For more than a month, the Kenya Medical Practitioners, Pharmacists, and Dentists Union (KMPDU) have been on strike, rallying in the streets to demand payment of their salary arrears and the prompt deployment of medical interns for their internships. They are also calling for the implementation of a collective bargaining agreement signed in 2017 following a 100-day strike.

The doctors pointed out that the government has not hired more doctors despite the national shortage, nor provided a training budget for postgraduate medical officers. Additionally, county governments failing to release doctors eligible for postgraduate training, remitting allowances, and have recurrently delayed salary payments, among other issues.

So far, medical practitioners have strongly objected to the National Treasury's allocation of Sh2.4 billion for deploying medical interns. The Union has dismissed the government's 91 percent salary cut for interns and further insisted that the strike will persist until all elements of the Collective Bargaining Agreement signed by the Union and the Health Ministry are fully enacted.

This standoff between the government and KMPDU which represents more than 7,000 members has since left thousands of Kenyans without much-needed public health services.

However, since the onset of the protests, there have been attacks. A peaceful protest of the medics resulted in police brutality which left the KMPDU boss Davji Atellah injured after he was hit by a teargas canister as he led a protest in Nairobi on March 1.

“This is one of the documented physical attacks on the unionist. But that’s not all: they are always targets. Their phones are tapped and they have learned to live by it,” Dr. Dennis Miskella, the KMPDU secretary general, told the Nation.

Nevertheless, these attacks have extended beyond the physical and verbal. We have found evidence indicating that they have also occurred within the online realms.

The Nation's investigations, in collaboration with Code For Africa, examined three hashtags — #FireTheDoctors, #GreedyDoctors, and #KMPDUexposed — and observed behavior suggesting an attempt to exploit trending topics on Twitter to spread disinformation amid the doctors’ protests.

Nation questioned KMPDU’s Deputy Secretary General, Dr Dennis Miskellah, on whether he was aware about the online war.

He remarked, "We are well aware of the online attacks, and they do not surprise us. When engaging with an adversary who fights unfairly, one can expect them to use all means possible. In the context of conflict, such tactics are expected. Our opponents will employ any tactic to hinder our progress. Propaganda is a typical part of such conflict. We do not take it as a personal affront to anyone; instead, we disregard it with the disdain it deserves, as it does not merit our response."

An X network that appears to be anti - doctors' has amplified hashtags, in a bid to discredit the protests and resulted in the hashtags trending in Kenya. The network includes a significant number of active X accounts, several of which have large user bases, including 30 accounts, each having more than 32,800 followers at the time of writing.

Some accounts exhibited bot-like characteristics due to their highly suspicious posting rates including producing more than 10 tweets in a day, having numbers in their usernames instead of actual names, and using profile pictures belonging to other persons.

We further observed that the main accounts that triggered this campaign appear to be digital marketers on X (formerly Twitter) suggesting they are paid influencers to market content on social media, as we noticed their frequent engagement in promotional hashtags during overlapping timespans.

The creation and amplification of hashtags.

We observed that the popularity of the hashtags was short-lived, according to an analysis conducted using the monitoring tool Meltwater Explore, indicating that the networks may have been activated to specifically respond to the medics’ protests.

Our analysis established the lifespan of the three hashtags on the period from 21 to 27, March 2024.

Attempts to make anti-doctors hashtags trend

Soon after the nationwide protests of the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) on March 21, there were a barrage of X posts specifically addressing the doctors.

The hashtag #FireTheDoctors, seems to have been prompted by three accounts @richiestorn, @iam_nyakoi, and @mrokerosi respectively.

#FireTheDoctors, the hashtag used against the protesting doctors, was launched by @RICHIESTORN on March 21, the same time it was reported that the doctors' protest entered the second week. The post which came at 7 am on March 22nd had a reach of 10,000. However, we identified three other accounts that initiated posts using the same hashtag; @mumbi001m, @africmumke_ and @iammithamo.

Mutahi Ngunyi, a renowned political scientist in Kenya, also joined the hashtag, with a post at 8 pm, on March 22. He criticised both doctors and the media, likening them to "harlots" who have power but lack responsibility.

His post became the most engaged and was followed by a peak in the number of mentions of the hashtag which eventually reached Kenya's trending list on this day.

While there were a total of 1362 observed original posts bearing this hashtag. We observed that 352 users posted more than twice using the hashtag in an attempt to make this hashtag gain traction.

A review of the hashtags, also revealed that the majority of the hashtag’s activity came from original posts followed by reposts.

The significant traction of this hashtag was compounded by the fact that the top 30 actors who engaged it; either through original posts, reposts, or replies, have more than 32,800 followers.

Some of the social media accounts criticized the protesting healthcare workers, dismissing their genuine grievances and instead framing the strike as fake, often with frequent posting. An example of this was seen in the activity of the account @CrazyDREAMER254, which repeatedly insinuated that the protests were orchestrated by impostors posing as medical professionals.

The Nation also noted claims that Kenyan doctors are the best paid in Sub-Saharan Africa, yet data shows that Kenyan and African doctors are moving to Western countries in droves in search of jobs and better livelihoods.

Along this anti-doctors campaign network, several of the accounts used the hashtag #GreedyMedics, which was initiated by @kingkid__, In attempts to spread a narrative against doctors, the first account used a fabricated social media card, purported to come from Nation.Africa. The card alleged that Kenyan doctors are the second-best-paid in Africa.

It has since been flagged by The Nation as fake.

The Nation and Code For Africa noted the origins of this hashtag from 21 other x accounts.

However, most posts under this hashtag seemed to combat the false narrative that was being meted out against the protesting medics and linking them to pro-government entities.

Posts spreading the #GreedyMedics hashtag seemed to typically downplay the protests and support the grievances of the doctors. When the hashtag emerged on March 22 at 8:40 AM, it peaked on the same day with more than 300 mentions and trended in Kenya for the next four days, as it was amplified by accounts with more than 3,000 followers.

However, we observed the impact of this hashtag wasn't as enormous as compared to the rest, partly attributed to the fact that the actors were attempting to counter the narratives driven by #FireTheDoctors and #KMPDUexposed.

Further attempts to drive a vile narrative against the protesting doctors were observed in the hashtag #KMPDUexposed. The hashtag emerged on March 22 and received more than 9,000 mentions. It trended in Kenya between March 22 and 27. The account @MrOkerosi, which initiated the hashtag openly downplayed the medics’ protests claiming it was being staged by university students and not the real doctors.

High posting rates

Another indication of suspicious activity from the network was the high posting rate from some of the accounts. For example, five accounts @itskiprotich1 (43 posts), @jebetke_ (32 posts), @mrokerosi (22 posts), and @cityfrans47_ (5 posts) were among the most prolific, using the hashtag supportive of #KMPDUexposed, mostly in the form of posts and reposts.

On March 24, the account @kababaake1 quoted ten times to different posts using this hashtag. Additionally, the hashtag was initiated by 1899 X accounts, while 458 accounts posted more than twice using the hashtag in attempts to trigger the virality of the campaign.

Similarly, we observed a total of 1362 original posts bearing the hashtag #FireTheDoctors and 352 users posting more than twice using the hashtag. For instance, twenty X accounts each bearing over 30 posts bore this hashtag.

@mkevin____ and @jabalandke were the most prolific with 51 and 50 posts respectively.

We also observed that the significant traction gained by this hashtag was largely triggered by reposts ( 2854 ) and replies ( 2704 ) on original posts.

Influencer analysis

The Nation identified particularly two X accounts @kusienyakelvin and @davidjesse_ taking part in all three campaigns using the hashtags #FireTheDoctors, #GreedyMedics, and #KMPDUexposed.

Moreover, the two accounts seemed to show strong solidarity with the ongoing doctors' protests. @kusienyakelvin and @davidjesse_, are not bot accounts and belong to Dr. Kelvin Kusienya and Dr. David Jesse Respectively. Kelvin Kusienya’s account is verified, with his bio stating that he is a medical doctor, a content creator, and a mentor, with Kakamega as his tagged location.

Similarly, 882 X accounts launched #FireTheDoctors and #KMPDUexposed campaigns.

An analysis of X posts, creation times, and mentions reveals that the accounts within these networks — surf noise, info defense, and node of time — are connected, with info defense and node of time being closely associated with one another and surf noise existing on the periphery. the cross-amplification efforts between the accounts were most evident.

As Kenyan doctors continue to protest over poor working conditions, poor pay among other raft of issues, the Nation and Code For Africa observed online coordinated attempts to control narratives can further restrict the information environment. Various accounts in the identified network appear to be taking part in coordinated amplification efforts against the doctors and KMPDU. Our investigation shows an analysis of three hashtags the network amplified and managed to push to X’s trending list, thus creating a false perception of Kenyan doctors and discrediting their concerns.

This network identified by The Nation also, in the recent past, launched hashtags and applied similar amplification tactics against Kenya’s media houses.

KMPDU’s Dr Miskellah explains that the attacks have not only been online and physical, but they also extend to tapping of their mobile phones. “We have learned to live by it,” Dr Miskellah told the Nation.

He adds, “The initial propaganda emerged when individuals from the Ministry of Health and certain MPs attempted to propagate the false claim that I orchestrated an attack on my team members, including my boss Dr. Atellah. This narrative aimed to promote the idea of a "power struggle" within the union.”

The government, as communicated by its spokesperson Isaac Mwaura, alleged that the doctors' strike was politically driven to obstruct the health reform plans of Ruto's administration.

"On April 4, he stated, "There is a political agenda to undermine the Social Health Act and the Universal Health Coverage."

However, the Kenya Medical Practitioners, Pharmacists, and Dentists Union’s secretary general strongly refuted this claim by the government spokesperson terming it as propaganda.

“They were also trying to advance the narrative that we’re being financed by politicians. But if we were to have any political sponsorship, they would be able to know. For us, we consider such things as propaganda. When people cannot raise their points, they raise their voices. They just want to muddy the waters and cause confusion. But of course, our members are smart,” said Dr Miskellah.

The SG also pointed out that there is an acute shortage of doctors in Kenya explaining that the current ratio of doctors to patients in Kenya is 1:17,000, yet the World Health Organisation recommends that a doctor should handle 1000 patients.

“We are not greedy doctors,” commented Dr Miskellah on the #GreedyDoctors. “Being a doctor is a career. We ask for what is rightfully ours. We must stop imagining that, for a second, we will stop asking for what is ours.” he remarked.