More than a month after the kidnapping of three aid workers in Kenya’s Dadaab refugee complex, insecurity continues to affect aid efforts. The situation is being exacerbated by heavy rains and accompanying risks of waterborne diseases.

Nearly 100 additional Kenyan police have been deployed in the camps in the last month. UNHCR is supporting them with vehicles, shelter and telecommunications equipment. Together with our partners, we are exploring options to gradually resume full operations despite continued security incidents in and around Dadaab. In the meantime, refugees are still receiving life-saving aid, namely food, water and health care.

The situation has been complicated by an outbreak of cholera in the camps, which is believed to have started among new arrivals who had most likely acquired it in Somalia or en route to Dadaab. Rains and flooding had affected the trucking of water to parts of the camps, and we fear some refugees resorted to using unsafe water from flooded areas.

There are now 60 cases in the camps, including 10 laboratory-confirmed cases and one refugee death. To manage the outbreak, UNHCR and partners have set up cholera treatment centres for severe cases. Most cases can be managed through oral rehydration solutions (ORS) that can be given at home or at the health posts. We are working with UNICEF and the Ministry of Health to train health workers in the community-based management of diarrhoea so that patients can begin treatment at home.

We have increased levels of chlorine, which kills cholera-causing bacteria, at water points in the camps. These are monitored to make sure they are maintained at the correct levels. We are also promoting hygiene practices among the refugees, especially the use of latrines and hand washing with soap. Each refugee received 250 grams of soap with the latest food distribution and this will continue monthly for several months.

In Ethiopia’s Dollo Ado area, a nutrition survey at the Kobe and Hilaweyn camps has found high levels of malnutrition among children under five years of age. Refugees at both camps arrived from Somalia in extremely poor health condition, with many families losing children to malnutrition en route or after arrival in Ethiopia. Health and nutrition programmes have been set up by a range of experienced partners to address malnutrition, especially among the youngest children, but progress has been slow, as this survey confirmed.

However, the number of deaths among children under five has decreased dramatically compared to the very high level seen at the height of the refugee influx this summer. This reflects improved access to quality health care and nutrition services, as well as improved water and sanitation facilities. UNHCR is leading the coordination of a nutrition response to the survey's findings.

Meanwhile, intermittent downpours in Dollo Ado continue to cause flash floods in the area. The airstrip was hit by floods in the past four days and has subsequently remained out of service.

Nonetheless, work continues on the fifth refugee camp in the area, Bur Amino. The ground is rocky and this slows down the digging of latrines, a minimum number of which must be in place before refugees can be relocated from the transit centre. More than 7,600 recent arrivals from Somalia are now encamped at the transit centre, where they receive basic shelter, relief items and hot meals.