Eyes on Kenya

The impact of the post election crisis on the Kenyan Health system is devastating. In the past years the Kenyan Health system has made some great progress in the prevention and treatment of Malaria, Tuberculosis and HIV / AIDS. Now Kenya is facing several tremendous set backs.

First of all the system has to handle the primary crises: Sever injured people needed treatment. Displaced persons have to gather in camps and challenge the local health system. In those camps people live close together and steps have to be taken to prevent the out break of epidemics.

Violence against women has always been a problem in Kenya. But in the past month the number of reported rapes has exploded. Most cases were reported in hospitals from women who needed immediate physical treatment. The real number of rapes has been much higher, since many women do not report any attacks. Women are not only left with a sever trauma, which would require experienced support. Also the risk of suffering from an STD, in the worst cases from HIV is burdening those women.

With the help of donors and a the great effort of Kenyan Health workers, Antiretroviral treamtent (ART) has been implemented even in rural areas. This is even under normal conditions a great challenge. People on ART can not stop to take the drugs, in order to prevent drug resistance. So drug supply should never run short. With the crisis all over the country it becomes a problem. And keeping up the treatment for the displaced persons seems to be almost impossible. The long term effect is an increase of drug resistance, which can lead to severe health problems, as well as it requires much more expensive drugs, which become for some patience unaffordable. The drug resistant virus can also be transmitted, causing the failure of normal treatment regimes in new patients.

The treatment of HIV/AIDS is only possible with well trained medical staff. Especially in the health professions work migration with in the country is high. With violence along ethnic lines many health works were effected and are now displaced. Other will refuse to go into certain areas in the future. With the ongoing crises well trained medical staff will look for other options abroad. People with experience in HIV /AIDS treatment are needed all over Africa, some jobs are well paid through international organisations. And it becomes more interesting to look for options in industrial nations, e.g. the United Kingdom. The “brain drain” will add to the negative long term effect on Kenya’s health system.

The UN Office for the Coordination of Humanitarian Affairs (IRIN) has summarized the situation:

Healthcare threatened by political crisis

NAIROBI, 7 February 2008 (IRIN) – Health officials are concerned about the long-term impact of Kenya’s political crisis on healthcare, especially in areas hardest hit by violence since the end of December 2007.

“The most worrying issue is that of drug resistance among patients of chronic diseases,” Ian van Engelgem, the medical coordinator of Médecins Sans Frontières (MSF), told IRIN on 5 February.

He said HIV and Tuberculosis (TB) patients who had missed out on their regular medication for up to a month due to displacement and violence could develop resistance to the drugs.

“Right now a lot of HIV patients are on first-line drugs; they could require second-line drugs, which are more expensive, if they develop resistance as a result of skipping their ARV [anti-retroviral] medication for a period of time,” Van Engelgem said.

The fact that internally displaced persons (IDPs) have better access to healthcare compared with the host community where the camps are located is another concern.

“If IDPs have access to free healthcare, the same should also apply to them [host communities] as they are equally affected by the unrest,” Van Engelgem said.

Displaced health workers

Joanne Greenfield, malaria adviser for the UN World Health Organization (WHO) in Nairobi, said displacement and ongoing violence in parts of the country could lead to a crisis in the provision of healthcare in the affected regions.

“The security situation, especially in the Rift Valley [Province], is affecting the provision of health services to the general public as a significant number of health workers are either displaced and/or cannot report to their duty stations,” Greenfield said.

WHO, the lead agency for the health cluster of humanitarian actors – comprising UN agencies, NGOs and government organisations – has also expressed concern over the health of thousands of IDPs, mostly women and children, in the Rift Valley.

On 6 February, newspaper reports indicated that chicken pox and diarrhoea had broken out in two IDP camps in Naivasha, a town in Rift Valley Province, which has been severely affected by the violence.

“The number of sites hosting IDPs appears to increase by the day,” the agency said in a statement. “Initial WHO assessment has found that these sites are very crowded, with poor shelter, water supply, sanitation (in some camps, toilet to person ratio is 1 for 500), food shortages, no cooking fuel, precarious access to healthcare and shortages of antibiotics, children’s medicines, malaria medicines and life-saving drugs for chronic illness. Nearby hospitals are also facing similar shortages of drugs and supplies.”

Sexual violence
In a worrying development, WHO said, hospitals in the region had reported dramatic increases in cases of sexual violence. The agency said counselling services in most IDP sites were not available, including for reproductive health, sexual violence or HIV/AIDS.

“In many settings, survivors have no access to even the minimum health and psychological support, leaving them vulnerable to a range of potential negative health problems, including HIV/AIDS,” WHO stated.

George Mugenya, the medical superintendent of health at the Rift Valley General Provincial Hospital in Nakuru, said services were slowly returning to normal but the displacement remained a key concern.

“When the violence was intense, we put elective cases on hold to handle only emergency cases; now that it is calmer, we are noticing that some services are still affected because of the displacement of some of the medical staff,” he said. “Some workers have not reported to duty while others come irregularly and this has affected services such as those offered in the maternity section but, overall, things are returning to normal.”

He said the challenge was in re-stocking the hospital’s medical supplies and reviving clinic services for patients of chronic diseases.

Teams led by WHO officials visited the towns of Eldoret and Nakuru to coordinate the health cluster activities. The teams visited IDP camps and hospitals to monitor disease outbreaks as well as the availability of medical supplies and health workers.

According to WHO, the biggest worry at all sites was diarrhoea in children as well as acute respiratory infections. It was also concerned about irregular access to malaria, HIV/AIDS and TB medicines, while patients with asthma, hypertension and diabetes also lacked access.

Kenya’s Ministry of Health, together with WHO, the UN Children’s Fund (UNICEF), the Kenya Red Cross Society and other health NGOs, undertook a joint health assessment on 30 January of Uasin Gishu district in the Rift Valley, which is hosting 150,000 IDPs in 11 camps.

As a result, the medical officer reported that a mass immunisation against measles and polio, as well as the de-worming of children and provision of Vitamin A supplements, would begin in February.

The health officials also discussed the possibility of introducing mobile services for areas where normal services had been disrupted.

The following text is a statement by the Kenyan Women’s Consultation Group on the Current Crisis in Kenya. For more than two weeks Kenyan women from several Organizations met and discussed the current crisis and approaches to end it. Action Aid International, Vital Voices, UNIFEM, Nairobi Peace Initiative and Urgent Action Fund-Africa facilitated the consultations. The statement was presented to the international mediation team including, Kofi Annan, Graça Machel and Benjamin Mkapa at Serena Hotel Nairobi on January 25, 2008.

The statement has been published before, for example at Pambazuka News.

Since we think it is a very valuable statement, we have decided to quote it in full length:

Women’s Memorandum to the Mediation Team

Serena Hotel, Nairobi, January 25, 2008

Kenyan Women’s Consultation Group on the Current Crisis in Kenya (2008-01-29)

Your Excellency Kofi Annan
Your Excellency Graça Machel
Your Excellency Benjamin Mkapa

We thank Your Excellencies for the opportunity to address this forum. We make this presentation on behalf of Kenyan women who have been meeting in Nairobi over the last two weeks. Action Aid International, Vital Voices, UNIFEM, Nairobi Peace Initiative and Urgent Action Fund-Africa have facilitated the consultations. A committee of 11 women present here, represents the larger group.

Kenyan women assert their rights as citizens of this country to participate in all political processes and initiatives that seek to find solutions to the crisis that currently that our beloved motherland faces. We are mindful of our special responsibilities in all the spheres of nation building including truth & justice seeking, peacebuilding and reconciliation. We embrace all our diversities as we collectively seek solutions. We acknowledge that in the resolution of the current conflict, there has to be ‘give and take’ from both sides of the political divide. We assert that as citizens we must take responsibility for resolving and transforming the conflict and the inclusion and participation of civic groups, including women’s groups at the community level is critical to the success of efforts to resolve the conflict.

The important role of women’s participation in the prevention and resolution of conflicts is reaffirmed in The Constitutive Act of the African Union, The AU’s Solemn Declaration on Gender Equality, The Protocol to the African Charter on the Rights of women in Africa, The African Charter on the Rights and welfare often Child, and by United Nations Security Council Resolution 1325. The resolution stresses the importance of women’s equal participation and involvement in all efforts for the maintenance and promotion of peace and security, and the need to increase their role in decision –making with regard to conflict prevention.

The UN Resolution 1325 further calls on all actors involved, when negotiating and implementing peace agreements, to adopt a gender perspective, including, inter alia

a) The special needs of women and girls during repatriation and resettlement and for rehabilitation, reintegration and post conflict reconstruction.
b) Measures that support local women’s peace initiatives and indigenous processes for conflict resolution, and that involve women in all of the implementation mechanisms of the peace process.
c) Measures that ensure the protection of and respect for human rights of women and girls, particularly as they relate to the constitution, the electoral system, the police and the judiciary;
All these instruments recognise the centrality of women to the development of democracy and democratic institutions and the importance of their participation at every level, and in every process. Women are central actors and ‘right holders’ in any process that addresses sustainable development, security and human rights. During this crisis, Kenyan women have been at the forefront in community peace building and mediation efforts in the North Rift and other areas.

(c) by Gado

Is there a conflict? What are The Facts?

A political crisis has engulfed the country following the announcement of presidential results on December 30, 2007.There are allegations of a flawed tallying process by the electoral commission , hence the dispute as to who the actual winner of the presidential vote was. As a consequence, violent conflict broke out in many parts of Kenya from December 30, 2008 and continues to this day. This conflict is expressed in the following ways:
1. Spontaneous and organised demonstrations against the ECK and the government.
2. Killings that have so far claimed the lives of over 700 Kenyans. These killings are by a) extra judicial executions by the police of targeted communities and demonstrators. b) Militia executions, torture and mutilations of civilians targeted at particular ethnic communities (these include forced circumcisions & castrations) and c) by ordinary citizens
3. Criminal conduct by citizens looting, burning and destruction of private and public property.
4. Increased sexual violence against women and children.
5. Suspension of constitutional freedoms including the freedom of conscience, assembly and worship.
6. Violation on the rights of the media and right to information by a ban on media broadcasting of live events.
7. Ethnic and politically instigated evictions of populations of certain communities from their properties resulting in large numbers of internally displaced Kenyans ( approximately 260,000)
8. Ethnically instigated employment displacement of workers in certain regions (tea peckers in Kericho) and eviction rental properties.
This situation has resulted in:
- A breakdown in the rule of law and a lack of confidence in institutions of law and order.
- Breakdown of social relationships and trust among Kenyan Communities and an exacerbation of existing ethnic tensions.
- Human insecurity (including food insecurity).
- Continued systematic and widespread violation of human rights and a lack of respect for the sanctity of life.
- Proliferation of propaganda by all parties including the state and an increase in hate media on all media (FM stations -in particular vernacular FM stations, print, electronic and new media -text messaging, email, internet) that demonises particular communities.
(more…)

Looking at the current outbreak of violence in Kenya, and thinking about who knows how to end the violence, one should consider that Kenya has two Nobel Peace Price winners.

One is the well known founder of the Green Belt Movement- Prof. Wangari Maathai. She wrote a comment in the Guardian today titled “Time to show greatness”. After explaining the background of the previous election, the disappointment in the fight for a constitution, she calls upon the civil society of Kenya:

“Even as political leaders play their role, citizens should refrain from violence. All 42 communities in Kenya are bound by geography and history to live as neighbours. Killing, destroying property and displacing our brothers and sisters creates a legacy that will haunt our children and their children. Let us stand up for each other, irrespective of our ethnic backgrounds and political persuasions. Injustice to one is injustice to all of us. If we, individually and collectively, are not the conscience of our country, then who is?”

The other Kenyan nobel peace prize winner is the Dekha Ibrahim Abdi, winner of the 2007 Alternative Nobel Peace Price, a prize given out to honour those “working on practical and exemplary solutions to the most urgent challenges facing the world today”. The Jury commended her “for showing in diverse ethnic and cultural situations how religious and other differences can be reconciled even after violent conflict, and knitted together through a cooperative process that leads to peace and development“. Dekha Abdi’s knowledge and work is most important for Kenya now, more than ever. She showed that it is possible to restore peace. It is a slow process and it takes a lot of patience, nevertheless it is possible. You only wished people would have listen to what is a true Kenyan heroines.

Another brave Kenyan woman is the human rights activist Gladwell Otieno. She read a manifest from several activists at the Grand Regency Hotel in Nairobi on Saturday. She stated 11 demands, among them preparation for a new election, asking foreign governments not to acknowledge Kibaki as a President and not to give out visas to members of the government or their families, in order to prevent them from running away with State money. Gladwell Otieno became famous by fighting corruption and naming names of those with big off-shore accounts. She was pushed to resign as the as executive director of Transparency International (Kenya) by leading members of TI Kenya, who had close bonds with the Kibaki administration (truly one of the darkest chapters of TI’s history.)

It would be easy to continue with this list of Kenyan women having the courage and knowledge to improve the situation in Kenya and it sure is not the lack of trying that prevents their ideas from succeeding.

In almost every violent conflict, women suffer most. It was no surprise that most people killed in the church in Eldoret were women and children. Violation of women’s rights has been a huge problem even in times of peace in Kenya. Within this current conflict situation, rape is being used as weapon, one that destroys women’s lives and their families.

It is of importance that these atrocities towards women are not only attributed to the times of conflict, but to be mapped as they occur and not forgotten and charges brought against those that committed them. There, for instance, has been little coverage of the pre-election violence against women.

The number of women running for Parliament was as big as never, but only a little bit more than a dozen women were elected, less than in the last election. Even two weeks before the election the TV Station Al-Jazeera reported at least 255 cases of assaults against women in connection with the election campaign, leading to exactly 0 charges. (This fact alone is reason enough not to call this election fair.)

Al-Jazeera about violence against Female Candidates during the election campaign aired on the 14th of December 2007

One of the reasons for this violence against female politicians is the persistence of an extremely patriarchal political system since the independence. The system of men (old) taking over power from even older men who are not ready for change (Kenyatta was succeeded by his Vice president Moi, Moi by his Vice president Kibaki, e.t.c) Odinga, who wants to break this monotony and promises change is a serious threat to the seemingly established system. With truly democratic elections the leadership of old men has a lot to lose with more than 50% of the potential voters being women.

It would be encouraging to know that the voices already raised by these women of distinction, voices of credibility, voices that have been appreciated and rewarded by the rest of the world, are not ignored by the people they are now addressing.