With plans afoot to reopen the country after months of a dusk-to-dawn curfew and containment measures, the spotlight turns to the informal settlements in Nairobi, which could be a ticking time bomb.
Nairobi has been the epicentre of the Covid-19 pandemic in the country, accounting for nearly half of the 1,286 cases announced so far.
More than 600 positive cases having been reported in the city as the numbers continue to soar.
But of great concern is the fact that the confirmed cases have been mostly from the informal settlements, with Kibera, Dandora, Kawangware, Kayole, Mathare and Eastleigh under the spotlight.
Eastleigh was put under partial lockdown in the first week of May, which was extended to June 6.
Kibera, one of Africa's largest urban slums, has also been identified by the Ministry of Health as a growing concern in terms of coronavirus infections. According to a 2019 World, Bank working policy report, 41 per cent of Nairobi’s population lives in informal settlements meaning about 1.8 million of the city's 4.4 million population according to 2019 census.
The report also says that 43 per cent of Nairobi’s population is considered poor.
Worse still, most parts of the capital have been experiencing acute water shortages following the closure for repair of the Ng’ethu and Sasumua treatment plants, which supplying close to 97 percent of the city's population.
This has resulted in limited access to safe hand washing, an inexpensive and highly effective way of slowing the spread of the virus, as well as proper sanitation, becoming a matter of life and death.
On Saturday, President Uhuru Kenyatta said Kenya will not remain under lockdown forever, with the government's containment measures to curb the spread of Covid-19 scheduled to expire on June 6.
It has emerged that, following the President’s directive, committees charged with response to various aspects of the pandemic started meeting yesterday to come up with plans for reopening the country’s economic and social sectors.
This is despite a projection by the Ministry of Health that Kenya’s Covid-19 peak could be in August or September, when it will be recording at least 200 cases daily.
However, the plan to reopen the country comes at a time when a UN Habitat report has warned that the Covid-19 pandemic will hit the world’s most vulnerable people hardest, including the estimated 1.2 billion people living in informal settlements worldwide.
This is because these densely populated areas lack household water and sanitation, have overcrowded public transport and limited access to formal healthcare facilities and lack basic services.
Consequently, the recommended measures to prevent the transmission of Covid-19, such as hand washing, physical distancing, self-quarantine and community-wide lockdowns are impracticable.
Many slum dwellers work outside the formal sector, with unstable incomes and minimal savings and cannot-afford water, soap, food or medical treatment. And with no financial rescue packages like in developed countries, they are highly vulnerable.
Another report by The New Humanitarian echoes the UN agency's concerns, saying that the urban poor in informal settlements are facing enormous strain from the virus as social distancing, self-isolation and even hand washing are impossible luxuries, since they have to make the unenviable choice between catching and spreading the disease or the certainty of hunger.
Worryingly, a large proportion of the population also frequently suffers from chronic illnesses, including respiratory infections, cancer, diabetes and obesity, increasing their susceptibility to Covid-19.
“Owing to their neglect, informal settlements are off the grid and as such, difficult to monitor and service. This makes them hotbeds for infectious disease outbreaks and as such Covid-19 because in many cases social distancing is virtually impossible,” said the report.
“They are also unable to access treatment and care for existing diseases because of lack of access to medical and health services making it difficult to track cases and isolate infected people.”
Nonetheless, they are a critical supply of labour for cities putting at risk the other population in the city.
However, Nairobi Metropolitan Services (NMS) chief health officer Ouma Oluga has said they have been implementing robust health interventions to keep the spread of the virus at bay including mass testing, isolating positive cases and mapping households.
He said that the directorate of health at NMS has already completed household mapping in Kibera, Lang’ata, Mukuru with only parts of Mathare continuing.
Additionally, 5,100 community health workers have been distributed all over Nairobi as well as 720 community health units that have mapped out every single place in the city.
“We have mapped out almost all households to look for disease patterns. Once we have mapped out the households, this is what we will use to monitor the population in the city,” said Dr Oluga.
He said the ongoing mass testing is aimed at mapping out hotspots in Nairobi where more effort in terms of public health measures is supposed to be directed to as well as mopping out cases to stop community transmission by isolating positive cases from the community.
“We are concentrating on informal settlements because they are difficult to manage like access to water, proper sanitation, physical distancing and restrictions on movement as this is one of the best ways of preventing more transmissions,” the health official said.
The former KMPDU secretary-general also pointed out that contact tracing is currently ongoing in Nairobi for those who have tested positive for Covid-19.
“We are going on with contact tracing in a multi-agency team. We have a disease surveillance team, security agencies with the national command centre also assisting us in this. We are currently doing so in Kibra,” he said.
“There is not a single contact of a Covid-19 positive person that we have not managed to get and I can say it has been 99 per cent successful,” Dr Oluga said.
NMS director-general Mohammed Badi, last week, said his administration has also deployed health workers at all border points to identify and isolate any suspected Covid-19 case as part of a management and containment programme.
This is in addition to dedicating Ngara Health Centre and South B Clinic for testing of truck drivers and all hotel workers within Nairobi as well as mapping out all communities in the county putting in place 2,400 hand wash stations, complete with liquid soap and sanitisers.
Maj-Gen Badi further said that together with the Health Ministry, they have rolled out free mass testing in various sub-counties in Nairobi.
He added that Mbagathi Hospital and Kenyatta National Hospital have been dedicated for treatment of Covid-19 infected persons with 55 staff deployed to man the 58 quarantine facilities which were handed over to the new office by the ministry.
At the same time, the NMS boss said they began household registration on April 30, to map all households that need maternity care, child care, emergency treatment and chronic diseases.
“In partnership with Shofco, we are giving free Uber/Bolt rides to pregnant mothers during this Covid-19 period,” he said.