DADAAB, Kenya, November 28 (UNHCR) – Ibrahim held up an X-ray of his broken thigh bone, taken when he first arrived in the Dadaab refugee complex of north-eastern Kenya. Five months later, he still cannot walk.

"I fell off a car when I was heading to Kenya from the Bay region [in southern Somalia]," the 31-year-old explained, sitting at the entrance of his white tent in the red earth. "When I arrived in Dadaab, I went to the hospital. But I left because I was afraid they would amputate it."

UNHCR field officer Henok Ochalla rebuked him for not using crutches, and called for an ambulance to take the father of six to the nearest camp hospital. "If only we had an extended presence in the camps, we would be able to assess the situation of families and to refer medical cases like Ibrahim's," said Ochalla.

He and his colleagues were going from tent to tent in Dadaab's Ifo 2 camp, visiting families and noting down the details of people affected by the recent floods. This was the first time in weeks that UNHCR staff had been able to walk more or less freely among the blocks of Ifo 2.

Escalating insecurity – including the recent discovery of two improvised explosive devices and the kidnapping of three aid workers – has forced humanitarian agencies to scale down their work in Dadaab. Life-saving aid such as food distribution, water trucking and urgent medical aid is continuing, but less urgent services have been temporarily suspended.

"It is challenging for agencies to balance humanitarian assistance and define an acceptable threshold of risks to the lives of staff on the ground," said Dominik Bartsch, UNHCR's head of operations in Dadaab. "Despite recent security incidents, we have worked intensively on a feasible way to maintain life-saving activities, especially for the most vulnerable refugees."

The increased presence of policemen in Ifo 2 has allowed aid agencies to gradually resume activities in the camp. Last week saw the drilling of a new borehole, the building of a drainage system to prevent floods, and the installation of a 10-tent temporary hospital. A measles vaccination campaign is continuing.

However, the combination of floods and several weeks of reduced services is taking its toll. An outbreak of acute watery diarrhoea, including some cases of cholera, has affected more than 360 refugees across the camp so far. Symptoms of malnutrition are becoming more visible in children, with at least 300 refugees approaching the health post every day.

While UNHCR and its partners strive to respond within a shrinking operational space, the refugees themselves have stepped up to the daily challenges. Trained professionals such as health promoters, teachers and community peace and security teams have ensured the continuity of services in these uncertain times.

Ugandan refugee Walter helped to set up the new school in Ifo 2, a UNHCR-tented hall that hosts 1,000 students in 11 classes. He had arrived at Dadaab as a 15-year-old, completed his secondary education and received his teacher's certificate. Looking around the school he helps run, he said, "We have been working every day because it was critical for the kids doing their exams. They had a hard time fleeing Somalia, and we owe them this effort."

UNHCR's Bartsch affirmed, "The refugees are contributing to their communities and providing a safe environment in the camps and for the humanitarian agencies. We fully support this valuable work they do day after day."

With the fragile security situation in and around Dadaab, this partnership between refugees and aid agencies will continue to be crucial in preserving some sense of normalcy in the camps. Dadaab is the world's biggest refugee camp, home to some 460,000 refugees, more than 150,000 of whom arrived this year after fleeing drought and conflict in Somalia.

Meanwhile, Ibrahim was not fully convinced he should see the doctor as advised. Perhaps his leg will never recover after these long months of inaction. Perhaps he will eventually be able to hobble around with the help of crutches.

For now, he sits at the entrance of his white tent in the middle of the red desert, smiling as a UNHCR worker promises to bring him a new sleeping mat next week – if nothing prevents him from doing so.

By Sonia Aguilar in Dadaab, Kenya