Health care a casualty in Kenyan crisis.

CMAJ • March 25, 2008 • 178(7) 818 K enya’s slide into ethnic tension, anarchy and political violence has thrown the country’s health sector into crisis. Drugs and other medical supplies are in short supply. Health facilities are overwhelmed by the injured and untreated. Camps for those displaced by the conflict are crowded and unsanitary. In many places, healthcare workers have abandoned their duties in fear for their lives. Many are still hopeful that former United Nations secretary general Kofi Annan can ultimately negotiate an end to the violence that erupted along ethnic lines following the disputed December 2007 election and that has resulted in the killing of an estimated 1000 people and the displacement of 600 000 from their homes. sion and suspicions are rife among the workers and some of the patients, which does not augur well for the provision of quality health services.” The World Health Organization (WHO) says that camps for the displaced have been overwhelmed in some areas of the country and are now struggling to deal with food and water shortages, inadequate shelter and horrific sanitation. In some camps, the toiletto-person ratio is 1 to 500. Diarrhea in children and acute respiratory infection have become endemic. “In many settings, survivors have no access to even the minimum health and psychological support, leaving them vulnerable to a range of potential negative health problems, including HIV/AIDS,” says WHO spokesman Fadéla Chaib. “People are being forced to drink unsafe water, risking diarrheal diseases, infection and severe dehydration. The longer the crisis continues, the greater Yet, even if peace is negotiated (as of CMAJ’s Mar. 3 deadline, it had not been reached), experts fear the long-term impact on the health care system will be devastating: healthcare personnel will be lost, while efforts to contain the spread of diseases like HIV/AIDS will be hampered as patients who miss treatments develop resistance to the drugs being used to treat them. More immediate is the challenge of treating the wounded and displaced. That challenge is particularly difficult because of the dramatic increase in the number of patients and the shortage of staff caused by insecurity, says Dr. Stephen Ochiel, head of the Kenya Medical Association. Several doctors fled their stations as ethnic killings intensified, Ochiel says. “Our public health facilities are not only overstretched, but they are also faced by lack of drugs, medical supplies and feelings of insecurity among health workers. At the same time, tenHealth care a casualty in