Since accompanying the flying doctors on an evacuation last month, I have been captivated and intrigued by Mandera – a tiny, arid town that from the sky, barely seems to house any form of existence.
This is probably the harshest place I have been. Tucked in the far corner of northeastern Kenya, Mandera District is bordered by Ethiopia and Somalia. It is desolate, dry and all but forgotten.
The problems here are epic. Drought, clan conflict, child marriage, cattle raids, lack of access to education and healthcare, near non-existent infrastructure, limited access to food and water… If there is ever a health or societal problem to have, Mandera is sure to be the place that has it.
Years of neglect and marginalisation have pushed this part of Kenya well past the boundaries of humanity.
For decades, the county has performed far below acceptable norms on development indicators. Literacy is less than 10%, malnutrition well below emergency levels and most shocking, maternal mortality rate (MMR) stands at 3,795 deaths per 100,000 live births. Comparatively, that’s more than double of the neighbouring county, Wajir* where Andrew Witty visited two years ago when he announced the Save the Children partnership. This statistic awards Mandera one of the worst, if not the worst place in the world to give birth. Worse then war torn countries like Somalia or Sierra Leone.
Two years ago Kenya gave renewed hope to the forgotten corners of the country by devolving the power of 12 Government functions to 47 newly established county administrations. The devolution of national power marked a major milestone in Kenya’s governance process, putting greater political strength and economic resources in the hands of the people. National ministry budgets were distributed to newly defined counties, those deemed the most marginalised including Mandera, receiving a greater portion.
Because of devolution, the flow of funding reaching Mandera in the past year – which incidentally, is more than they have received since Independence in 1967 – has meant the county has been able make some inroads in their development plan. Last year, street lights were installed for the first time and the first ever tarred road is due to be laid at some point this year. Two incremental steps on a very long road to progress.
These are early signs that devolution may well be the catalyst that will bring Mandera out from behind the shadows and into the national fold. But there is one thing the change in governance isn’t providing a solution for and that’s the increasing security issues facing the county’s 250k residents.
The Mandera Triangle, as the region is known, is home to a complex network of administrative and clan related disputes and more recently, terrorist activity from militant group al-Shabaab. In December last year the group killed 36 quarry workers and just weeks before that 28 people, mostly teachers and Government workers, were killed on a bus bound for Nairobi. In July this year al-Shebaab militants attacked a small village in the middle of the night killing 14 innocent workers..
The rise in terror attacks in the area has led to a mass exodus of the very people Mandera needs if it is to have any hope of sustainable development. Among them teachers and healthcare workers, even humanitarian agencies have been forced to reconsider having a physical presence.
As I sit and trawl through the dozens of articles, blogs and opinion pieces my thoughts go back to the gunshot patient we picked up. I start to think more deeply about his circumstances and what would have happened to him if we didn’t pick him up given the void of healthcare workers.
The more I read, the more heavy-hearted I become at the thought of a place being in such a vortex of deprivation. Like many places around the world, Mandera is plagued with misfortune. For every step forward there is a step back. How does it stop? Who will help the people who have no choice but to stay in Mandera when everyone else has gone?
AMREF Flying Doctors saved one man’s life but their impact on overall statistics is limited without economic and humanitarian help from others. Having seen the dedication and integrity of the team here, I have no doubt if there was any chance of making it happen they would try.
Source and further reading:
*Maternal Mortality Rate (MMR) in Wajir County: 1,683 per 100k