Dadaab:Shadows of lives
June 2012

Camps are no refuge
Dadaab holds the shameful title of the largest
refugee camp in the world. Its five camps (Dagahaley, Hagadera, Ifo, Kambios and Ifo 2) are home
to 465,611 registered refugees1 as well as
thousands who are not yet registered. Threequarters are children under 12, women and theelderly.2
Envisaged as a temporary solution to house
refugees from Somalia’s civil war, the Dadaab
refugee camps are now 20 years old, and havebecome a permanent home for the majority of
those who have sought shelter there.
Forgotten for years by the international community
and the media, for a brief moment during thesummer of 2011 Dadaab was in the public eye,when images of its exhausted refugees andmalnourished children made front page news allover the world. Emergency funding was released,aid agencies scaled up their efforts, and two
additional camps were opened.
But the attention was short-lived, and many of lastsummer’s gains have already been reversed. Since
the summer, the conflict in Somalia has spilledover into the camps, and Dadaab is no longer aplace of safety.
I left the fighting in Mogadishu for
Dadaab because I heard that it was safe,that there would be education for mychildren, medical services, food, andabove all peace. My husband stayedbehind in Somalia. Now I am in Dadaab,my main problems are the bandits whochase me when I go to collect firewood, thelack of latrines in the camps, and the poor
shelter and sleeping materials. I would liketo go to a third country where my children
can be properly brought up and educated.”

Following a number of serious security incidents,including the kidnapping of two Médecins Sans
Frontières (MSF) staff, the relief efforts in Dadaab
were drastically scaled back in October 2011, andall ‘non-lifesaving activities’ were suspended. This
included the registration and medical screening of
newly arrived refugees, with the result that thoseseeking asylum in the past nine months havereceived no official recognition and little assistance.

Source: UNHCR camp population statistics (27 May 2012).
Total population 465,092; 201,537 are 0-11 years old;
16,461 are 60+; 120,278 are female aged 12 to 59 years old.
Source: UNHCR camp population statistics (6 May 2012).

1

Newly arrived refugee from Mogadishu,
living in Ifo 2 with her five children2Refugees are still arriving from Somalia, in
reduced numbers, though no official figures areavailable to confirm this. Most appear to be
women and young children. Many are highly
vulnerable and have limited coping mechanisms.
Although some have received tokens for foodrations and essential relief items from the UN’s
refugee agency (the UNHCR) and the World Food
Programme (WFP), they have not been provided
with materials to build shelters, so are dependent
on the goodwill of fellow refugees for a place tostay.
Kenya’s Department of Refugee Affairs (DRA) has
recently announced a month-long window forregistering refugees (running from 5 June to 4 July2012). While this is a welcome development, itremains a temporary and limited measure, andone for which many refugees have had anexcessively long wait.
Relocating refugees to the new camps of Ifo 2 andKambios is ongoing, but these camps are not yet
fully operational and lack many basic services.
While there is no food distribution in Kambios, the13,413 residents, for example, have to make their
way to Hagadera to receive food rations.

With the violence in Somalia intensifying, thesecurity environment in Dadaab is not improving.
Continuing clashes in the border areas, and bomb
attacks and assassinations within the camps, aremaking life for the refugees increasingly difficult.
Insecurity has also left humanitarian organisations
struggling to do their work. With the situation
changing daily, planning and delivering aid is amajor challenge. Compared to a year ago, there
are now fewer aid staff – both international andlocal – on the ground, which has had an effect on
the quality of assistance provided. For example,
over the past few months, health posts have had
to function for weeks at a time without qualified
medical staff.
Most refugees in Dadaab have already sufferedviolence, hunger and terrible loss in Somalia. They
have made the dangerous journey to Kenya insearch of safety, shelter and assistance, only to
discover that the camps no longer offer refuge.

The problems in the camps are being exacerbatedby a lack of funding, which has forced the UNHCR
and its partner organizations to continue toprioritise lifesaving activities at the expense ofother activities.3
I came to Dadaab because I heard thatNGOs were taking care of people andproviding food, shelter and education. But
the reality is that the food is not enoughand the shelter is poor. I don’t even own acontainer to fetch water, and going tocollect firewood is risky because of thedanger of being raped.”
3
Effects of funding shortfalls Dadaab/Alinjugur, April
2012. UNHCR information note.

Newly arrived refugee from Berhani, Lower
Juba, living in Ifo 2 with her husband,
mother and three children

I’ve lived here since I was a child of one.
Life in the camp isn’t bad, though you haveto queue too long for food, which is of poor
quality and never enough. The primaryschools are overcrowded, the teachers are
no good, and girls’ education is neglected. I
wish I could move freely and get a job. In 20years I’ve never left the camp, I have noidentity documents, and I feel like a prisoner.”Refugees’ health:an unacceptable
pattern

Long-term refugee living in Dagahaley withher husband and two children

MSF’s hospital in Dagahaley camp, which provides
all the healthcare for the camp’s 123,530
residents, is running above capacity. This is partly
because the two new camps currently offer basic
healthcare only, so patients in Ifo 2 or Kambios
who require inpatient care are referred to hospitals
elsewhere. Over the past five months, for example,
half of the severely malnourished children
admitted to MSF’s inpatient feeding centre werefrom Ifo 2.

While generally the medical data indicates a returnto the ‘usual’ situation between emergencies, thisdoes not mean that these levels are either normal
or acceptable. Without significant change, thispattern – of crises punctuated by lulls – willcontinue indefinitely, with health workers constantly on standby to deal with the next looming healthemergency threatening the lives of Dadaab’srefugees.

Results of a mass Muac4 screening of children
aged six months to ten years in Dagahaley camp in
March 2012 showed global acute malnutrition(GAM) at 2.56%, severe acute malnutrition (SAM)
at 0.5%, and indicated that 12% of children wereat risk of malnutrition.5

MSF in numbers
In Dagahaley camp, between January and May
2012, there were:

While these rates are nowhere near those at thepeak of last year’s emergency (when GAM was38.3% and SAM was 18.8% on the outskirts ofDagahaley camp), they should not be a cause forcomplacency, as malnutrition levels can fluctuate
widely in the complex environment of a refugee
camp.
Influencing factors include the physical conditionof refugees on arrival, as well as their access to
medical screening – in the absence of medicalscreening, warning signs may not be picked up.
Delays in getting assistance, and the need forlong-term refugees to share food rations with newarrivals, can also contribute to rising rates ofmalnutrition. The capacity of the aid system toprovide and distribute food, and to provide quality
healthcare, is also a significant factor.
Overall, the numbers of severely malnourishedchildren admitted to Dagahaley hospital arecoming down. There were an average 188
admissions per month from February to April2012, compared to 797 admissions in August
2011.

73,153primary health careconsultations

5,483

hospital admissions

1,129

hospital deliveries(including 55 caesareans)

1,050

children with severe
malnutrition andmedical complications
treated as inpatients

1,769

children with severe
malnutrition treated as
outpatients

6,594

children with moderatemalnutrition enrolled
in the supplementary
feeding programme

4,276

mental healthconsultations andcounselling sessions

4
The middle upper arm circumference (Muac) of eachchild was measured as a gauge of nutritional status.

5
These figures were lower than in the other camps,
possibly due to the fact that there have been nointerruptions to MSF’s medical services despite theheightened insecurity.

Dadaab’s future:possible solutions
After the brief blaze of publicity last summer, theDadaab crisis has once again been put on thebackburner, while the international community
turns its attention to piracy and state buildingin Somalia. Yet it is crucial that the needs of
Dadaab’s half a million refugees are not forgotten,
and that carefully considered and long-lastingplans are made for their future.
Commonly, in a refugee crisis, three solutions are
put forward: voluntary repatriation; local integration; and resettlement to a third country.
Given that the conflict in Somalia shows no signsof abating, large-scale repatriation – usually thepreferred option – is not likely to be feasible in thenear future. Prospects of formal local integration
are limited, as refugees are not permitted to movefreely outside the camps, to find paid employment
or to enjoy other basic rights of citizenship. Andwith only 19,598 refugees from Dadaab having
being sent to a third country since 2006, resettlement currently represents a solution for just thelucky few.
It is clear that the current paradigm of the camps
is not working, and that alternatives need to befound. The options left on the table are to extract acommitment from the international community formore generous quotas for resettlement abroad,relocation in safer zones/smaller and moremanageable camps and to develop more opportunities for self-reliance among refugees.
At the same time, there needs to be acceptance ofthe fact that the Dadaab camps will continue toexist – at least for now – and that hundreds ofthousands of refugees will remain dependent bothon the host government and on the aid system toensure that their needs are covered and that they
are able to live with dignity.

There’s so much that could be
improved in the camp: the overcrowding,the water shortages, the poor shelter, theuntrained teachers. Refugees aren’tprovided with clothes, and protection ispoor. Bandits often come to the camp toloot, steal and rape, and the police dowhatever they are told as long as they
are paid enough. If only I could havecontinued my studies after secondaryschool, I think I could have had a brightfuture.”
Long-term refugee living in Dagahaleywith 12 family members

Recommendations
There is no doubt that Kenya shoulders a
disproportionate burden with respect to Somali
refugees, and it is clear that this responsibility
needs to be better shared. At present, international donors are shirking their responsibilities
towards the refugees, and failing to provide thesupport to ensure that Dadaab is a place ofrefuge.

→ All refugees in the camps should be guaranteed

International efforts to make aid available toSomalis within their own country should not affectthe provision of aid to refugees who have fled thecountry, nor affect their right to seek asylum inneighbouring countries.

→ Medical assistance should be available for all

protection and assistance.
→ Registration facilities in the camps should bereopened on a permanent basis to ensure
timely registration of all new arrivals withimmediate medical screening, food rations
assistance and a temporary shelter allocation.

refugees, including quality secondary healthcare, proper surveillance and the ability torespond to health emergencies.
→ International donors must reengage with theThe aid system, meanwhile, needs to ensure thatthe wellbeing of Dadaab’s refugees is a priority.
The stakeholders have a key role to play inproviding a humanitarian solution appropriate to
the needs of the refugees who face a future within
the camps’ perimeters.

refugee crisis in Dadaab, providing sufficientfunding to the UNHCR and its partners to meetthe needs of the refugee population.
→ The Kenyan government must remain commit-

ted to guaranteeing the right of Somali refugees
to seek asylum, and to its responsibilities assignatory to international refugee conventions.6

MSF is doing everything it can to bring about the safe release of Blanca Thiebaut and Montserrat Serra,
the two MSF staff who were abducted in Dadaab, Kenya on 13 October 2011, while providing humanitarian assistance to Somali refugees. MSF calls on all Somalis – the diaspora, community leaders andespecially the authorities in control of areas in Somalia where our kidnapped colleagues are being
detained – to do everything possible to facilitate their safe release.

Contact
Médecins Sans Frontières
78, rue de Lausanne – 1211 Geneva - Switzerland
valerie.babize@geneva.msf.org

All pictures © Lynsay Addario/VII
Published by Médecins Sans Frontières – June 2012

6Kenya is signatory to the 1951 Refugee Convention,
the 1967 Protocol, and the 1969 Organisation of African
Unity Convention Governing the Specific Aspects ofRefugee Problems in Africa.