Journalist And Author Natnael Gecho Betalo At The Entrance To Kakuma Refugee Camp In Turkana County Kenya
Kakuma to Nairobi: The Two-Front War for Safe Motherhood Among Ethiopian Refugee Women. (The Maternal Healthcare Crisis for Ethiopian Refugees in Kenya)
By Natnael Gecho Betalo, Journalist (Ethiopian Journalist in Exile)
Funder: Wits Centre for Journalism
The journey to motherhood is universally challenging, but for Ethiopian refugee women in Kenya, it is a gauntlet run in the shadow of displacement, trauma, and systemic neglect. Whether navigating the overcrowded, arid confines of a refugee camp like Kakuma or struggling to survive in the informal settlements of Nairobi, their fundamental right to safe, dignified maternal healthcare is routinely undermined.
This investigation, supported by the Wits Centre for Journalism, uses a mixed-methods approachto expose the profound barriers faced by this vulnerable population. Through the raw, compelling voices of refugee women and the sobering data from humanitarian and legal experts, a singular truth emerges: the very systems designed to protect them often fall short, forcing them to rely on the fragile bonds of community for survival.
Context: Displacement and Demographics
Kenya hosts a significant displaced population, and within that, Ethiopian nationals form a major group. As of October 31, 2025, the total Ethiopian refugee and asylum seeker population in Kenya stands at 43,808, comprising 29,026 registered refugees and 14,782 asylum seekers (Source: UNHCR Kenya Operational Data Portal – October 2025). The reasons for their flight are grimly consistent: conflict, persecution, illegal arrest, and life-threatening political situations, as one refugee, Eya Kidane, attested.
The host country’s overall refugee population is substantial: out of 864,693 total refugees and asylum seekers, 747,333 live in camps and settlements, while 117,360 reside in urban areas such as Nairobi. Kakuma Camp, located in the remote, hot desert area of Turkana County in northwestern Kenya, is a primary destination, hosting over 200,000 refugees from various countries. The stark reality of their living conditions like the “very dirty” houses in Kakuma described by one interviewees forms a constant backdrop to their health challenges.
Voices from the Margins: Camp vs. Urban Realities
The experience of maternal healthcare access diverges sharply between women in a designated camp and those in an urban centre, yet the core struggle for adequate care remains a devastating common thread.
The Camp Conundrum (Kakuma)
For women like Aysha Mohammed and Meaza Beyene, both residing in Kakuma, the services are theoretically free, but accessing quality, continuous care is a persistent nightmare.
- The Appointment Trap and Lack of Follow-up: Aysha Mohammed detailed a gruelling three-year ordeal of weekly follow-up appointments at the camp medical centre for a serious, “unknown disease.” She described a system where doctors “shift every week” and appointments are perpetually delayed or misplaced, preventing her from getting a referral. They tell her to come next time, when she goes in the following time she doesn’t find the one who gave appointment.
- Life-Saving Community Solidarity: Aysha’s salvation came not from the humanitarian system, but from her fellow refugees. After losing hope, the community leaders rallied, with “many refugees living in camp contributed to save my life,” raising seven hundred thousand Kenyan shillings in a single week for a life-saving surgery at a private German centre in Nairobi.
- Gaps in Care and Environment: Meaza Beyene acknowledged the initial relief of a “free” service, but highlighted critical gaps: “no nutrition management,” “no house to house follow-up,” and the dire need to change the crowded, unsanitary living environment after childbirth, which “exposes mother and new born children to a different disease.”
The Urban Price (Nairobi)
In Nairobi, women like Eya Kidane and Ezra Elka trade the overcrowding of the camp for the financial burden and legal precarity of the city.
- Financial and Information Gaps: For Ezra Elka, the biggest issue is cost. “In the city, there are no free services for me.” The necessity of choosing between buying medicine and buying food for her family underscores a profound ethical dilemma. Eya Kidane confirmed that while free services exist for urban refugees, they often face “shortages of specific medicines or medical equipment,” forcing them to buy items from the market without any income.
- Legal Status as a Barrier: Ezra’s asylum seeker status, pending for eight years without refugee determination, became a direct barrier to accessing care. Her application for free service was denied because her initial registration location was a camp, not Nairobi. This fear is a constant inhibitor: “I live with a constant fear of being arrested or deported. This fear prevents me from seeking care when I need it most.”
- The Information Void: Unlike in the camps, urban refugees lack a guided support system. Ezra noted, “It is difficult to get accurate information about what services are available to me and where to find them… I have to rely on my own networks or on word-of-mouth.”
Language, Trauma, and Systemic Failure
Across both settings, the impact of language barriers and the trauma of displacement on maternal healthcare is severe.
- The Communication Breakdown: Aysha Mohammed’s experience “There is no translator when I went to a medical centre all time, I couldn’t even understand what they say, I could not express what I feel exactly” is a direct indictment of the clinical setting. The lack of culturally and linguistically sensitive care leads to “many people not getting proper service.”
- Unaddressed Psychological Impact: The profound stress of displacement from the loss of immediate family due to political violence (Aysha) to the constant fear of being an undocumented minority (Ezra) is a major health factor. Yet, psychological support and counselling are minimal and lack continuity due to language barriers and a reliance on fleeting appointments. Meaza Beyene stated plainly that the “mental health support is often not enough to deal with the trauma of displacement.”
The Legal and Policy Disconnect
Alan Kigen, an advocate of the High Court of Kenya, provided critical legal context that highlights the gap between policy and practice.
- Legal Rights vs. Reality: While the Refugee Act, 2021 and the Refugees (General) Regulations, 2024 legally enshrine healthcare as a right for all refugees, the reality is starkly different. Kigen notes that services are “undermined by donor funding shortfalls, shortages of reproductive health supplies and staff,” and “inconsistent gender-based violence (GBV) clinical services.”
- Systemic Barriers: Kigen pointed to chronic issues that compound the healthcare crisis, including complex and slow administrative processes for status determination and documentation, which delay access to services, and the fear of rejection and reprisals that discourages women from reporting abuse or seeking legal remedies.
Even the UNHCR‘s “Global Strategy for Public Health 2021-2025” candidly acknowledges these barriers, citing “financial costs, long distances to health facilities, and social barriers like language differences and discrimination.” The formal commitment to the “highest attainable standard of physical and mental health” provides a policy-level benchmark that the refugees’ lived experiences consistently fall short of.
A Call for Solutions-Focused Action
The women interviewed were clear in their recommendations, urging a shift towards a more responsive and accountable system.
The single most important change advocated for by Aysha Mohammed is the establishment of a “strong and organized feedback giving system” with a “direct system where the refugee women provide their complaints regularly.” This call for accountability is echoed by her demand that “high officials must have a continuous follow-up system.”
Further recommendations point to the necessity of empowering refugee-led organizations to improve services and to addressing basic needs, such as changing the “dedicated postpartum shelter” “house women living” in Kakuma to save mothers and newborns from preventable diseases.
The collective testimony of Ethiopian refugee women in Kenya reveals a maternal healthcare system strained to its breaking point, where displacement and its after-effects are poorly mitigated. Their story is a powerful call to action for humanitarian organizations and the Kenyan government to bridge the profound gap between the promise of protection and the harsh reality of their daily struggle.
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