Tensions are high in the Rift Valley, in western Kenya, and in Nairobi. Over the last month, post-election violence has spiked as demonstrations flare in towns and villages. Some people have been wounded, while others have sought to flee. Because the situation is very unstable and changing quickly, Médecins Sans Frontières (MSF) has set up a flexible system for treating the wounded that relies on mobile medical teams. In Nairobi, the morning after the results of the presidential election were announced, violence spread in the Mathare shanty town, home to approximately 400,000 people. It ebbed and flowed in intensity as supporters and opponents of President Mwai Kibaki fought, followed by clashes within communities. On Jan. 30, the emergency team took in nine wounded patients at the MSF aid station in Mathare. One week earlier, team members treated 19 patients in one day. Within two weeks, MSF staff treated 134 victims of violence in Mathare.

Injuries becoming increasingly serious

Initially, patients were treated in the Blue House clinic in Mathare, where MSF has been working with HIV/AIDS and tuberculosis patients since 2001. To deal with the influx of wounded, on Jan. 16, MSF opened an aid station in Huruma, a neighbourhood Mathare. An MSF team of doctors and nurses provide first aid to the wounded there. Their injuries illustrate the forms the violence is taking, resulting from both demonstrations and confrontations with security forces and from violent clashes among civilians, becoming increasingly serious every day. An 18-year-old, for example, was shot in the arm while the police were chasing 20 men who had just set fire to some stores.

Wounds inflicted by knives, machetes and sticks

The MSF team is also treating patients who have been struck by machetes, knives and sticks, causing serious, disabling injuries including fractures and deep cuts to the head or limbs. Some victims were mutilated. Once those patients are stabilized, they are transferred to a Nairobi hospital for surgery or further examination. The teams also include mental health counsellors so that victims can recount the violence they experienced and, if necessary, reconnect with family members.

Multiple sites of violence

Violence, combined with widespread rumors, feed people’s fears. The insecurity is equally palpable elsewhere in the country. Blockades have been set up in the streets, disappearing as soon as they are erected. When groups of young people brandishing knives emerge in the streets, residents flee to improvised camps. In Naivasha, a town 70 kilometers northwest of Nairobi, tensions flared suddenly on Jan. 26 and 27. When an MSF team arrived on Jan. 28, there were 30 people in the hospital who had been beaten and shot. However, many hospital employees were unable to get to work because of the insecurity. A team from Nairobi, including an anesthesiologist, nurse and doctor, managed to reach the site. That same day, supplied with medicines and medical materiel, the team was able treat the patients. They included two seriously wounded individuals who had suffered head trauma and were referred immediately to a Nairobi hospital. However, the four other seriously wounded patients had to wait until the next morning to be transported to Nairobi by ambulance.

Thousands of displaced persons

The violence also prompted thousands of Naivasha residents to flee. More than 3,000 sought refuge in a prison. Approximately 1,500 more went to a police station. In the days that followed, many Naivasha residents continued to flock to displaced persons’ camps under police escort. A new team, this one including two doctors, a nurse, and a logistician, went to Naivasha to help meet their needs. The team began by conducting medical examinations in the displaced persons’ camp set up in the prison and made sure that individuals with AIDS and other chronic illnesses continued to receive their treatment. The team will also monitor the camps to ensure that they have adequate supplies of water and latrines. Further west, another team based in Kericho visited several sites, where between 500 and 2,500 displaced persons are gathered, to hold consultations and vaccinate children against measles and polio, with Ministry of Health approval. The MSF emergency team, which includes 16 members, will be strengthened so that it can continue to respond appropriately to the fluctuating situation.

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