Sending refugees to Somalia will ignite health crisis in East Africa

Sitting in a shelter made of branches and torn fabric, Amina cradles a small boy on her lap. The child is listless and shockingly thin. He is severely malnourished and needs to get to hospital fast.

This was one of many stories five years ago, during the height of a major malnutrition emergency. Amina and her five children had just arrived in Kenya’s Dadaab refugee camp, after walking from the Somali border, 70 km away, across the baking red desert. They had been driven from their village by a long and vicious war and a terrible two-year drought.

Thousands of other Somalis were arriving at Dadaab each month, weak from the long walk and too little to eat. One in five of the newly arrived children were severely malnourished, and at our hospital in the camp, Médecins Sans Frontières (MSF) teams were rushing to put up tents to make more space for the sick and the dying.

That emergency was in 2011. Our hospital staff have since dismantled the extra tents and the health situation in Dagahaley camp, where we are working, has returned to its usual precarious level. Things could change at any time. In a vast camp like Dadaab — which houses some 350,000 refugees, and where people live on top of each other, with poor sanitation and limited food rations — infectious diseases can spread like wildfire.

Last year saw a major outbreak of cholera in the camp, and there are regular cases of measles, mainly among new arrivals from Somalia. Our hospital sees a constant stream of people with diarrhoeal diseases, skin diseases, respiratory tract infections, and malnutrition.

Mental health conditions among the population are very common. At the same time, chronic diseases, including diabetes, hypertension, and end-stage cancers, are also on the rise.

No one would say that life in Dadaab refugee camp is good for your health. Denied the right to work or travel, with no opportunity to become integrated into Kenyan society and with little hope of being resettled abroad, major depression and other mental health disorders are common among the refugees — around 80 percent of patients attending  MSF's mental health services in Dagahaley camp are in need of medication.

MYRAID HEALTH RISKS

As well as all the other myriad health risks of the camp, patients in need of advanced healthcare face difficulties getting referrals to specialist hospitals elsewhere. But the health consequences of being forcibly returned to Somalia are likely to be a great deal worse.

Facts about the health situation in much of Somalia are sketchy — because of the insecurity, few journalists or aid workers venture there. But we do know that in large parts of the country, even basic healthcare services are scarce or non-existent. In Dadaab, we often find that children arriving from Somalia have never been vaccinated against the common childhood diseases — another telling indication of the health landscape there.

If the return of the refugees is not done voluntarily, it is likely to have major consequences for their health, escalating their vulnerability to malnutrition, weakening their immune systems, and making them vulnerable to infectious diseases.

People with non-communicable diseases will also be at increased risk, as symptoms do not usually become severe until an advanced stage of the disease, lessening their impetus, in a difficult situation, to seek healthcare until it is too late.

Patients with chronic diseases who are already on treatment need continuity of care to safeguard their health — whether they are diabetics who need insulin or people living with HIV who need to take antiretroviral drugs each day. With diseases such as tuberculosis, interrupted treatment brings with it the risk of drug-resistance developing.

If the Kenyan Government goes ahead with the threatened closure of Dadaab, I dread to think what will happen to the patients and the most vulnerable refugees.

Sending the camp’s residents back to Somalia without due care is likely to become the next health emergency in East Africa.

Melat Haille is the medical coordinator for Médecins Sans Frontières.

Editor's Note: This article was updated on June 28, 2016.