Kenya: In the shadow of COVID-19, a growing mental health crisis in Dadaab refugee camp

No durable solutions in sight

The number of refugees being resettled from Kenya had already slowed to a trickle even before COVID-19; now it has almost completely stopped. Returning voluntarily to Somalia, where insecurity is widespread and the health system is deeply stretched, seems even less of an alternative for most camp residents. As of August this year, the United Nations Refugee Agency had reported no returns from Kenya to Somalia. The promise of local integration for refugees has gradually faded as initiatives to extend state services to refugees remain stalled.

Finding sustainable solutions in the time of COVID-19 is hard, but meaningful action for Dadaab’s refugees has always fallen far short. A string of commitments, from the 2017 Nairobi Declaration on Somali refugees, which sought a regional solution to one of the world’s oldest refugee crises, to declarations of support at the first Global Refugee Forum have all come to nought. The little progress that had been made in expanding education opportunities for refugees is now being undermined by COVID-induced disruptions.

Thirty-year-old Fawzia Mohamed came to the camp with her family in 1992, when she was barely two years old. She has lived in the camp ever since. She laments the uncertainty that casts a shadow over their lives. “How can you stay in a country for three decades, but not know where you belong? You remain a refugee without any prospects. It has an even greater impact on the many youths in this camp, who are hurting economically and socially. The rate of unemployment is very high in the camp. But if the movement restrictions could be removed, then the living conditions of refugees could really change.”

For most Somali refugees who have known nothing but the camps, durable solutions have come to seem frustratingly elusive and unattainable. Dadaab’s refugees face the prospect of a life sentence in one of the harshest places on earth. Long-term encampment and the fast-vanishing hopes of a life free of the daily indignities of the camp is having devastating consequences on their physical and psychological health.

COVID-19 increases uncertainty

COVID-19 is likely to more significantly worsen conditions in the camps as concerns for Dadaab’s residents risk slipping further down donors’ priorities. At the same time, the economic shocks of COVID-19 around the world have greatly diminished the remittances refugees once received from families abroad. The after-effects of COVID-19 will likely deal a severe blow across societies, and poor and marginalized Kenyans will not be spared. But refugees, even those with access to some form of humanitarian assistance, remain extremely vulnerable. The slightest shock risks upending their lives completely.

“As the Kenyan government draws up COVID-19 recovery plans, integrating refugees would represent a resounding acknowledgement of its commitment to seek a permanent solution for the forgotten refugees of Dadaab,” says Dana Krause, MSF head of mission. For donors, there has never been a more apt moment to demonstrate international solidarity with refugees, and they must fully share responsibility with the Kenyan government, not only through financial commitments, but also through restoring resettlement and complementary pathways for refugees.”

MSF in Dagahaley

MSF has been providing health care to refugees in Dadaab for most of the camp complex’s existence. MSF’s health services are open to host communities and are a crucial lifeline for unregistered refugees who are denied access to basic services in the camps. MSF’s current programs are focused in Dagahaley, where it provides comprehensive primary and secondary health care to refugees and host communities. The medical services include sexual and reproductive health care, medical and psychological assistance to survivors of sexual violence, mental health care, and palliative care.

Since the beginning of the COVID-19 outbreak, MSF has put in place measures to ensure adequate infection prevention and control. This includes setting up screening at triage, establishing an isolation area, and organizing health education sessions. In Dagahaley camp, MSF set up an isolation unit with 10 beds, with the capacity to expand to 40 beds if needed, and also trained health workers to create a pool of frontline responders. At the same time, MSF also supported county governments in Garissa and Wajir, organizing training for health staff and reinforcing infection prevention measures in two sub-county hospitals.