Alarming malnutrition rates, aid too slow Médecins Sans Frontières (MSF) has found alarmingly high rates of malnutrition among the Somali refugees arriving and settling in the outskirts of the Dadaab refugee camp in northeastern Kenya. MSF will reinforce its intervention in the camp because of these findings. Day after day, thousands fleeing the conflict in Somalia continue to arrive in the overcrowded camp. Their situation has been made worse by the drought affecting their country and Kenya. The region in general is suffering from a severe drought after two failed rainy seasons. The refugees’ situation is made worse when they arrive at the camps: here, exhausted after several days or even weeks travelling, they are receiving inadequate assistance.

Kenya © Serene Assir/MSF
A mother feeds her child therapeutic milk at the MSF-run hospital in Dagahaley, part of the larger  Dadaab refugee camp. The Dadaab complex is made up of three areas: Ifo, Hagadera and Dagahaley. Dadaab is the largest refugee camp in the world and now it is full. New arrivals are obliged to settle in makeshift shelters on the outskirts of the camp. Despite the fact that MSF has repeatedly asked for a solution to decongest the Dadaab camps, there has been no response. The number of people in these camps is approaching 400,000, even though they were only ever meant to accommodate 90,000 inhabitants. MSF is providing medical care to the 113,000 residents of Dagahaley. The number of new arrivals increases each month, with an average of 500 new arrivals a day. About 25,000 people are currently living outside the camp boundaries, and this figure is expected to grow even more. Since earlier this year, MSF teams have also been providing assistance to the new arrivals on the outskirts of Ifo, while waiting for the opening of the extension (Ifo 2) that will enable the scaling up of activities. Worrying malnutrition rates At the beginning of June, a new reception centre in Dagahaley, managed by the Kenyan Authorities and the UN agency for refugees (UNHCR), was opened, with the aim of improving assistance for the new arrivals. An MSF team has been doing daily health assessments of people arriving at the centre. While carrying out systematic nutritional screening of children younger than five years of age, alarming malnutrition rates were found. This led to a rapid nutritional assessment in the area in mid-June. The results exceeded MSF’s worst fears. A mixture of extreme heat, lack of water and sanitation, delays in the registration of new arrivals and provision of food rations have resulted in the living conditions of new arrivals being very difficult. During the three-day rapid nutritional assessment in mid-June, some 500 children between six months and five years old were measured and weighed. As many as 37.7 per cent were suffering from global acute malnutrition, and of these, 17.5 per cent were severely affected and had a high risk of death. Children up to 10 years old were also showing elevated rates of malnutrition. "I expected to find a difficult situation but not a catastrophic one," says the coordinator for MSF in charge of the nutritional assessment, Anita Sackl. "The majority of new arrivals actually fled because they had nothing to eat, not just because their country has been at war for decades," she says. Because of these worrying results in the new arrivals area, MSF is now including children above five years old in their nutritional programs in Dagahaley camp.
Kenya © Yahya Dahiye/MSF
Refugees at one of Dadaab's three camps. Humanitarian aid too slow The ongoing delay in providing humanitarian aid is also a problem. The refugees must wait 40 days before being officially registered by UNHCR and receiving a card entitling them to the regular food distributions. Until these 40 days had passed, they receive only a two-day food ration and a five litre plastic container to keep water in. "It was totally unacceptable," says Monica Rull, head of MSF projects in Kenya and Somalia. However, she nonetheless welcomes the most recent improvements: "Now, since the beginning of July, newly arrived refugees at least receive food for 15 days. However, it is still not enough. The World Food Programme must ensure more regular food distributions. A nutritional survey for all the Dadaab camps needs to be done. Children up to 10 years old should also be included in order to confirm malnutrition rates in older children and thus adapt the nutritional programs." MSF is also calling for an accelerated registration procedure. Currently, there is only one registration centre for the entire Dadaab complex, situated in the Ifo camp. In some areas of makeshift camps outside Dagahaley, MSF found that some refugees were not receiving even three litres of water per day. This amount is just enough for the daily water intake in hot climates, but it hardly ensures basic hygiene practices. Therefore increasing the water supply is also necessary. MSF teams have begun distributing more than 100,000 litres of water by truck every day. Enlarging the medical program Pressure is mounting in the Dagahaley hospital run by MSF, as well as at MSF’s five health posts. More than 1,600 children with severe acute malnutrition are currently receiving treatment in the ambulatory programs, and more than 700 new admissions are reported each week in the supplementary programs. The majority of these come from the newly opened health post located in the outskirts of the camp, where most new arrivals are settling. Last week, staff registered an average of 107 new admissions to intensive nutritional care per week at the hospital. As the establishment was already operating outside of its capacity, an extension of 60 beds for pediatric cases (including malnutrition) has been constructed. MSF reiterates the need for all actors working in the camp to scale up activities in order to provide appropriate assistance to the refugees. This includes immediate assistance in the border areas as well as finding acceptable solutions to decongest the current camps.     MSF has been providing medical care in Kenya since 1992, and has worked in the camps at Dadaab for a total of 14 years. Since 2009, MSF has been the sole provider of medical services in Dagahaley camp, providing a 170-bed general hospital and five health posts to supply healthcare to the 113,000 people living in the camp.