KENYA: A growing refugee crisis

Photo: Allan Gichigi/IRIN

A refugee woman awaits registration in Dadaab, Kenya (file phto): Fears of a major refugee crisis in Daadab have been raised with the camp hosting triple its capacity

NAIROBI, 19 June 2009 (IRIN) - Ever-worsening security in Somalia is prompting large numbers of civilians to flee into Kenya, where facilities to host them are stretched to bursting point, raising fears of a major refugee crisis.

Dadaab in eastern Kenya, is home to an estimated 279,000 mainly Somali refugees - triple its designated capacity. Its Dagahaley, Hagadera and Ifo camps together comprise the largest refugee site in the world.

Kenya's closure of its Somali border in January 2007 did little to stem the tide. "On average, about 7,000 Somali refugees are coming into the country every month this year," Kellie Leeson, International Rescue Committee (IRC) country director for Kenya, told IRIN.

"We need more land for Dadaab to spread the camp out so that people can live in dignity," she said. The UN Refugee Agency (UNCHR) is talking with the Kenyan government in an effort to obtain more land.

IRC is providing healthcare services in Dadaab as well as water and sanitation services in Kakuma camp, northwestern Kenya.

"The high [refugee] population has made it extremely challenging to deliver services," Leeson said. "Water has been a really big challenge as well as provision of adequate latrines."

Overcrowding

"The overcrowding [in Dadaab] means that international standards for basic services are not being met," according to Refugees International.

"There is a shortfall of 36,000 latrines and 50 percent of the refugees have access to less than 13 litres of water per day," the NGO said in recent special report on Somali refugees.

The agency went on to appeal for the reopening of a reception centre for Somali refugees shut by the Kenyan authorities in May 2008. "This will ensure an orderly and humane screening and registration process, while having the added benefit for the Kenyan government of reducing cross-border security threats."

On this point Leeson said: "Health screening at a border reception centre is needed in order to prevent the spread of disease inside the congested camps."

In March, Human Rights Watch (HRW) warned that Kenya was in the midst of a rapidly escalating refugee crisis.

Between August 2008 and the end of February 2009, "just over 35,000 new arrivals [in Dadaab] received no shelter and have been forced to sleep under open skies in makeshift shelters that provide little protection from the harsh weather, or in cramped confines with relatives or strangers who were already living in conditions well below minimum humanitarian standards," HRW said.

Soured relations

Relations with the surrounding Kenyan population have also at times soured. "The host community is struggling especially with the high food prices and drought," Leeson said. IRC, along with UNHCR, and other partners, is working with local community leaders in an effort to prevent conflict in Dadaab and Kakuma.

The local community neighbouring Dadaab has in the past resisted the expansion of the camp boundaries, saying it is already encroaching on their land.

In Kakuma, most of the refugees are of Somali origin, coming either via Dadaab or Nairobi. Its population has almost halved since 2006 due to the large scale repatriation of its Sudanese population in the wake of a 2005 peace accord.

"Now there are about 42,000 refugees remaining in the camp, who can't yet return home, and are fully dependent on [external support]," she said.

"A lot of people thought Kakuma would just go [away]," she said, "But the numbers of refugees are still high and we must meet their urgent needs."

Dependency

A statement by the Jesuit Refugee Service (JRS) said: "Ten percent of the refugees in Kakuma have lived in the camp for over 10 years, some longer than 15 with no perspective and no hope of a durable solution. This causes dependency and problems with the local community."

According to JRS, societies and governments tend to perceive refugees as a problem. "But, we need to see that behind the large numbers are human beings like you and me. They have been uprooted from their countries by conflict, persecution or violence," said Frido Pflueger, JRS/Eastern Africa director.

IRC's Leeson urged the Kenyan government to also fully implement its own Refugees' Act of 2006. "On paper, the act gives rights to refugees, but in practice it is not yet fully enforced and many people in positions of authority aren't aware of its content or the rights it confers," she said. "We also urgently need extended funds as the [refugee] population continues to grow," she said.

GLOBAL: Chronic diseases reach "epidemic" proportions - WHO

Photo: IRIN

Samjhana Lama from Nepal died from heart disease after treatment delays (file photo)

DAKAR, 19 June 2009 (IRIN) -

Chronic diseases-especially cancer, diabetes, and chronic respiratory and heart diseases - kill twice as many people worldwide every year than do infectious diseases HIV, malaria and tuberculosis, combined. But despite their stealth ascent to epidemic proportions - mostly in poor countries, according to World Health Organization (WHO) - chronic diseases receive scant donor and government attention.

Chronic diseases like diabetes and heart disease progress slowly and account for 60 percent of all deaths, according to WHO.

"It [chronic disease] is a silent killer," said WHO's Boureima H. Sambo, non-communicable disease (NCD) advisor for West Africa. "For other epidemics like measles, meningitis or cholera, you see and hear people dying. But in a hospital ward of dying chronic respiratory, hypertension and cancer patients, there is not as much noise," he told IRIN.

Less than 1 percent of official development assistance funds chronic disease prevention and treatment, according to the Organisation for Economic Cooperation and Development (OECD). From WHO's overall 2008-2009 budget of US$3.9 billion, 13 percent went toward chronic diseases.

Major donor funding for chronic diseases has increased since 2004 when it was less than US$200 million to US$700 million in 2008, according to OECD.

But funding still lags far behind the numbers of deaths caused by chronic illnesses, as reported in the medical journal "The Lancet". HIV prevention and care received US$2.5 billion from major donors in 2005 when there were less than five million reported HIV deaths.

While more than 25 million died from chronic diseases the same year, donors gave US$200 million toward NCD's.

Double burden

Africa is expected to have the biggest increase in deaths from NCD's over the next decade, or an additional 28 million sufferers, according to WHO. "The emphasis thus far [in Africa] has been on infectious diseases," Boureima told IRIN. "But we have a growing burden of NCD alongside the known burden of communicable [infectious] diseases."

Hypertension and obesity affected up to 60 percent of those surveyed in West Africa by WHO, said Boureima. "Children as young as 12 are smoking, some parts of the region abuse alcohol and vegetable consumption is low. Risk factors of today are chronic diseases of tomorrow," he told IRIN.

Despite dozens of resolutions at WHO to fight chronic disease dating back more than 60 years, Stig Pramming with the UK-based NGO Oxford Health Alliance told IRIN chronic illness is still not "on the [international development] agenda."

Recommendations from a UN-organized ministerial meeting in Doha, Qatar in May on NCDs will be considered at the UN Economic and Social Council (ECOSOC) 7 July meeting in Geneva. WHO is working with governments to incorporate chronic diseases into the UN Millennium Development Goals, according to WHO NCD staff.

How much?

While the cost of chronic diseases has been estimated to be in the hundreds of billions in lost income and health fees, it is hard to put a price tag on fighting those diseases, said Oxford Health Alliance's Pramming. "Chronic diseases are a complex problem not solved through a simple treatment. It is the way we eat, move. It is our lifestyle and social determinants like access to health care and [quality of] those health systems.

"Health care systems are very much focused on acute diseases and are not geared to follow people over the long term."

SOMALIA: Coping with humanitarian tragedy in Mogadishu

Photo: Yasmin Omar/IRIN Radio

A man with his child in a Mogadishu hospital: Fighting between insurgents and government troops has resulted in deaths, injuries and displacements of hundreds of thousands of civilians in the city - File photo

MOGADISHU, 5 June 2009 (IRIN) - A woman sits holding a baby in a queue at a medical clinic in Mogadishu, the violence-hit capital of Somalia, where fighting between government troops and insurgents has displaced hundreds of thousands of people.

"His leg is paralysed; maybe because we don't have anything to eat," the young mother says.

More than 100 people are waiting in the burning sun. Some will be here for hours, but there is no alternative. The few hospitals in the city are overcrowded, and the remaining civilians have to go to great lengths to find help.

The clinic is run by AMISOM, the African Union peace-keeping force in Somalia.

"At least we can do something," says Joseph Asea, head of the AMISOM health clinic in Mogadishu. "We have 30 patients now, but when fighting is bad there can easily be 70."

An ambulance arrives. A boy with an improvised bandage around his elbow is carried in. The nurse takes it off to reveal a fresh gunshot wound. She treats it with disinfectant.

He is lucky to be alive; over the past few weeks, hundreds of people have died in the fighting.

The people in the clinic are relatively safe and treatment is still available. "So far, we are able to supply the people with treatment and medicines," Asea said.

Photo: Hassan Mahamud Ahmed/IRIN An ambulance driver in Mogadishu: The few hospitals in teh Somali capital are overcrowded and civilians have to go to great lengths to find help

Access issues

According to the UN Refugee Agency, UNHCR, at least 96,000 people have been displaced from Mogadishu since the start of the latest fighting on 8 May.

Most are in informal camps outside the city, with hardly any access to humanitarian aid.

"The situation is deteriorating and the daily rate of displacement is increasing," said Roberta Russo, spokeswoman for UNHCR Somalia.

She said the rate of new arrivals this week from Somalia to Kenya "went from an average of 100 a day to 150-200 a day".

Russo said access was still one of the major problems faced by humanitarian agencies trying to bring relief to the displaced.

This week UNHCR had to stop distributing aid to the outskirts of Mogadishu because of the fighting and consequent insecurity on the roads.

Food and security

AMISOM patrols some of the roads to monitor security. AMISOM troops also protect the port of Mogadishu where the UN World Food Programme (WFP) is dispatching much-needed food aid.

At the main berth, the cargo of MV Jaipur is being offloaded. It was hijacked by Somali pirates, but is now on duty again. From here, the food aid will be distributed across the country. Some three million people in Somalia depend on food aid.

"Without the protection of AMISOM we couldn't do this work," says Abdi Yusuf, a government police officer in the port.

The AMISOM peacekeepers also protect President Sheik Sharif Ahmed at Villa Somalia in Mogadishu, a multi-storey building in the heart of town.

"I feel very safe here," the president said, but he called for more international help for his country. "We have an influx of foreign fighters who support the insurgents. If they manage to take over, it's easy to imagine what can happen next. So we are urging the international community to do more."

A first step could be boosting AMISOM numbers. From the initially pledged 8,000 soldiers, only 3,400 were deployed by African Union countries.

"So far we could deliver the services to the people that we want to," said Maj Ba-Hoku Barigye, AMISOM spokesman. "Happily we understand that Ghana, Zambia and Malawi are close to contributing to the force."

The UN Security Council's unanimous decision to extend the mandate of AMISOM by another eight months could provide some breathing space.