As Kenya counts the human and material cost of the political violence, hospitals are reporting an increase in reported rapes during the immediate post-election period, spurring the government and health organisations to find ways to treat these cases as well as protect the displaced from further incidents of sexual violence.

"In the first two days of the violence, 56 people were treated for rape and admitted; there are so many other victims back in the slums who have not received any medical attention," Lucy Kiama, chief nurse at the Nairobi Women's Hospital, which specialises in sexual violence, told IRIN.

She added that the number of rape survivors seeking treatment at the facility had doubled during the violence. Many women who came to the hospital, she added, reported that there were many more in the slums who had failed to seek treatment because of security reasons or fear of stigmatisation.

Political unrest erupted in many parts of Kenya on 30 December 2007, immediately after the Electoral Commission of Kenya declared incumbent President Mwai Kibaki the winner of the election held on 27 December. Kibaki's main challenger, Raila Odinga, rejected the result and claimed he won the election, alleging it was rigged in Kibaki's favour.

The UN estimates the violence has led to the displacement of 250,000 people across the country, many of whom are living in hastily assembled camps. Health workers have also expressed concern that women and children remain at risk of sexual attacks in these poorly protected camps, especially given that the referral systems that would exist normally to handle sex attacks have broken down.

"Women and children were raped, men and boys as well … it is still taking place in the camps because of the large numbers of displaced people," said Florence Gachanja, national programme officer for the UN Population Fund, UNFPA.

According to Jeanne Ward, an international consultant on gender-based violence, it is crucial that protective measures such as lighting and separate latrines for men and women be set up in the camps to prevent further attacks.

She noted that in emergency situations where the infrastructure breaks down, women and girls tend to be put at increased risk of violence, particularly sexual violence.

"These sexual attacks may be crimes of opportunism, where people take advantage of the breakdown of normal protection mechanisms to rape, or in cases where the war pits one group against another, such as ethnic violence, the rapes may be targeted at one particular group of women and girls," she said, noting that in Kenya's case, it was too early to tell whether the rapes were gratuitous or targeted, although investigations had begun.

"Sexual violence has immediate consequences for the physical and psychological health of the survivor; for instance, they need to have access to post-exposure prophylactic [PEP] kits to prevent them from contracting HIV," she added. "Where people are displaced, it is vital that they know where to go in case they are attacked and that they receive psycho-social post-trauma care."

Taking action

The government and NGOs have begun to respond to the situation, with UNFPA providing PEP kits to medical centres through the Kenya Red Cross Society and other NGOs, and larger hospitals setting up satellite centres in badly affected areas to provide a minimum service to the injured, including people who have suffered sexual attacks.

The Nairobi Women's Hospital, in collaboration with the Psychological Association of Kenya, has opened counselling centres in the slum areas of Mathare, Huruma and Kibera, the areas worst-affected by violence in the capital.

The hospital has appealed to counsellors to volunteer their services for victims of sexual violence among internally displaced persons in other parts of the country, especially in the Rift Valley areas of Eldoret, Timboroa, Nakuru, Burnt Forest and Limuru, and the cities of Kisumu and Mombasa, which were also severely affected by the violence.

Jane Onyango, executive director of the Federation of Women Lawyers in Kenya, cautioned that gender issues must not be forgotten when seeking solutions to Kenya's current crisis.

"In situations such as this, the legal process is hard as it is often difficult for most of the women to identify their abusers," she said. "There is a need for greater collaboration among institutions dealing with women's issues," she added.

Onyango said the federation planned to visit the violence hotspots to assist in the process of conflict resolution and in counselling internally displaced people.

According to Ward, despite the current difficulties, Kenya has addressed the issue of sexual violence and has mechanisms in place that make it better able than many of its neighbours to handle the current situation.

"Nevertheless, there will be a need to create a multi-sectoral response to ensure that beyond addressing the health needs of survivors of sexual violence, security issues are dealt with, the legal process is streamlined and the police have the capacity to handle the cases in a safe and ethical manner," she said.