Shame of cholera crisis in Kenya’s refugee camps

Hagadera Camp

Hagadera Refugee Camp in Garissa County on July 23, 2023. In this camp alone, two deaths have been recorded and 3,000 people have tested positive for cholera.

Photo credit: Adrams Mulama | Nation Media Group

Within the Hagadera Refugee Camp, amidst makeshift shelters scattered across the landscape, a cemetery stands, laden with sorrowful stories of loved ones that need not have died.

The sacred place holds many memories for Abdullahi Ali, this is where he buried his firstborn son last year who died of cholera during an outbreak in Hagadera Refugee Camp, which he and his family call home.

The three-year-old is one of the over 200 Kenyans who lost their lives to a disease that infected about 12,000 people in the country.

Cholera was first recorded in October of last year. In Hagadera Camp alone, about two deaths were recorded, and 3,000 people tested positive for cholera.

“Within two hours I had lost my son. It started in the middle of the night when my son woke up crying. He had on-and-off diarrhoea. We slept, and in the morning, I rushed him to the L6 health post, only to be pronounced dead on arrival,” Mr Ali said.

This waterborne illness is often linked to unhygienic conditions, a significant worry for those already struggling with displacement. Hygiene is lacking at the camp, and many here share inadequate toilets.

Mr Ali says that they collect water from a water point, but it is never sufficient.

“Additionally, some individuals in our community lack toilets, which forces them to make do with what's available. As a result, some people are even compelled to relieve themselves in open spaces,” he added.

Mr Ali fled violence and conflict in Somalia and sought refuge here.However, the challenges he and his family faces have intensified due to food rationing, overcrowding, inadequate clean water and sanitation facilities, and limited healthcare resources. These conditions have created a breeding ground for diseases such as cholera, measles, and typhoid.

“Life is indeed a struggle. I escaped war, but now I’m inside a breeding ground for disease. This cost me my son,” he said.

According to Mr Reuben Nyaora, the head of the reproductive and community health program at the International Rescue Committee, the limited availability of clean water and proper sanitation in the camp makes the rapid spread of cholera inevitable.

"The recent outbreak claimed two lives and infected many, regardless of age. Numerous individuals came into the camp from the Somali border without being screened or recorded, making it difficult to detect potential infections. This lack of proper screening has resulted in many people entering with various infections, leading to frequent outbreaks," explained Mr Nyaora.

As more refugees stream into the camp, the limited resources such as water and toilets have been pushed to their maximum capacity. Three per cent of the population at this camp lacks proper toilet facilities and resorts to open defecation, while 85 per cent of the population uses shared latrines.

Cholera, a bacterial infection caused by ingesting contaminated food or water, leads to severe dehydration and can be fatal within hours if left untreated.

"If you are in an area without access to water, there is a risk of consuming unwashed food and eating without cleaning your hands. This can result in the ingestion of faecal matter," Mr Nyaora said.

According to recent World Health Organisation (WHO) report, Kenya was among the top five countries in Africa with the highest number of cholera infections. The country’s case fatality ratio stood at 1.8 per cent.

The cholera outbreak, says Hassan Maiyaki, country director, Doctors without Borders (MSF), in Kenya, is linked to reduction in essential water and sanitation activities including providing clean water, distributing soap, constructing and repairing latrines, and organising waste management. Experts have raised concern that the disease outbreak in this modern era is an indictment of the government for lack of commitment to contain preventable diseases.

Researchers who published their work in the International Journal of Public Health warned that neglecting cholera prevention services, especially in areas with poor sanitation and hygiene, was a ticking time bomb.

Dr Catherine Gathu, clinical assistant Professor, Department of Family Medicine, Aga Khan University Medical College, East Africa, said poor and unreliable water supply and worsening socioeconomic conditions precipitate the situation.

“Community sensitisation is needed. Head knowledge must be followed with practical application. Operationalising the knowledge into practices like hand hygiene and proper faecal waste disposal is key in preventing the spread of the disease,” Dr Gathu, adding that water should be boiled before drinking, and since contamination via food is common, all food and fruits should be washed with clean water.

Dr Gathu said Kenyans should use the mantra: Boil it, Cook it, Peel it, or forget it! Modifying human behaviour, she points out, is not easy, but can be done through community outreach programmes.

“Personal hygiene and responsibility should be emphasised as an intervention in controlling the spread of cholera. Ultimately, the cholera outbreak must be given a front seat in our conversations for us to eradicate it once and for all,” she emphasised.

Dr Ojwang Lusi, a public health expert, says the country needs to start educating Kenyans on the risk that comes with the disease and how fatal it is.

“All we need to do is start educating people on the risk that comes with poor handling of food, they also need to observe hygiene by boiling water before drinking. With the drought that has hit the country, water is scarce and people are consuming dirty water. We may record more cases,” Dr Lusi warns, observing that public health awareness seems to have been neglected in the country.

“Kenya needs to strengthen its health care system to effectively respond to cholera outbreaks,” said Ms Carol Wainaina, a research officer at the African Population Health Research Centre.

“Cholera is treatable, and more importantly, preventable, however, on several occasions, Kenya’s health system has not been well-prepared to respond to outbreaks. This has included failure to identify and trace people who have the disease, as well as reporting and management of suspected cases,” said Ms Wainana, adding that epidemics can escalate quickly in countries where health systems are weak.

“The Ebola emergency in West Africa is a case in point,” she says.

Dr Lukoye Atwoli, an Associate Professor of Psychiatry and Moi University School of Medicine Dean, said a cholera outbreak is a sign that Nairobi’s waste disposal system is inefficient, leading to human waste mixing with water and food.

“In public health, a cholera epidemic says a lot about an organisation and the effectiveness of the health system than any sophisticated monitoring and evaluation assessment could uncover,” said Dr Atwoli.

“In a modern, open and democratic society, such as we aspire to become, citizens should not countenance any excuses for repeated epidemics of a disease that can only be transmitted through the mixture of human waste and drinking water.”