June 17, 2011
Nenna Arnold is a community outreach nurse at the Dagahaley refugee camp near the town of Dadaab in northeastern Kenya, where she cares for refugees from nearby Somalia who are fleeing violence, insecurity, and a devastating drought. Dadaab is Nenna’s fourth mission with MSF, the largest project she’s ever been a part of, and, she says, her biggest challenge yet.
“It started when Abu, our liaison officer, told me that there were lots of people who had just arrived and were settling outside the boundaries of the refugee camp. This was last September. We went straight to see them to ‘assess the situation.’ Only, it isn’t a ‘situation.’ It is a group of human beings living in conditions most of us can’t imagine. They have no shelter, no plastic sheeting, very little food. Children are even being killed by hyenas because they have no protection. The men sleep during the day and try to protect their families at night. Unfortunately, the women who are there without men tell us that the hyenas are the least of their worries.
Most of these ‘new arrivals’ come from Somalia. They have travelled a long way to get here, often on foot. Some people are lost, scared, confused. Maybe they just arrived in Dagahaley after a 16-day walk from Mogadishu to escape the escalating violence. Most have lost family members to violent deaths; some have been raped or beaten. Some arrive injured or maimed. Some even lost family members during their journey to safety.
The journey itself proved, for many, to be just as dangerous as the chaos they were fleeing. Wild animals, bandits, climate, disease, hunger, thirst. They left their homes with no provisions. No food, no water. Only the clothes on their backs. The lucky ones brought one or two small belongings. Perhaps something as simple as a jerry can to store water, or a cooking pot.
Those of us who are focused on the area where the new arrivals are settling feel that the situation there is a humanitarian emergency. These people are surviving with just the bare minimum that a human can survive with.
When the refugees arrive, they are often sick. Since they often have to wait up to two weeks for rations, the nutritional status for both adults and children is dire, particularly for the children. The first thing I did was to organize a group of community workers to go and assess the children and pregnant women of the group. We loaded up the back of the MSF vehicle with patients, including many, many malnourished and sick children. We dropped them either at the health post or the hospital, depending on the severity of their condition. We found one young mom who was having problems with her pregnancy. She lost the baby, but she lived. Another sick baby was brought to the hospital too late. There was nothing they could do. But the others… the others have a chance.
We have been doing periodic vaccination activities. We go to the new arrivals’ site with a team of community health workers and a loudhailer, and we set up a table underneath a tree. At the latest one, we vaccinated 257 children in two mornings, most of whom had never been vaccinated before. This way we can prevent any outbreaks of disease and prevent the children from getting life-threatening and life-changing diseases.
We proposed building a temporary health post in the new arrivals area, and it opened in March. The people there – up to 10,000 of them – have difficulty accessing the existing heath posts due to distance, or because they don’t yet know the layout of the camp or what services are on offer. On the first day the new health post opened, we did 165 consultations and admitted 98 people into our nutrition programs. Since then, we have been seeing an average of 110 patients per day.
At times I feel overwhelmed by the enormity of it all, but I try to focus on what I can accomplish. Training the community health workers to better identify people who should be referred to the health posts early, before they are so sick we can’t save them. Training the staff who do the dressing changes so they can tell when a wound is infected or not healing well. Managing 100 health post staff and 78 community health workers. Sundays don’t come often enough, and certainly don’t last long enough.
But despite all the difficulties, I really think I have the best job in the whole project. I love the people. It’s so nice to be able to come out here to the new arrivals’ area and to be able to help the people who really need it most.”
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)