Providing HIV care in the aftermath of Kenya's post-election violence Medecins Sans Frontieres' lessons learned January – March 2008

Following the disputed presidential election in Kenya in December 2007, widespread violence broke out resulting in an estimated 1500 people killed and 600,000 displaced from their homes.[1] Although problems had occurred during previous elections, this level of violence was unprecedented in Kenya, a country regarded as a model of democracy and stability. The rapid escalation of events caught many services off guard, and health care was significantly disrupted.The violence was particularly severe in Kibera, a large slum near Nairobi where Medecins Sans Frontieres (MSF) has been operating three primary health care centers. Medical services in these areas were rapidly affected and there was concern that patients with HIV, in particular, would be unable to obtain their medications, resulting in treatment interruption. The problem was compounded since many patients and health care staff had returned to their home villages to vote, and were prevented from returning to Nairobi due to the violence.MSF's three clinics in Kibera had been providing comprehensive primary care in addition to full HIV services, including Highly Active AntiRetroviral Therapy (HAART) for several years. By the end of 2007, 5200 patients were enrolled in the HIV program and 1800 were on HAART. [2]This report describes MSF's response to the challenges of providing HIV services in Kibera slum during the post-election violence. The experience produced some lessons learned that could apply to other contexts that are generally stable but where violence or disorder may be anticipated.Kibera is home to approximately 800,000 people, many of whom are transient and without regular employment. There are very limited municipal services such as sewage and electricity. MSF has been working there for ten years and at the time of the election was operating three health centers; two provided full primary care services with a comprehensive HIV program (Kibera South and Silanga Health Centres) while a third (Gatwekera)