Residents in a camp for displaced persons in Nakuru, in Rift Valley Province, western Kenya, were deeply shocked when a gang of men attacked and sexually assaulted five boys, but the health officials dealing with sexual violence during the recent political upheaval have had to become immune.

"Since the violence started we are seeing similar numbers of cases to what we would normally see over the same timespan, but there is one major difference: 90 percent of the cases we are seeing since the political crisis began are gang rapes," said Lucy Kiama, head of the Gender Violence Recovery Centre at the Nairobi Women's Hospital. "The gangs range from groups of two men to as many as eleven."

An estimated 300 women have been treated for rape since the year began, many of them women and girls who had travelled from Rift Valley Province to the capital, Nairobi, often a journey of hundreds of kilometres that could take many hours by bus.

The women usually arrive too late for post-exposure prophylaxis, which can prevent HIV infection following exposure, but receive post-trauma counselling and treatment for other injuries. For a few weeks, roadblocks on the highways linking Nairobi to the Rift Valley also prevented many from travelling to hospitals for treatment.

Kiama said she could not rule out the possibility that these gang rapes were planned and ethnically motivated, but said they were also likely crimes of opportunity carried out by men taking advantage of the lack of proper security.

According to Jeanne Ward, an international consultant on gender-based violence (GBV), the spike in gang rape in a situation as violent as Kenya was at the beginning of the year was not unusual. "Most violence is carried out in gangs during times when there is a breakdown of law and order, so gang rape is merely a replication of the other kinds of violence using the same methods," she said.

"There are always pre-disposing factors with the kind of sexual violence we're seeing in the camps, such as a lack of respect for human rights, a sense among perpetrators that it is okay to do it," Ward said.

"However, there are also exacerbating factors in play, such as alcohol abuse, close camp quarters, men whose traditional roles have suddenly changed, limited security - these also create an environment where rape can become common. The basic fact is that they know they are able to carry these crimes out with impunity," she added.

"Legal redress may be available in urban centres like Nairobi, Mombasa [Kenya's port city] or Nakuru, but in the rural areas there is no way women have access to legal services."

Another common thread in many IDP camps is the sexual coercion and exploitation of girls and women by people in positions of responsibility or power.

An interagency assessment of GBV reported that in the early stages of camp development at the Nakuru showgrounds (an agricultural exhibition facility), community members reportedly took girls from the camp to serve as domestic help, likely increasing their risk of sexual exploitation.

The same report said women had stated that men in the community around the camp set up on the showgrounds at Eldoret, another town in Rift Valley Province, were inducing girls to leave the camp with the promise that they would "eat something sweet".

"In some cases, team leaders responsible for handing out food have been making girls give them sex in exchange for the food they are actually entitled to," Kiama said. "So even when the sex is consensual, it is often survival sex - the girls and women don't feel they have a choice."

Psychological first aid not sufficient

She noted that many women appeared to be in a state of shock. "The kind of trauma we are seeing is different; not only are these women raped, but many have lost loved ones, land and property, and suddenly find themselves in the strange surroundings of an IDP [internally displaced persons] camp.

"What we are giving them is a kind of psychological first aid, but handling these cases will necessitate long-term care, but as many of the IDPs are still moving from place to place, this will prove difficult," Kiama said. "One woman came here so traumatised she did not speak for several days - she needed speech therapy; others are suicidal, and others want revenge."

Besides the physical health risks of these crimes, such as HIV and unwanted pregnancies, the long-term psychological health of women who had been attacked was also at risk. "There is still so much IDP movement, and we have no way of tracing these women to provide them with the longer-term counselling they will need," she added. "These are going to be the long-term consequences of this violence."

Improving protection

The continued rape and sexual exploitation has highlighted the need for better protection of women and girls in the camps. In response, several organisations, under the umbrella of the United Nations Protection Cluster, have come together to ensure that new camps are constructed with separate toilets for men and women, sufficient lighting and more organised sleeping quarters.

Kenya's Red Cross Society has been running seminars on GBV. "We were taught about the Inter-Agency Standing Committee [a mechanism for coordinating humanitarian assistance by key UN and non-UN partners] guidelines [on gender-based violence in emergencies]," said John Mbugua, coordinator of health service at the Nakuru IDP camps, whose team also attended.

"After the seminars we formed groups where we could start spreading the message and see how we could protect people." The guidelines outline preventive and curative measures for dealing with GBV in IDP camps, including providing activities for bored young people such as sports, and income-generating projects to keep older men and women busy and able to support their families.

Other initiatives include sensitising camp residents to the inhumanity and risks of sexual violence, strengthening the legal system, and ensuring that the police and other staff handling sexual assault cases were properly trained.

Now that President Mwai Kibaki and his erstwhile rival, Raila Odinga, have signed a political settlement, it is hoped that the IDP camps will be disbanded and Kenya's 600,000 displaced people will return to their homes.

However, camp officials in Nakuru said so far few people had left the camp and many would remain until the government could guarantee their safety or provide them with alternative homes.