am now a beneficiary of the good free health services offered by MSF. As an activist, I continue to lobby for better policies to ensure that all Kenyans who need treatment can access it.