The seven plagues of Dadaab


Last fall, Hagadera Hospital reported several children with leg paralysis. Laboratory analysis of stool samples confirmed they had polio. Neighboring Somalia has little routine or preventive medical care. Violent and unstable conditions allowed polio to exist, and refugees carried the virus into Kenya.

To prevent further polio infection, three trained Community Health Workers (refugees paid about $40 “incentive” per month) bustled along unmarked, winding, stick-fence lined lanes on a house-to-house campaign that Mildred, the Kenyan nurse who headed our vaccination team, said resembled Passover.

We marked each door or gate we visited; a chalk “X” meant all under the age of 5 had a tiny sip of pink polio vaccine and a drop of oil from a vitamin A capsule squeezed into their mouth.

Our group was one of five teams which combed the Hagadera section of Dadaab refugee camp in the three-day campaign; we tallied 300 children one morning alone.


Malaria infections surged from seasonal rains, as mosquitoes bred in puddles, ponds and trash. Local slang for fever is “malaria;” refugees fear fever or headache is its first sign, and often buy malaria medications even if they are unprescribed by the hospital or clinic. This puts the camps at risk for resistant infections, though a new medication combination used now still works well.


Older Americans remember the measles: sore, light-sensitive red eyes, pink skin blotches, high fevers and runny noses. We saw several measles cases per week in Hagadera, often in poor Kenyans from the bush. Most seriously ill were adults, but sometimes children couldn’t swallow and were fed through tubes.

Measles cases are given Vitamin A, because studies show it lowers the death rate. Vitamin A deficiency is common among refugees, who are not given vegetables. Though their oil ration is fortified, Somalis use it only for cooking, which destroys the vitamin. It is hard to grow anything in the dry soil, and few can afford imported greens.


An outbreak of painful, bloody urination got so bad the hospital laboratory complained they were being given too many urine samples. Though the unusually severe floods had ended, the camel watering area had remained a much larger than usual, a lovely adventure for the young boys to explore.

Unfortunately, wild birds and snails bred a parasite in the water that infected the boys with schistosomiasis (shist-oh-some-eye-as-is). Fortunately there is medication for this, for without treatment they would have lifelong pain, as well as high risk of bladder cancer.


AIDS has been a plague in Africa for years. In Kenya, 15 percent of the population have the virus. The epidemic is just starting in Somalia and the refugee camps. Strict morality codes and limited transportation have kept the disease confined. There were twenty-four confirmed known cases in the camp population of about 170,000.

True numbers are unknown, however, since many patients fear disclosure. Voluntary prenatal screening picked up four cases last year, but the mothers refused to allow their husbands to be told.

They did not take preventive medication that would have kept the babies from getting AIDS because they feared being caught with it, thus being exposed.


A patient with severe diarrhea required eight quarts of intravenous fluid in 12 hours, in addition to drinking. She could do little but lie with her bottom over a one-foot hole in her bed, over a bucket catching fluid running out of her.

We heard cholera had arrived at a nearby border town in Somalia. While we waited for the test to confirm this case as cholera, we prepared for an epidemic. Cholera can kill in hours and spread rapidly in unhygienic conditions.

Planning was hampered by a tight budget. Refugee health does not attract many private donations right now, unlike AIDS. Many countries, the United States included, failed in their commitments to fund the United Nations. This caused delays in replacing overflowing latrines, building new latrines for arriving refugees, and drilling for clean water.

By the time I left, we had treated 24 cholera cases during three weeks of relatively dry weather. When the rains fully arrived (which can cause latrine flooding) 16 cases arrived daily at the hospitals.


One morning, while waiting in our four-wheel drive ambulance to transport our staff to the hospital behind our protective police escort, my foot felt odd. Something was moving against my sock.

I leapt out, yanking off my shoe. “There’s a cricket in my shoe!”

The rains brought a cricket infestation. Mealtimes in the open air canteen became unbearable – it became necessary to inspect your water glass before each sip, as crickets jumped at all body parts, including under dresses, women’s hijabs and men’s sarongs.

Working on a computer at night was difficult because of hard little objects flying at the bright screen. A cricket jumped into my armpit once as I typed. Mosquito nets protected us during sleep – but failing to tuck them in, or opening them for a breeze, were sure to trigger a cricket onslaught.