Hagadera Hospital is a fully-fledged health facility at the Dadaab refugee complex, in North Eastern Kenya. Dadaab, the biggest refugee camp in the world, is divided into three camps: Ifo; Dagahaley; and Hagadera. It is home to over 440,000, mostly Somali, refugees who have fled the famine and drought in their country. According to the United Nations Refugee Agency (UNHCR), 70,000 people fled to Dadaab from Somalia in the Horn of Africa in June and July, and 1,500 arrived daily in the months to follow. The rate has since gone down.
Hagadera Hospital is run by the non-governmental organisation International Rescue Committee, and has 120 beds. It provides free inpatient and outpatient services and has a 24-hour operating theatre for emergency surgery. But despite this, the lives of Somali women with labour complications remain at risk.
The doctor delved further into this issue by stating that, under normal circumstances consent is needed from a patient for a caesarean section. But in Somali culture, this consent must come from the woman's father in-law, and if he is not available, then consent must come from the expectant woman's husband. This, she emphasized, was the complication. A majority of the refugees at Dadaab are women, as their husbands and men-folk either remained behind in their villages to protect their belongings, or were working in the Somali capital Mogadishu at the time the famine struck, and their families were forced to flee the region in search of aid. This forces hospital staff to either send someone to Mogadishu, or to the women's villages in south Somalia, to search for their husbands or fathers-in-law for consent."As a result, we have seen women remain in labour for two or sometimes more days before we get the right people to give the consent for a life-saving operation," she said.
Apart from losing the unborn infants, said Gikundi, the women run a high risk of developing vesicovaginal or obstetric fistula which is caused by extended pressure of the child's head against the soft tissue in the mother's pelvis during childbirth. The tissue eventually dies from the lack of blood supply, and a hole develops between either the rectum and vagina or between the bladder and vagina. Women who suffer fistula are usually unable to control the flow of urine or faeces and are often stigimatised by their communities and families because of their condition. Ms. Gikundi stated that at the hospital, they repair average of three cases of vesicovaginal fistula every month, which is a very high rate.
Delays in seeking care for pregnancy-related complications and in consent for life-saving procedures like caesarean sections, among other reasons, have hampered progress in reducing maternal mortality and morbidity among refugees in Dadaab. This has been evidenced by the death of 14 women during labour at Dadaab, between January and July 2011.Other obstacles to maternal health are the practice of female genital mutilation (FGM), and the almost non-existent use of contraceptives. According to public health experts at the UNHCR, almost all the Somalis at Dadaab practice FGM. Studies in many countries have linked FGM to the increased risk of maternal and child morbidity and mortality due to obstructed labour with research showing that women who have undergone FGM are twice as likely to die during childbirth and are more likely to give birth to a stillborn child than other women.
Another obstacle to maternal health among the refugees is the failure of family planning. The infant nutritional expert at Hagadera Hospital, Hadija Mohammed, said that many Somalis believed that family planning and using contraception was against their religion. "Though, the truth is that Islam clearly permits family planning," said Mohammed. She added that many people wrongly believed that using contraceptives would cause infertility and other health complications. A July survey by UNCHR of the three camps that make up Dadaab: Ifo; Dagahaley; and Hagadera, found that contraceptive uptake among refugees in the camps was 2%, 3% and 1% respectively. As a result, the fertility rate at Dadaab is alarmingly high. On average women here have more than nine children in their lifetime.
On a positive note, UNCHR reports that there is a high attendance of antenatal care clinics with statistics showing that between January and July, 95% of all pregnant women at Ifo and Hagadera camps attended antenatal clinics four times during their pregnancies, as recommended by the World Health organization. In addition, between 84 to 94% of women at Dadaab gave birth under the supervision of a skilled birth attendant between January and July 2011.This, according to Ms. Gikundi, could be attributed to the availability of a 24-hour ambulance service to transport pregnant mothers to hospital, boosted by having informants, who are equal to community health workers, who keep monitoring pregnant women and reminding them of the importance of attending antenatal clinics.
By Isaiah Esipisu
Edited by HERAF STAFF
SOURCE: IPS NEWS