Health officials are concerned about the long-term impact of Kenya's political crisis on healthcare, especially in areas hardest hit by violence since the end of December 2007.
"The most worrying issue is that of drug resistance among patients of chronic diseases," Ian van Engelgem, the medical coordinator of Médecins Sans Frontières (MSF), told IRIN on 5 February.
He said HIV and Tuberculosis (TB) patients who had missed out on their regular medication for up to a month due to displacement and violence could develop resistance to the drugs.
"Right now a lot of HIV patients are on first-line drugs; they could require second-line drugs, which are more expensive, if they develop resistance as a result of skipping their ARV [anti-retroviral] medication for a period of time," Van Engelgem said.
The fact that internally displaced persons (IDPs) have better access to healthcare compared with the host community where the camps are located is another concern.
"If IDPs have access to free healthcare, the same should also apply to them [host communities] as they are equally affected by the unrest," Van Engelgem said.
Displaced health workers
Joanne Greenfield, malaria adviser for the UN World Health Organization (WHO) in Nairobi, said displacement and ongoing violence in parts of the country could lead to a crisis in the provision of healthcare in the affected regions.
"The security situation, especially in the Rift Valley [Province], is affecting the provision of health services to the general public as a significant number of health workers are either displaced and/or cannot report to their duty stations," Greenfield said.
WHO, the lead agency for the health cluster of humanitarian actors - comprising UN agencies, NGOs and government organisations - has also expressed concern over the health of thousands of IDPs, mostly women and children, in the Rift Valley.
On 6 February, newspaper reports indicated that chicken pox and diarrhoea had broken out in two IDP camps in Naivasha, a town in Rift Valley Province, which has been severely affected by the violence.
"The number of sites hosting IDPs appears to increase by the day," the agency said in a statement. "Initial WHO assessment has found that these sites are very crowded, with poor shelter, water supply, sanitation (in some camps, toilet to person ratio is 1 for 500), food shortages, no cooking fuel, precarious access to healthcare and shortages of antibiotics, children's medicines, malaria medicines and life-saving drugs for chronic illness. Nearby hospitals are also facing similar shortages of drugs and supplies."
In a worrying development, WHO said, hospitals in the region had reported dramatic increases in cases of sexual violence. The agency said counselling services in most IDP sites were not available, including for reproductive health, sexual violence or HIV/AIDS.
"In many settings, survivors have no access to even the minimum health and psychological support, leaving them vulnerable to a range of potential negative health problems, including HIV/AIDS," WHO stated.
George Mugenya, the medical superintendent of health at the Rift Valley General Provincial Hospital in Nakuru, said services were slowly returning to normal but the displacement remained a key concern.
"When the violence was intense, we put elective cases on hold to handle only emergency cases; now that it is calmer, we are noticing that some services are still affected because of the displacement of some of the medical staff," he said. "Some workers have not reported to duty while others come irregularly and this has affected services such as those offered in the maternity section but, overall, things are returning to normal."
He said the challenge was in re-stocking the hospital's medical supplies and reviving clinic services for patients of chronic diseases.
Teams led by WHO officials visited the towns of Eldoret and Nakuru to coordinate the health cluster activities. The teams visited IDP camps and hospitals to monitor disease outbreaks as well as the availability of medical supplies and health workers.
According to WHO, the biggest worry at all sites was diarrhoea in children as well as acute respiratory infections. It was also concerned about irregular access to malaria, HIV/AIDS and TB medicines, while patients with asthma, hypertension and diabetes also lacked access.
Kenya's Ministry of Health, together with WHO, the UN Children's Fund (UNICEF), the Kenya Red Cross Society and other health NGOs, undertook a joint health assessment on 30 January of Uasin Gishu district in the Rift Valley, which is hosting 150,000 IDPs in 11 camps.
As a result, the medical officer reported that a mass immunisation against measles and polio, as well as the de-worming of children and provision of Vitamin A supplements, would begin in February.
The health officials also discussed the possibility of introducing mobile services for areas where normal services had been disrupted.