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.

As the high-level mediation efforts continue, hundreds of thousands of displaced people still don't know how long they will have to wait until it is safe to return home. Their lives are effectively on hold, and they are filling their time as best they can.

In Endebese, near Kitale, businesses have begun to spring up inside the camp.  Some have erected makeshift stalls selling vegetables and other food.   Many people have brought their livestock with them to the camp, often preferring to keep them close to their tents for fear of theft – cattle rustling is common in the area.

Sheltering in the shadow cast by one of a few trees I found Morris Sanja, a tailor, busy sewing a seam to a blue skirt. "It was the only thing I could think to bring with me,” says Morris pointing to his sowing machine “it's a part of my life.  I carried it all the way here – 15 kilometres in all. With my sewing machine I can make a small amount of money, I need to support my family – I have five children.  People here have very little money, they will only use my service when they have to and even then I must charge a lower rate to make repairs.”

One of the largest camps has been established in the Show Ground in Eldoret, which would normally be playing host to an agricultural show at this time of year. Inside the camp I met the Principle of the High School, Mr Paul M. Ngethe, surrounded by several men assembling flat-packed school desks. Mr Ngethe had been seconded to the Show Ground after his own school was burned down during the post-election violence.

“We have 700 pre-school children, 2,700 primary, and 510 high school students. There aren’t enough classrooms so the classes take turns using the tents. There are 19 government-funded teachers including myself but we couldn’t operate without volunteers – we have almost 100 volunteer teachers, some from within the camp and others who have come in from outside. It’s not easy to teach in these conditions but now we have these desks it will help the children to concentrate.”

Walking around the school ground, the children appear to have adapted well to their new environment. Some classes are held outside and some in tents, some with desks and others without, but the appetite for learning is consistent.

Filling the long hours in the camp can be difficult and sports such as football and volleyball offer a welcome distraction. At one of the water points I meet Jessie who tells me to come with him to watch the football match that’s currently underway. “We’ve divided the camp into eight teams,” he tells me, “we’re running a full tournament with the final next Tuesday.”

Eldoret is the principle town in central Rift Valley Province, also known as East Africa’s breadbasket on account of the volume of maize and other crops produced in the area. But as time goes on there is a dual threat looming over the displaced population. January and February mark the land preparation season in Kenya and for the majority of the displaced, being absent from their land at such a crucial time is a huge concern. Failure to prepare the land to plant their crops when the rainy season begins is likely to carry severe consequences for longer-term food security, not just locally but throughout Kenya. 

When the rains do arrive, conditions within the camps will deteriorate markedly. Oxfam Public Health Promoter, Wangari, explains: “The rains will turn the camp to mush, mud everywhere, drainage sumps flooded and a much higher risk to people’s health especially respiratory disease and diarrhoea.”

For those with the necessary means: friends or relatives to stay with and money to pay their fare, there is the opportunity for a new life away from the camp. Twice a day a bus leaves the Show Ground destined for Nairobi. Demand for places is high – from its peak of 18,000  the population of the camp has fallen gradually to around 13,000. The bus won’t leave until all the seats are taken and every inch of available space has been packed with what little belongings people have salvaged from the life they’ve now left behind.

As the bus pulled away one of the passengers called through an open window, “There is nothing here for us, in Nairobi maybe we can begin again.”

It is clear that it is not just the Kenyan politicians who are facing tough decisions. For the displaced it is a hard reality: remain in the camp in the uncertain hope that normality will return, or uproot one’s family and leave behind jobs, schools, and friends in search of a new home where they can feel safe.

As violence erupted following the disputed election results, many Kenyans sought protection in police stations and churches. The small Presbyterian church in Makutano, Rift Valley Province, was one such refuge – a safe haven for hundreds of people in the early days of violence. Since those first few days, the sheltering population has largely moved out from the church, setting up camp in neighbouring government-owned land.

Improving sanitation and water provision

I accompanied Oxfam’s Public Health Engineer, Hassannur, on one of his regular visits to the camp. We arrived to find the men of the camp hard at work digging new latrine pits just outside the camp area. Already four or five metres deep, the excavation was still going strong. While one man used a pickaxe, another filled a bucket with the loose earth, and above a third man hauled the full buckets to ground level using a rope tied with knots for extra grip.

“We’re aiming for six metres deep,” says one of the men, “it’s hard work but it gives us something to do.”

Although Hassannur is clearly anxious to get the work finished he seems satisfied with the progress, and we move on. As we walk, he explains the system Oxfam uses in the camp. “We pay each man a small amount for their work. They’re volunteers not employees, the payment is just enough to act as extra incentive.  We also provide all the tools – buckets, shovels, picks – and the building materials. We’ll use a timber frame to support the corrugated iron structure – it has a zinc covering so it won’t rust when the rains come.”

Funded jointly by Oxfam International and UNICEF, this programme aims to bring camp sanitation and water provision up to internationally recognised standards, which have been designed to minimise the risk to displaced people’s health. The race is now on to get the camp up to scratch before work becomes hampered by the impending rainy season.

More latrines are being dug inside the camp, but here several men are shovelling the excavated earth into sacks and wheeling it away in a barrow. We follow one load 50 metres or so and find a large stack of sacks shaped in an oblong. “We’re using the earth to elevate the water tank,” explains Hassannur, “the tank needs to be raised above the height of the taps to create the necessary pressure. Here we’ll use a 10,000 litre bladder tank, enough for about 700 people.” The population of the camp is around 2,000 so I ask what the other 1,300 will do for water. “The church has a water supply but it was sabotaged – the pipe linking it to the water point was cut. We plan to repair the line, only we’ll use galvanised steel instead of rubber so that it’s more difficult for saboteurs in the future.”

Once the water and sanitation infrastructure is in place, Oxfam’s Public Health Promoter, Ester Kabahuma, will work with volunteers to promote basic hygiene and ensure that the facilities are kept clean – a system which has already seen success in other camps. This empowering, integrated approach to public health means the residents of Makutano can have some control over the health of their community, and hopefully remain healthy until they feel able to return home.