Surviving Dadaab

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In Kenya, hundreds of thousands of Somali, Rwandan and Sudanese refugees are fighting for their lives, lacking food, medicine or clean water and ignored by the world

The Dadaab refugee camps has been called “the forgotten emergencies of 16 years.”

During intense civil war in Somalia in the 1990s, refugees streamed across the Somali border into northeast Kenya to seek protection in this dry, arid land occupied by nomadic ethnic Somalis. International aid poured in and three hut cities camps – Hagadera, Dagahaley, and Ifo – were set up around the tiny village of Dadaab.

Engineers bored holes for wells, piped water to communal taps and built one latrine for every 15 people, shaded structures for refugees waiting for food, and temporary rough-cut buildings for hospitals, clinics and schools. What started as 35,000 swelled to 135,000 refugees living in the Dadaab camps by 2005.

Repression by the now-deposed Islamic Courts Government, followed by the Ethiopian invasion of Somalia, has today raised the numbers to an estimated 170,000 – and more are coming, slipping across the vast desert, even though Kenya has closed its border. Meanwhile, funding and international interest dwindles.

Médecins sans Frontires (Doctors without Borders) left years ago. The United Nations High Commissioner for Refugees then arranged for the agency I volunteered with, the German Technical Organization, to manage medical care. Infrastructure in the camps is crumbling and conditions for aid workers are frustrating and inefficient.

As several Kenyan health care workers said to me, “This is worse than working in the bush. I feel like I’m doing quack medicine.”

War in Somalia came as close as 50 miles to the camps. Young men came to the clinics everyday with maimed, amputated, painful or paralyzed limbs from old gunshot wounds.

Most medical records are the responsibility of the patient and are usually tattered cards with scribbled handwriting. Prescriptions and laboratory requests are manufactured out of scrounged scrap paper.

Due to a shortage of urine specimen cups, pregnant mothers rewash their sample bottles, and old medication bottles are also used to collect samples. Two hospital wards share one faucet. There is often no soap.

There is no oxygen, except in one central operating room more than five sandy miles from the three hospitals. The anesthesia machine is old and the gases hard to calculate and measure due to the heat. The air conditioner is broken.

The drug list created sixteen years ago for emergency medical needs has not changed much. Essential medicines for heart problems – nitroglycerin, morphine, and hydrochlorothiazide – are missing.

About once a month certain antibiotics, seizure medicines or insulin run out.

Obtaining advanced medical care for patients is slow and unpredictable. A middle-aged father was admitted with advanced prostate cancer in his spine; screenings might have picked it up at an earlier stage. I was heartbroken to find the next day he was paralyzed from the waist down.

He would live the rest of his short life bedridden as a cripple.

One day an eight-year-old girl, run over by a machine gun-mounted truck in a skirmish, laid stoically with blood oozing from one ear. Pieces of cardboard box lined with cotton were taped as a splint for her fractured thigh bone.

Mission-based volunteer surgeons, who come to the camp hospitals several times a year, like to repair cleft palates and congenital heart disease in children.

In contrast, I saw several young adults who will die from rheumatic heart disease. Despite being parents of young children, they will not receive the relatively simple cardiac surgery that could help them.

Even if families can somehow raise money to pay for private care, refugees are confined to camp medical facilities unless referred or given a special travel document by the UNHCR. Sometimes they steal or borrow a Kenyan identity card and go to Nairobi where they obtain private medical care.

A colleague treated a 17-year-old boy who left his mother and home last month to volunteer in the Islamic Courts militia. He returned with sniper fire cleanly through both of his eyes. Though miraculously still alive, he was blind and his eye sockets oozed and wept.

Hagadera Hospital serves a population about the size of Lewiston, yet I was the only doctor. Fortunately, the nurses and clinical officers (similar to physician assistants) are considered “qualified staff” and do much of the first line work. They are well trained, professional and committed, though overworked.

I have great respect for the staff doctors, who perform surgery and obstetrics as well as general medical care. They were surprised to hear that, like most American family physicians (an unknown specialty in Kenya), I had not assisted in surgery for years – nor had I performed a cesarean section or appendectomy, which they do routinely.

I had to re-learn maternity care from them as it’s practiced in the bush, without fetal monitors or even oxygen.

Maternal health is one of the biggest culture clashes. Birth attendants (lay midwives), themselves refugees, perform the majority of the deliveries, of which 70 percent occur at home. Patients complain the hospital is too hot, public, and inconvenient and that travel to it is dangerous.

Indeed the heat forces some patients outside to sleep, and male nurses and male clinical officers to wander in and out of the open ward. Taking a donkey cart to the hospital costs money and is a rough ride for a woman in labor, plus it provides little security at night along the dark lanes.

A pregnant mother is allowed by authorities to cross the border for medical care. By the time she reaches us she has been in hard labor for five days. The baby is born by C-section, miraculously alive.

There were times I felt as if living in a desert scene from a science-fiction movie, because of the myriad human and non-human creatures different colors and body types. They ranged from tall, thin Somalis with bronze skin and straight noses and guttural, staccato speech, to short, sturdy, dark, thick-lipped Kenyans with undulating measured speech patterns, to the occasional pale, caucasian misfit “expatriate” European worker.

There were also veiled women in colorful flowing robes, boys with switches driving goats, fatty-rear pouched sheep, gangly Marabou storks eating garbage, glossy blue and red starlings, iridescent peach and green bee-eaters, red sand for miles, thorn trees, and, of course, single-humped camels.

A well-educated 45-year-old man brought empty boxes of heart failure medicines – he is unable to afford a new supply since he fled to Hagadera. The hospital had little free medicine to give him.

The Dadaab camps are like their people; patched up, making do and struggling. These “forgotten emergencies of sixteen years” are still absent from the news despite the recurrence of vicious fighting in Somalia. A city’s worth of people is confined to concentration camps, dependent on inadequate donated food, water, sanitation and health care.

Their Somali relatives, fleeing violence, are no longer legally able to cross the border to join them for asylum. International disinterest and a global resistance to immigration have created a fourth world of permanent refugee camps, such as Dadaab. Complicating matters are 40-year-old border tensions between Kenya and Somalia and the fear of fundamentalist Muslim terrorists.

Whatever the excuse or cause, Dadaab and its people are survivors.

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Dr. Alice Chartrand Haines and her husband, Prof. David Haines of Bates College, recently spent two months in northeast Kenya working with Somali, Ethiopian and Sudanese refugees. She lives in Auburn.

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