Providing the right assistance to people displaced by violence requires a clear understanding of their needs. Oxfam's Tom Baldwin reports on a Community Health initiative in western Kenya.

Noigam camp in Churangeni district is a 90-minute drive over rough roads from Eldoret in Rift Valley Province. Since the post-election violence it has become home to almost 7,000 displaced people, largely of Kisii ethnicity with a minority of Kikuyu. Since the camp was formed, agencies including Oxfam have supported its residents with such things as building latrines and washing areas, ensuring safe water supplies, and distributing shelter materials.

Today, Pamela and Michael, two of Oxfam’s Public Health Promoters are organising what’s known as a baseline survey, to gain a clear understanding of the issues still effecting the health of the camp’s residents. They are enlisting volunteers from within the camp population to carry out the survey which Oxfam is running with its local partner, the Kenyan Red Cross.

Pamela and Michael have already spent two days training the volunteers in hygiene promotion, which covers basic hygiene awareness, and how to guard against diarrhoea, malaria, and other serious illness. In carrying out the survey, the 15 volunteers will conduct a total of 90 interviews with ten per cent of the camp’s households chosen at random.

Volunteer Dominick is interviewing 20-year-old Mary Kwamboka and her 18-month old son. He works diligently through the questionnaire, covering water collection and storage, washing habits, latrine facilities, and any instances of ill health. After 25 minutes, the interview is complete.

“It went well,” says Dominick, looking relieved. “It’s important that we know what problems people face, so then we can understand how we can help with solutions. I myself am just waiting for my high-school results, if I do well I hope to train to become a doctor, so this is good experience for me.”

A few tents away, Ruth has just finished interviewing Ester Moraa and her daughter Dorca Kerubo. Each tent is made from a white tarpaulin suspended in the middle by a long cord, which provides the structure for the whole row of some 25 dwellings. Inside, Ester and Dorca each have a baby on their knee, and to one side Dorca’s five-year-old daughter is asleep on the tarpaulin floor.

“There are three generations of my family living in here, nine in all,” says Ester, “the men sleep in another tent.” her gesture suggesting they are some way away. “We come from Geta, five kilometres from here. We had a home and some land to farm but they’re all gone. They burnt everything; our house, our land, even our latrine is gone. We left with only the clothes we were wearing.”

“What we need is clothes for the children,” explains Dorca, “and food, we have no milk or protein substitute for the babies.”

We have been talking for five minutes or so when Dorca’s daughter lets out a wail and wakes abruptly from a nightmare. “She’s been like this since…” Ester doesn’t complete her sentence but smiles and strokes the young girl’s arm in reassurance. I knew that many of these families must have witnessed horrendous violence before reaching the camp, but this was the first time that I had any real sense of the psychological cost they bore.

Better equipped to support the community

A few days later the surveys are complete and the results assimilated. Incidences of diarrhoea are frequent; a problem often associated with overcrowded, unhygienic conditions. Water storage is also a big concern, with many households using dirty containers. Latrine use is also shown to be a problem – not during the day, but at night there are no lights so children in particular are reluctant to use them.

The results of the survey show that mitigating the risk of ill health in the camp is not simply a matter of supplying the hardware. Behavioural factors are just as important. The residents of the camp are not used to living in these basic conditions, and must adapt their way of life accordingly, which is why mobilisation of Hygiene Promotion Volunteers is such a strong initiative. In carrying out the survey, the volunteers have confronted many issues that they may not have previously been aware of, and as a result will be much better equipped to support and advise the community.

Michael and Pamela now have the data they need to provide guidance to the volunteers in delivering a public health programme specifically designed to meet the needs of this particular camp, and tackle head-on the most serious threats to community health. In every camp the issues threatening the residents health will be different, but through community participation Oxfam can ensure that it is accountable to the people it aims to help, and that solutions are not imposed but designed and delivered collaboratively.