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Post-Election Violence Wracks Kenya
April 4, 2008
This article is part of the Spring 2008 issue of the MSF Alert newsletter.
OPERATIONAL OUTLOOK: KENYA
Kenya 2008 © Brendan Bannon
Long a bastion of stability in East Africa, Kenya rapidly disintegrated into violence following the country’s disputed presidential election. Two months of violence, largely along tribal and ethnic lines, left more than 1,000 dead and as many as 300,000 people homeless, according to the Kenyan Red Cross, before the opposing political parties reached a tenuous power-sharing agreement on February 28.
Doctors Without Borders/Médecins Sans Frontières (MSF), which has been working in the country since 1987, had, for the most part, been focusing on providing treatment to thousands of people living with HIV/ AIDS and tuberculosis in both the capital, Nairobi, and western Kenya. In the wake of the violence, MSF teams were forced to switch gears from overseeing specialized care for chronic diseases to treating machete and other trauma wounds and running mobile clinics for Kenyans fleeing the violence in their communities.
MSF quickly reinforced its teams on the ground by dispatching surgeons, emergency physicians, nurses, and logistical specialists to the country in the tense, violent weeks that followed the election results.
Assisting wounded and Displaced in Western Kenya
Kenya 2008 © Brendan Bannon
MSF teams conducted assessments by helicopter in different areas in the west of Kenya where large numbers of displaced people were reported to have fled. Eldoret, a busy transit town in Western Province, was one of the first places where MSF teams assisted people fleeing violence. An MSF staff began assisting the estimated 30,000 people who arrived in Eldoret in early January. A team distributed relief supplies, such as plastic sheeting, blankets, and jerry cans, to people living in camps around the city.
Many displaced people settled just temporarily in churches, police stations, or any place that offered even a modest sense of safety. They often headed in the direction of areas of the country they considered ancestral or tribal homelands. The rapid movement of people forced MSF teams to be highly reactive and mobile.
“The population was very mobile,” said Dr. Marcela Allheimen, medical coordinator for MSF’s teams in western Kenya. “At the beginning they didn’t stay in one place for more than three days. You had to have everything with you to assess the situation in half an hour and to respond immediately because maybe the population wouldn’t be there the next day.”
The violence has torn people out of their normal lives and many—used to Kenya’s stability—have been unable to cope with the effects. “For these people who have always lived in houses, coping mechanisms are difficult, people are still learning how to live as a displaced person,” said Alexis Moens, MSF emergency coordinator in Kitale.
Supporting the Kenyan health system
Kenya 2008 © Marcus Bleasdale/VII
Much of MSF’s work has been to provide temporary support to Kenyan health facilities where staff had either fled or were too afraid to show up for work. Over a single weekend in late January, MSF supported the Kenyan Ministry of Health to treat nearly 200 wounded in Naivasha and Nakuru. An MSF surgical team, for example, also worked in Eldoret hospital in early January to help with a backlog of wounded and burn patients.
“What’s been really dramatic to me was the intensity of some of the violence,” said Dr. Gary Myers, an MSF surgeon. “On at least three of the patients I’ve seen, the machete wounds that they’ve had have caused near amputations. In my experience working with MSF it’s been unusual to see fractures caused by knife wounds, but at least half of the patients I saw here were injured in this way. If they didn’t have surgery they would most likely lose their limbs.”
Between February 8 and February 21, another surgical team working in Kericho hospital performed 22 operations. As of late February, only 50 percent of the hospital’s regular staff had returned to work and the MSF team was prepared to continue supporting the hospital over the coming weeks.
“Our teams have witnessed severely wounded people”
Kenya 2008 © Brendan Bannon
With sporadic protests breaking out in Nairobi, MSF opened first-aid posts and turned its primarily HIV/ AIDS clinics into basic trauma care centers. After some disruption, Kibera South Health Center—one of MSF’s three health clinics in the Kibera slum of Nairobi—was able to reopen on December 31.
In the first two days of reopening, MSF staff treated 62 patients, over half of whom had been wounded during the violence. In Mathare, a slum on the eastern outskirts of Nairobi, MSF staff were able to go back to work on the first of January. Initially, the teams treated 19 emergency cases, some of whom had been wounded during the violence.
“In Masaba hospital, which we support to take care of the wounded, people were lying on the floor all over the waiting room. Trucks were bringing more people—some wounded, others already dead,” said Remi Carrier, coordinator of MSF’s emergency team in Kibera, of the tensions in mid-January. Between January 16 and February 4, the MSF team in Mathare treated 150 wounded.
“People have been victims of armed civilians increasingly organized in groups that perpetrate indiscriminate violence—with knives, machetes, and sometimes axes—against the population as a whole,” said Filipe Ribero, MSF emergency coordinator for Mathare. “Our teams have witnessed severely wounded people, with lacerated bodies and mutilated limbs or heads.” Many of the victims had to be evacuated to hospitals.
MSF sent three ambulances around the slums and responded to calls for assisting the injured. For the most seriously injured, a system of referral was set up with the public referral hospital and a private hospital. Then again on February 21 and February 22, the team in Mathare treated 25 wounded people following fresh violence. AIDS and TB patients unable to received treatment
The insecurity has also had serious consequences for the thousands of Kenyans receiving treatment for diseases such as AIDS and tuberculosis. Some MSF patients were unable to reach clinics in Kibera and Mathare to receive their medicine early on in the crisis.
“With AIDS and TB, the discontinuation of treatment is very bad because it can foster drug resistance in patients,” said Dr. Allheimen. MSF set up a free telephone hotline, created advertisements, and distributed posters and flyers to find lost patients. Concerns for the future
Even with the power-sharing agreement signed by Kenya’s ruling political party and the main opposition group, MSF teams are continuing to work throughout western Kenya in multiple locations and will monitor health and humanitarian needs as people continue to move to their ancestral lands. The violence has disrupted many people’s ability to plant their crops and left hundreds of thousands homeless.
“The food security in the country is at stake,” said Dr. Allheimen. “February and March is the planting season, and many people will not have been able to reach their lands or obtain seeds for their crops. The food security is one of the concerns that we will be following in the coming months.”