March 2014

Dadaab refugees:An uncertain tomorrow

Introduction
For many of the thousands of refugees living in Dadaab, northeastern Kenya, the passage from one humanitarian crisis to thenext is nothing new. The vast majority fled conflict in Somalia andarrived to a ‘home’ that offers fear, insecurity and overcrowded living conditions as part of the daily reality. Many others have beenborn there, and know nothing but life in a refugee camp.
Composed of five camps - Dagahaley, Hagadera, Ifo, Kambios andIfo 2 - and with a population of 403,727 refugees, Dadaab is thelargest refugee camp complex in the world. Three quarters of its
population are children under 12, women and the elderly.1 OverDadaab’s twenty years of existence, the population has continued
to struggle to survive, and live amidst the effects of a protracted
emergency with no clear end in sight.
The reasons why most Somalis fled their home country – namely
danger and insecurity – are as pertinent today as they ever were,and preclude most refugees from even considering returning toSomalia, today or at any time soon.
The recent Tripartite Agreement between the Kenyan and Somali
governments and the UNHCR 2 signed in Nairobi on 10 November
2013, outlines the practical and legal procedures for the voluntary
return of the hundreds of thousands of refugees from Kenya
to Somalia.

“ Nobody chooses a life as a refugee, and most refugees struggle to get by on what the government andaid agencies provide. Any decision to return should bemade willingly and gladly, and not be forced on themby a cut in aid.”
Dr Jean-Clément Cabrol, MSF Director of Operations

1 Source : Registered Somali refugee population, UNHCR, November 2013.

However, while the discussion on reintegrating the refugees backinto Somalia could be considered as a positive step, it should not
happen at the expense of providing adequate aid and protection
to Somali refugees who are currently living in Kenya. Registration
facilities in Dadaab have been closed since October 2011; as aconsequence, newly arrived refugees receive insufficient aid. Recent funding cuts by the World Food Programme have brought
about a reduction in food rations. Security conditions in the camps
are such that refugees are often at risk of violence, and the aid organisations that assist them are often forced to operate with askeleton staff. Médecins Sans Frontières (MSF), for example, hasbeen unable to maintain a permanent presence of international
staff since July 2012.
Reintegrating refugees back into Somalia could be part of a realand sustainable solution for Somali refugees; nevertheless, maintaining assistance to the refugees needs to be high on the agendaof all stakeholders. Security and dignity must be ensured for both
refugees living in Kenya and those returning to Somalia.

2 Content of Tripartite Agreement available on UNHCR website :www.unhcr.org/news/Tripartite_agreement_KenyaSomaliaUNHCR%20
2013.zip

The Somali government and its partners must guarantee that returnees have rights and receive assistance, while aid must continue to be provided in Kenya’s refugee camps to those who do notwish to return.
As part of a continuous process of evaluating the needs andconcerns of the refugee community, a team of 21 interviewers
from MSF carried out a series of interviews with refugees at theorganisation’s health facilities in Dagahaley camp. A total of 1,009
interviews were carried out between 1 and 14 August 2013.
While the results of this assessment cannot be extrapolated to theentire refugee population of Dadaab, the findings – taken alongside MSF’s continual discussions with the refugee community, theobservations of MSF teams on the ground, and the medical datafrom MSF’s activities – provide an insight into the general situation of the refugees today in Dagahaley camp.

Profile of respondents
All 1,009 refugees interviewed were adults attending the MSF
hospital or one of the four MSF health posts as either patient orcaretaker. Sixty-seven percent were women and 33 percent men,reflecting the fact that women are the primary caretakers in theGeographical origin
camp. Seventy percent came from the two Somali regions ofLower
Juba and Middle Juba. Sixty-two percent of respondents
60.0
arrivedat50.3%the camp before 2007. Among the rest of the res50.0
pondents,
only
ten percent arrived after January 2011, when a40.0
nutrition crisis throughout the Horn of Africa brought on by two30.0
successive droughts, and an increase in the conflict following
18.0%
16.2%
20.0
14.1%
interventions from the international community,
saw substantial
10.0
increases in the numbers of Somalis seeking refuge.
1.3%

0Lower Juba

Middle Juba

Banaadir

Bay

Other

Year of arrival in Dagahaley
70.0
62.2%

60.0
50.0
40.0

28.3%

30.0
20.0

9.4%

10.0
0
1991-2006

2007-20102011-2013

Geographical origin
Reasons for departure
60.0
100%
50.0
80%

50.3%

40.0
60%
30.0
40%
18.0%

20.0
20%

16.2%

14.1%

10.000Insecurity

Drought

Lower Juba

Economicreasons

Middle Juba

Crop failure

BanaadirLack ofmedical care

Bay1.3%Lack ofemployment

Other

Year of arrival in Dagahaley“ 70.0I am not ready to go back to Somalia for the moment, but I
62.2%
60.0
am
ready to go anywhere else that the UNHCR may resettle us
as50.0a family. All my children were born here in the camp. I ex40.0
pect
my family to be Kenyan and to educate my children here.”
28.3%

30.0
20.0

Somali refugee living in Dagahaley camp
9.4%

10.00
1991-2006

2007-20102011-2013

Deteriorating living
conditions
A common complaint amongst refugees over the past year hasbeen the poor quality of their shelters. Forty-one percent of refugees questioned said that their shelters do not provide sufficient
protection from the rain, although this fell to 20 percent amongst
those provided with shelter materials by the UNHCR. However,
only half of people interviewed had access to this shelter material. It is clear that the poor quality of shelters urgently needs tobe addressed.
Another pressing concern – though not a new one – is access tolatrines. Of those interviewed, 11.3 percent have no access to latrines and are forced to go to the scrubland around the camps.
This impacts not only on sanitation and therefore health, but isalso a security issue. Among women interviewed, 26 percent who
have no access to latrines said they felt unsafe when they had to
go to the scrubland.

Prevailing insecurity
The level of insecurity in the camps – including killings, abductions and rapes – remains a major concern for refugees and theorganisations that assist them. Despite some improvements inthe situation, and a reduced number of serious incidents throughout 2013, the security environment for refugees remains extremely unstable. Whether the insecurity experienced by refugees is linked to the lack of latrines, or the lack of access tofirewood for cooking (10 percent of those interviewed have toleave the camp to search for firewood), cuts in essential services
are having a negative impact on the security of refugees.
For aid organisations such as MSF, the security situation in andaround the camps continues to prohibit the permanent deployment of international staff. Fewer and fewer aid staff work in thecamps, despite the importance of their presence in ensuring thatrefugees receive high-quality assistance.

Fragile health situation
The results of a recent UNHCR nutritional survey show that there
has been a significant reduction in the prevalence of both severe
and global acute malnutrition in the camps.3 In Dagahaley, approximately ten out of every 100 children aged between 6 and 59
months are acutely malnourished (moderately or severely) while
one out of every 100 is severely malnourished.
Ongoing surveillance activities reveal the existence of a large cohort of malnourished children with an average of 175 new admissions per month in MSF’s outpatient therapeutic feeding program.
Each month, approximately 49 malnourished children with medical complications are admitted to the MSF hospital (based on August to November 2013 data). In October 2013, the World Food
Programme announced that food rations for November and December would be cut by 20 percent. Although there has not been
an increase in admissions to MSF’s nutritional programs, if such a
cut were to occur again, this would have a serious impact on thealready fragile situation in the camps.
While there are plans to increase the number of latrines available
to the refugees in Dagahaley, there is no clear timeframe for improvements to the concerning water and sanitation conditions inthe camps. This has resulted in regular outbreaks of water-relateddiseases, such as hepatitis E and cholera, in recent years. At least
two cases of cholera were confirmed in the Dadaab camps in December 2013. Under such poor conditions, the disease canspread quickly, requiring a swift response from aid organisations
which are already stretched to the limit.

MSF in numbers
In Dagahaley camp, between
January and December 2013,there were:

216,597

primary healthcare consultations

8,692

hospital admissions

2,585

hospital deliveries

3,670

children with moderate acutemalnutrition enrolled in
the supplementary feeding programme

3,087

children with severe acute malnutrition
treated as outpatients

1,062

children with severe acute malnutrition
and medical complications
treated as inpatients

10,827

mental health consultations
and counselling sessions

3 From February 2013 until September 2013, rates of severe acute malnutrition fell
from 2.5% to 1.2%, while global acute malnutrition rates fell from 13.2% to 10.8%.
Source: UNHCR Nutrition Surveys, Dadaab. Preliminary report, October 2013

50.0
40.0
28.3%

30.0
20.0

9.4%

10.00
1991-2006

The return issue
The assessment carried out by MSF took place before the signingof the Tripartite Agreement, and the concerns of the refugees atthis time were abundantly clear. Their reasons for fleeing Somalia
were almost 100 percent linked to insecurity within the country,with 60 percent of respondents citing the drought as a secondary
reason for having left their homeland.

It emerged in the interviews that the willingness of refugees to return to Somalia is very closely linked to their perceived health status, living conditions and feelings of safety in Kenya. Those refugees who are benefiting from an adequate provision of services
such as food, shelter and healthcare are more willing to consider areturn. On the other hand, those who are living in the mosthardship said they were less willing to return, even if there is a further reduction in services.
From this we can conclude that, for those surveyed, any systematic reduction in services will only decrease their ability and determination to go back to Somalia.
It should also be noted that the conflict in parts of Somalia is stillongoing and, if major offensives are launched, there is a very realrisk that more Somalis will need to seek refuge in Dadaab.
While any discussion about finding long-term solutions for Somali
refugees in Kenya should be cautiously welcomed, the wellbeingof the refugees must be at the forefront of any discussion, alongside a strict adherence to the refugee conventions. All key stakeholders must continue to fund and deliver quality services to refugees in Dadaab, as is their obligation under these conventions, towhich they are all party. At the same time, the right of asylum
must be ensured for all those who continue to flee Somalia.

2011-2013

Reasons for departure
100%
80%
60%
40%
20%
0Insecurity

These findings are consistent with previous studies and shouldcome as no surprise. And it is these same concerns which, according to those interviewed, will influence their willingness to return.
Eighty percent clearly stated that, given the current security situation in Somalia, they would not be willing to return.

2007-2010

Drought

Economicreasons

Crop failure

Lack ofmedical care

Lack ofemployment

Durable solutions
The future of the refugees in Dadaab has been under discussion
for decades, and there are no easy answers. However, possible alternatives exist for those refugees who are unwilling to go back toSomalia. Potentially durable solutions include persuading the international community to allow more refugees to resettle in a thirdcountry; relocating the refugees to a safer area in camps of amore manageable size; and developing opportunities for refugees
to become more self-reliant and integrated into the country of asylum. Despite the signing of the Tripartite Agreement, these alternative possibilities should still be considered and implemented.

“ The people living in the camp face several challenges. They
have been displaced from their homes and their livelihood has
been interrupted. Living in the camps and depending on donor
aid is a very big challenge. They are exposed to poor sanitation and are highly susceptible to water-related conditions
like diarrhoea, while the dusty conditions frequently cause
upper respiratory tract infections.”
Dr Abdul Malik Wanyama, MSF doctor

Legal aspects of the agreement :The Tripartite Agreement sets the conditions for voluntary repatriation of the Somali refugees. The voluntary character relates toboth the conditions in the country of origin (calling for an informed decision) and the situation in the country of asylum (permittinga free choice). In addition, return must be done in safety – legal, physical and material security – and dignity.
With regards to the obligations of the parties, the country of origin should take all measures to ensure the restoration of full national protection in order to create conditions that foster voluntary repatriation. On the other hand the country of asylum, Kenya, isbound by the obligation of non-refoulement and is obliged to continue to treat refugees according to internationally accepted standards as long as they are on its territory. Within this Agreement the UNHCR undertakes the role to facilitate voluntary repatriation,
which includes providing information and material assistance to the returnees.

Conclusions
The political context has changed rapidly in the past year in Somalia, but the plight of the refugees living in Dadaab has failed to improve. While discussions about voluntary repatriation can beviewed in a positive light, they must not be at the expense of providing assistance and protection to refugees. The reduction of assistance is unacceptable, and could be perceived as putting pressure
on refugees to return to Somalia. It is also counter-productive, as
any further reductions in the level of aid are likely to result in refugees becoming even less willing to return.

While it is understandable that political and security improvements in some parts of Somalia are being welcomed by its
neighbours and the wider international community, conditions
inside parts of Somalia today are clearly not conducive for refugees to return with their safety and dignity guaranteed. For
those refugees who do not take the voluntary decision to returnto their country of origin, assistance and protection must be ensured, while their wellbeing must continue to be the priority ofall stakeholders.

Recommendations► All stakeholders, and international donors in particular,
must ensure adequate funding for providing continued assistance and security in the refugee camps.
► The right of asylum must not be revoked, and proper registration facilities – closed since October 2011 – should bereopened to ensure immediate emergency assistance is provided to all those who continue to seek refuge.
► The Government of Kenya must ensure that refugees areprotected and that security is improved in the camps so that international aid agencies are not prevented from providing assistance to refugees.
► The concept of non-refoulement (protecting refugees frombeing returned to places where their lives or freedoms could bethreatened) must be respected, and any refugees who return toSomalia must do so in conditions of safety – including legal,
physical and material security – and dignity.

“ The reason I left Somalia was because of the warfare. Thesituation is still bad and I am not ready to move to Somalia
anytime soon. If I go back, I will start my life from zero.”
Somali refugee living in Dagahaley campContact
Médecins Sans Frontières
78, rue de Lausanne - 1211, Geneva - Switzerland”

Cover image by Brendan Bannon
All other images by Tom Maruko
Published by Médecins Sans Frontières March 2014