As the prolonged and punitive drought continues to ravage various parts of northern Kenya locals are coming to terms with the emergence of strange diseases linked to climatic shocks.
For the regional community, health services are critical to them at this challenging time when they have lost all their livelihood to prolonged and severe drought.
Health infrastructure and rapid disease surveillance missions along the Kenyan northern frontier border with Somalia are important as they will offer border communities solutions to strange diseases and also attend to the health needs of the cross-border communities.
The dream and hope of having such facilities and rapid health response to community needs have been shuttered for many years by threats from the Al-Shabaab terrorist group which is affiliated with Al-Qaeda and based in neighbouring Somalia bordering Kenya.
Fafi sub-county in Garissa, Kenya, is the epicentre and flashpoint of the past numerous Al-Shabaab attacks.
The presence of well-trained local Al-Shabaab sympathizers roaming the expansive sub-county that borders Somalia has exacerbated the disruption of social, Economic and health services in the region and contributed to general fears in some other parts of the County.
Fafi sub-county hosts the Hagardere refugee settlement which is one of the refugee camps that forms the Dadaab refugee towers.
The sub-county's close proximity to Somalia has made the terrorist group use the area as an entry point to Kenya and also smuggling routes for its fighters, weapons and sneaking recruited youths from Kenya into Al-Shabaab training bases in Somalia.
At Diiso village in Fafi sub-county, locals experience the disruption of health and other services by constant threats by the Al-Shabaab group and the closure of the only health facility in the far-flung drought-ravaged village.
The community member at Diiso village meet twice a day to deliberate problems grappling with their village and also suggest and deploy solutions that might alleviate suffering and address rising cases of strange diseases and other critical services like maternal health and primary health services.
They also address referrals made from their village to Garissa level Five hospital and handling of health emergencies.
In one of their village meeting, community members talk in a low tone as they check the presence of an outsider in the meeting space or any suspicious movement within the vicinity of the meeting.
The fear and community surveillance of’’ outsiders’’ is caused by complex fear, threats and systematic network Al-Shabaab manages or operates in the far-flung Kenyan border village with aim of expanding their terror leverage.
Community surveillance involves community members checking the road that leads into and going out of the village and a woman member checking areas within the meeting space for any movement of an "uninvited person or newface’’.
Diiso village is among the areas that witnessed large-scale Al-Shabaab attacks where their health facility which was providing services to two thousand people was hit by a rocket-propelled grenade.
The attack which also raised the fear that the terrorist group will abduct non-local health officials led to the authority evacuating the personnel to safety.
"It was on December 2019 that Al-Shabaab fighters attacked Diiso health facility using heavy weaponry. It’s the only health lifeline we had and it was hit by a rocket-propelled grenade,’’ stated Mr Abdi Hanshi an elder and a member of the community meeting space.
According to a nurse who was working in the Diiso health facility, the attackers surrounded the facility compound and started hurling grenades.
Later on, huge sounds were heard and they later learnt it was from rocket-propelled grenades.
"I was out of the health facility when I heard the sounds of an explosion which was followed by a huge bang. Since I was non-local working as a nurse in the area, I knew I was a key target for Al-Shabaab and decided to take cover in one of the houses in the village. Fortunately, after the attack, they moved around the village with aim of showing their strength and they fled the area," claimed a non-local health staff who sought anonymity.
The attacks at Diiso village also saw the Al-Shabaab attackers targeting the telecommunication mast which provides seamless communication and information sharing between communities, government agencies and health services which coordinate emergencies and referrals.
Local observers claim that the Al-Shabaab group understand the strength and capacities of Kenyan multi-agency forces in northern Kenya and hence deployed their trick of cutting communication between attacked villages and multi-agency command centres based in Garissa and other sub-county headquarters.
"You have to know Al-Shabaab is a dangerous rag-tag terrorist group and they fear engaging the Kenyan multi-agency forces. They target telecommunication masts so as to disrupt communication and information exchanges between the attacked villagers and security command centres," Averred Mr Khalif Hussein, a member of the Garissa human rights network.
Mass exodus of non-local health officials operating in the border areas and withdrawal of local health officials has forced some community members to seek primary health services from neighbouring border towns of Somalia.
Mr Hussein Olow, a taxi operator and cross-border trader has made fortune by ferrying patients from Amuma, Kenya to the Somalia side of the border where Kenyan patients get health services from Somalia's health personnel and facilities.
The cross-border trader who operates a Probox vehicle plies various routes likeAlinjughur – Amuma route and Amuma -
Somalia route where he ferries goods and people across the border.
Mr Ali, the cross-border trader understands the border terrain well as he was born and brought up in Kenyan border village ofAmuma.
He has been in the cross-border business for five years now and working closely with security agencies in ensuring he complies with all necessary border checks and compliance from various Kenyan security agencies manning the border routes and sections in the Amuma border frontier.
"The cross-border communities share the same language; they hail from the same community and clan and what separates them is the border between Kenya and Somalia.
"But also, other dangerous people can take advantage of the porous border and sneak into the country and causing insecurity. As cross border community work and cooperate with security agencies and also report any suspicious movements along the border.’’ Divulged MrAli, the cross-border trader.
From the Amuma border point, Mr Ali makes one trip per day and he ferries ten passengers most of them crossing the border to seek health services.
"Out of ten passengers crossing the border from Kenya into Somalia in Amuma, almost seven are patients seeking medical assistance from Somalia side of the border,’’ revealed Mr Ali, the cross-border taxi operator.
On the Somalia side of the border, the patients are attended to by Somali health professionals who offer a range of health services like laboratory, health consultation and treatment.
The Kenyan border town of Amuma is among other border or far-flung towns whose health facilities have shut down, partially opened but offering no services and others operating with no medical personnel.
The other affected areas in Fafi and Ijarasub counties of Garissa are Galmagala, Bula Golol, Bodai, Elkanbere, Yumbis, Haji Jimay, Deka Harja and Diiso which offered rural health services to the community.
Other community members in the far-flung villages are using the services of traditional healers for treatment and medical advice.
The traditional healers collect medicinal plants from sections of the expansive Boni forest and produce medicinal products that treat various ailments and diseases.
Boni forest straddles Lamu County to Ijara sub-county with a larger section of the forest found on the Somalia side of the border.
Collecting medicinal plants, tubers, roots and leaves from the forest come with a huge cost as they have to arrange their security and transport and also seek clearance from forest authority.
"Locals complain that some of our products are expensive but we [traditional healers pay a lot of resources to cater for our security and transport. The forest cuts across Kenya and Somalia and hence the presence of Al-Shabaab fighters have been reported in some section of the forest. So, some products are expensive and others are sold at reasonable fees," Divulged Bashir Kunow, a traditional healer.
The traditional healers conduct community and patient consultations based on symptoms and explanations; the healer uses indigenous knowledge in diagnosing the patient.
"I use indigenous knowledge and skills transferred to me by my late father and for the last five my traditional health services are much sought by the local communities because of the closure of dispensaries and other health facilities due to Al-Shabaab threats and attacks," said Mr Kunow, a traditional healer.
The regional expert from northern Kenya stated that both the Kenyan national government and the devolved unit need to come up with a strategic inter-governmental action plan to address the disruption caused by violent extremism.
"Yes, there is a sound relationship between national and county government but much more need to be done in northern Kenya. The strategic inter-governmental action plan is needed so that national government can intervene and assist in addressing disruption of health services,” observed Asha Abdi of Horn Afric consultancy group which works on the development and anti-violent extremism matters.
Mrs Asha further stated that health issues are part of devolved services while security which involves neutralizing Al-Shabaab attacks and expansion is a responsibility entrusted to the national government.
"Extra cooperation and coordination between national and devolved units are needed in taking health services to frontier border regions and centres,” continued Asha.
Garissa county health Executive Ahmed Nathir acknowledged the challenges of insecurity and the mass exodus of health personnel which led to the closure of health facilities in the border areas and far-flung villages.
"Well, the challenges are there and the new county administration is working with national security agencies and other partners in ensuring the facilities are opened and running. The county government has procured medical equipment and other stuff for dispensaries and health facilities," divulged Ahmed Nathir.
The Garissa County administration is also encouraging local students to take medical courses and bridge the gap left by the mass exodus of non-local health personnel.
However, Northern Kenya regional commissioners stated that the national government is working closely with the Garissa County Government in ensuring seamless service delivery and maintenance of law and order.
"We have deployed security forces to protect key critical facilities like health dispensaries and telecommunication masts,’’ stated Northern Kenya regional Commissioner James Kianda.
The regional boss further urged the county government to ensure health staff hired by the county show full commitment to serving rural and remote areas of Garissa County.
"The security is already there but again some health personnel have problems offering attitudes of fear and insecurity. Garissa County government should get a full commitment that the health staff are ready to serve in hard-to-reach areas.
"The government has set up a security camp near health dispensaries in rural Garissa and no point of alarm is arising from past insecurity issues,’’ stated the Northern Kenya regional boss James Kianda.