Kenya Update on Sit re Sexual Violence - Response of NGOs, women leaders..
Here is a detailed update of situation in Kenya from Nairobi. with brief update on key needs of women/NGOs and children related to ARV access and services related to sexual violence:
I am in Nairobi for just 1.5 days, but had chance today to speak to some key people involved in responding to crisis in Kenya. Today the situation is calm, but there is obvious concern and great nervousness about today's announcement that the opposition will go forward with rallies across the country next week. This is when students are back in school, and often the student protests are violent. So women's groups are asking a key question: How can they learn from past two weeks and try to mitigate/prevent further attacks on women and children/service gaps due to displacement, etc?
First the women's leadership response:
I spoke to women from Urgent Action Fund who were meeting at the hotel I am staying in. They included Ann Njogu, Vicky Karimi, many of the key human rights organizations. They have drafted and will issue (may have done so by now) a strong statement about peace-building and the response of women to the violence and the need of government to take actions to protect civilians.
Many of the people I spoke to today seem to consider that police and militia (loose gangs affilicated with diff ethnic groups) are responsible for the violence.. in other words, it's targeted and much is caused by the police. This is an important thing I learned.
I spoke to Millicent Obasa of CARE who formed Concerned Women for Kenya, a loose group that went around to intervene and find raped women and helped get them into groups and into care if needed. This new group remains very active around the sexual violence issue.
i also spoke and met with Rebecca Owiti of WOFAK, the voluntary home-based care worker in Kayole estate, a slum area with many WOFAK members with HIV. I provided her with some supplies and got an update about WOFAK. She reports that most of the WOFAK members now can access ARVs, but food remains the critical challenge. As many of you know, Rebecca's husband was killed and she is left with three one-year old triplets. Her own personal needs are high, so please, if you can, reach out to support her.
We talked about the possibility of positive women in diff groups documenting this period, for a possible report at the Mexico AIDS conference. This will be discussed in coming weeks.
The ARV situation: The National AIDS Council members and key NGOs met yesterday and have done a situation assessment of HIV services, and put diff groups in place to try to respond. The main issue is not that ARVs are lacking at public health centers in Nairobi, but that people cannot access them or could not when the violence was ongoing. So there are people who have not gotten ARVs because they were due to return, but many people get a one-month supply so this issue -- in Nairobi -- may not be as serious re treatment interruption as some worried.
That said, many people were unable to access medicine, or were displaced during the recent violence, and many are in Internally Displaced Camps where they may not have easy access to ARVs for many reasons. They need their medical records re ARV tx, and provide evidence of their need, etc. so are challenges. But there are ARVs - it's just a question of how to get people to the clinics.
MSF is active, and has been going into poorer communities, to try to assess the problem. I spoke with Monique Tondoi and Ian Van Engelgem, program coordinator for MSF in Kenya. They find that it's difficult to know how many or /why people have not come for ARV services, but this is an impt issue going foward: how to create better linkages in the slums, so people can keep accessing ARVs. Today I met the HIV coordinator for MSF and his main colleagues who are involved in treatment education. There is broad acknowledgement that the situation in rural Kenya is very different from Nairobi. Re how to improve access, we talked about one strategy: to more actively map which groups like WOFAK and KENWA are active in which areas, and establish active contact or better direct linkages between MSF or doctors at the clinics providing ARVS and the NGO home-based care workers/ key social workers, especially home-based care outreach workers.
Re PEP, there were very few requests for PEP, and to date MSF has offered ARV to 59 people. They do not know what is happening outside with other groups, but this is their figure. PEP is available, but the issue is: no women are demanding it. The reasons are outlined below. The issue of stigma of rape is a factor to consider.. going forward: where do women feel SAFE to receive emergency services. Some would suggest h aving the rape crisis counselors be in the NGOs where the women feel safe. They may continue to avoid rape centers or hospital due to stigma.
Scope of Rape/Sexual Assaults: The newspapers yesterday reported 1200 rape cases in recent post-election violence, but the general estimate I heard today from the HIV crowd and the women at Nairobi Women's Hospital is that REPORTED cases are 1600 women and children -- and also men. But these are the reported cases. WOFAK, CARE, Urgent Action, MSF and officials at the Nairobi Women's Hospital acknowledged that typically women who showed up talked about how many women they had left behind in their areas who were raped and staying in their homes.
The majority of rapes are gun shots. But so far,there are few cases requiring fistula surgery in Nairobi hospital to date.
There is a high % of rape of younger girls/children. BEFORE this wave of violence, the Nairobi Women's Hospital had 45% of their rape cases involving young children. In recent weeks, they had somewhere around 70 people, but they know that this is not right. For this reason, they have opened four rape crisis centers in slum neighborhoods, and are working actively to get into houses to find where women and children are keeping refuge, and also looking at the IDP camps. The food and access to waterneeds at IDP camps are severe.
I met Charlene Smith this afternoon, working with Urgent Action. She had prepared a small questionnaire-- sort of a check list of questions related to sexual violence - for the IDP camp workers as there is no protocol /document in place to know what /where people who experienced sexual violence have gone for help etc. She hopes to refine this document.
Actions: I reviewed the protocol at Nairobi Women's Hospital for rapid reponse to sexual assault. I also shared the modules I had with me developed for Rwanda by WE-ACTx on Trauma, Managing PTSD reactions, and mental health , using base source materials from Hesperian foundation and other health educators. I also shared a new legal advocacy handbook based on telling people about their basic rights related to health care. We also talked about the need - and gap -- of integrating a legal /human rights documentation aspect to the rapid response protocol so there is a body of evidence gathered when women show up at clinics to help them later. These documents were strongly welcomed.
We talked about integrating a few questions related to the essentials that shou;ld be asked by doctors/staff at clinics/IDP camps. I suggested a possible template questionnaire that could be created now and widely dispersed, shared with NGO staff /communtiy outreach workers going into homes, in order to standardize/document the info being collected, so this can be of use in future possible legal advocacy. The key issue is providing the grassroots and home based care workers with tools, as these are the contact people for women/children in their homes.
NEEDS: The Kenyan women are interested in anyone who has a protocol for rapid reponse that is for communty /local outreach workers use, and might include the few things one would want to ask/document to help provide an evidence base for the crime of rape. So if you have this, please contact me off the ITPC list, and I will pass on to the different contacts who are looking for other examples out there.
If any of you are in Botswana, where I know there is a multiservice rape center serving all NGOS in an area, we would like to learn from that model and share with Kenyans.
This picture above relates primarkly to urban Nairobi. In rural areas, the situation is very different, and quite bad. There are many people in IDP camps, and displacement and FOOD needs remain urgent. There is little info related to demand for or provision of PEP. In general, MSF and providers suggest that IF women come to report a rape, it is often after the 72 hour period.
The other NEED: modules for Trauma support for CHILDREN and FAMILIES. This includes any interventions aimed at the schools, in order to help the children who have been attacked reintegrate or be supported in school.
In Migori, Leah Okeyo, who joined me in Nairobi today, outlined a difficult situation where people are afraid to travel outside of certain areas. The issue of insecurity made it difficult for people to seek medical services.
There, ARV access was disrupted at district hospitals. Staff were sent home and people in one HIV ward were sent home as there was no way to protect them. At St. Joseph's Mission hospital, services were open but people were not coming to get HIV drugs due to insecurity.
Leah also suggested that medical providers give more than months supply of ARVS, to avoid the problem of interruption. But MSF staff felt that, as much as this might be a good step, it did not fit in with the Kenyan protocol of monitoring ARV use, so was unlikely to happen.
The Nairobi Women's Hospital needs the following things urgently. Some of them (non medicine) can be directed to the Red Cross, which is working with them. These items include antibiotics, blankets, clothes, and food -- and of course, funding to meet the increase in service delivery.
The hospital and the rape crisis centers and IDP camps are also in urgent need of: women's sanitary pads (Always brand is most popular), or if not available, tampons, and women's underwear. These can be directed to the women's hospital Sexual Violence Unit. They also need basins for water and cloths at the IDP camps.
Volunteers: there are plenty of doctors who have responded to the crisis in Kenya, but there is an urgent need for trained trauma counselors, and those with rape crisis program implementation.
I discussed the strategy of having a mobile corps of trained trauma counselors who could rapidly train outreach workers at community based NGOs like WOFAK to help them support the women and families where sexual assault has happened. This idea was welcomed and actively discussed. To date, there are some trauma counselors in Kenya, but at NWN and in other agencies, the general feeling is that there hasn't been this level of need and the sexual violence hasn't been related to political violence in the way it is now, creating different dimensions.
There is also a need for Child-based best practice initiatives to learn from that could help with the children who have suffered these physical attacks.
The other issue is that the FOLLOW UP of clients is not as clear. They work with NGOs, but there hasn't yet been a strategy of referring people into support groups or creating support groups for the children, families, parents -- this is a next step. I shared what the groups in DRC and elsewhere have done that I know about, and the WE-ACTx model. Again, there is a desire to learn from what others out there have done in similar situations of war.
Going forward: there is a plea for the global HIV community, for groups and leaders to SPEAK OUT, loudly, and to please do so IN SUPPORT of the Kenyan women.. but not just to issue statements from NY and do nothing more.
There is an urgent plea from some Kenyan women leaders for us to ACT by coming to Kenya: for world and women leaders with experience in peace-making to COME here and meet with political and civil society leaders, to provide support to women leaders and the NGOs, to bring resources and share field strategies -- in an effort to avert further violence. There has been criticism of politicians who have come in and flown out after failing to mediate, and a request for those with experience in peace-making, and disaster response, to help in Kenya.
I will keep you posted on other developments.
Finally, I suggested to some pf the women leaders /colleagues that they consider setting up a website or central list to centralize and share updates, needs and strategies. I think this will happen, and be discussed tomorrow a.m., and I will keep this list informed.
FYI: Leah Okeyo has started a discussion group on PulseWire to talk about how to help network and support Kenyan women. If you wish to join, go to www.beta.pulsewire.net and use the password: voices. After signing in, go to Community in the navigation bar, and you will find the Join a Group link. You will be notified of any new comment. Leah is actively inviting Athena, ICW, ITPC and PATAM members to provide their views to her, and suggestions for how to address future challenges around ARV access.
Finally, I interviewed with Ann Njogu, a lawyer who ran for Parliament recently, and a well known human rights figure. She talked passionately about the need to promote the fact that Kenya has a Sexual Offences Act, has a Constitution, and that everyone must promote upholding of the rule of law in Kenya. There were other discussions, including the need to immediately mobilize more stakeholders in diff communities, including prominent male leaders, to speak out against the sexual violence which is being carried out a lot at the police, and for this to possibly happen via PSAs on radio and television.
Within all of this, groups like CARE are active, hoping to fund any new activities and help map and assess the situation. AMPATH is also active and has mapped who is doing what, esp outside the capital and major cities.
So, having summed this up, my suggestion for those of you reading this is to take a small action this weekend: on behalf of your organization, let the GOR Kenya know that govt has a role to protect civiliians from sexual violence, that police must respect the law, that your groups support democratic rule in Kenya, and speak in solidarity with women's groups.