An article in this week's edition of The Lancet highlights the massive internal displacement of people that has occured since the erruption of violencein Kenya last December. Charles Obonyo and colleagues also speak of deaths and injuries, destruction of property and the disruption of transport, health and research and public services. At least 1000 have died, judging from mortuary counts, and more than half a million displaced from their homes.
Coordination and delivery of both routine and emergency medical services is affected and medical and health staff are obviously among those displaced in affected areas. Those that are available are not able to get to work because of transport problems. According to Obonyo et al, even those health workers who could access clinics feared ethinic violence.
About 30% of health facilities in affected areas were non-functional, with the result that people died of trauma that, under normal circumstances, they should not have.
About half a million people are internally displaced or have acquired refugee status in neighbouring countries; of those internally displaced, about 75% are women and children. Living conditions in the makeshift camps are appalling, with poor sanitation, outbreaks of communicable diseases, inadequate water and food supplies, and sexual abuse. The disrupted access to basic health services (preventive and curative) adversely affected those with chronic diseases who needed replenishment of medications (eg, drugs for tuberculosis, hypertension, diabetes, and antiretrovirals) and those in need of reproductive and maternal and child health services (eg, immunisation and antenatal care). There were sporadic reports of gender-based violence. The authors point out that there is an urgent need for counselling services for victims of psychosocial trauma and, without a data-collection system, the opportunity to monitor and assess the health situation has been missed. They also point out that the situation has revealed a weakness in Kenya's emergency preparedness and that mortuary services need to be improved.
The full article can be seen here http://www.thelancet.com/journals/lancet/article/PIIS0140673608605759/fulltext
