NAIROBI, KENYA – At Agnes Nakhulo’s fish stand in Kibera, one of Kenya’s poorest urban areas, the smell of fresh fish is a welcome relief from the stench of human waste, stagnant water, rotting food and burning heaps of rubbish.
Nakhulo, a single mother who sells fried fish at a stand in Nairobi West Shopping Center, says the filthy conditions here can be deadly. Her 4-year-old son died from diarrhea because of inadequate sanitation in Kibera. Nakhulo says that two of her friends have lost their children to diarrhea, too.
“It is our children who suffer most, with thousands of flies crawling across fetid, open ditches of human excrement and rubbish outside our houses,” says Nakhulo from beneath an oversized straw hat, which shields her from the scorching February sun.
The summer heat intensifies the slum’s stench.
Nakhulo says that there are no toilet facilities in most of Kibera, where she moved five years ago after leaving her husband, who she says was polygamous and used to beat her.
“One latrine is shared by up to 50 houses,” she says. “The pit latrine is made of old iron sheets, mud and dried poles. The toilet serves a minimum of 150 people.”
During the day, there are long queues for the latrines, which cost 5 shillings, 0.06 cents USD, to use. At night, high crime rates make it too dangerous to go outside so Nakhulo says they relieve themselves into plastic bags, known as “flying toilets” because residents routinely fling the bags out their windows and doors.
But human waste isn’t the only problem here. Clean water is also scarce, making it difficult for residents to wash their hands after using the bathroom and before preparing food. Nakhulo says she is grateful that her two daughters were able to fight off the diarrhea that killed their brother, but that typhoid and malaria are constant worries, too.
“My children have always been suffering from diseases due to lack of adequate health protection and proper sanitary facilities,” she says, as she turns a piece of fish in a frying pan on a jiko, a stove fueled by firewood.
Millions of people like Nakhulo suffer from a lack of sanitation facilities in Kenya’s slum communities. Disease runs rampant, especially among children, with half of hospital visits related to inadequate sanitation, water or hygiene. The government has set goals to make adequate sanitation and water accessible to all by 2015 and eliminate such areas by 2030. But as the problems increase, many say the goals are not attainable.
A 2008 World Health Organization report offered some hopeful results – 57 percent of Kenyans had access to drinking water from a pipe or a protected well, while 42 percent saw improved access to sanitation. But according to the Kenya Demographic and Health Survey, KDHS, released last year, less than 25 percent of those surveyed used adequate or sanitary toilet facilities that separate waste from human contact. Open pit latrines are the most common type of toilets in rural areas, and 12 percent of Kenyans have no toilet facilities at all.
Kibera includes nine villages and is home to nearly 200,000 people. Half of all Kibera residents live far below the poverty line.
John Makare, a local leader in the area, says that congestion is such a problem that there is no space to build more toilet facilities.
“Because of the lack of toilet facilities, we see one for every 500 to 1,000 people,” he says.
Kibera is not the only place dealing with sanitation and hygiene problems, but the use of polythene bags is more widespread in Kibera than elsewhere in Nairobi or other parts of the country, he says. As for the pit latrines in Kibera, most are shallow and poorly constructed with no vents and very little privacy for the user, he says.
“They are characteristically poorly maintained as evidenced by rusting roofs and pungent smells,” he says. “Households use the latrines for bathing, washing and, in many instances, disposing of solid waste. This reduces the sanitary conditions [because] stagnant water forms around the facilities.”
The City Council of Nairobi and other relevant government ministries and departments have failed to support the informal settlements with sanitation and garbage disposal facilities, Makare says. Consequently, there are huge mountains of uncollected garbage and human waste everywhere, exposing residents, especially children, to a myriad of health problems.
Nearly 30,000 children die from diarrhea every year, says Nimrod Waweru of the Ministry of Public Health and Sanitation. It is the third most common cause of death among children under 5, according to the ministry, which released a new policy for the management of diarrhea in 2010 in conjunction with the Department of Family Health. During the two weeks before the KDHS, 17 percent of children had diarrhea caused by improper disposal of excreta, contaminated water, dehydration or unhygienic preparation of foods.
According to the ministry’s Division of Sanitation and Hygiene, improved water and sanitation reduces diarrhea episodes by as much as 40 percent and diarrhea morbidity by 25 percent. Half of Kenya’s disease cases are related to sanitation, water and hygiene. Many children die from diarrheal diseases such as dysentery, cholera and typhoid before their fifth birthdays, like Nakhulo’s son.
William Ochieng, a cobbler at Kenyatta Market, says his two children, ages 7 and 10, have also suffered illnesses because of poor sanitation. On a sunny Saturday afternoon, Ochieng, dressed in all black, a white baseball cap and white Nike shoes, is busy hammering a nail into the heel of a woman’s high-heeled shoe. He admits that living in Kibera has not been easy because the small home he rents for his family does not have a toilet, so they are forced to share one with about 100 other households, leading to health problems.
“Diseases such as malaria, cholera, diarrhea and typhoid afflict us,” he says. “My two children, who are both in primary school, have been sick in the past because of the dirty environment.”
Kenya’s Situational Analysis and Needs Assessment report of 2008 suggested that the welfare of Kenyans depends not only on good health care services, but also on the quality of the physical, social and cultural environment they live in.
But many say the government’s promises in this regard are unrealistic. Making sanitation and water available and accessible to all Kenyans is one of Kenya’s Millennium Development Goals, MDGs, a set of socio-economic goals coordinated by the U.N. Development Program and adopted by world leaders in 2000 to be completed by 2015. In a 2009 press release, Charity Ngilu, water and irrigation minister, said the government aimed to achieve this goal even sooner.
“It is our desire to achieve the water- and sanitation-related MDGs sooner than 2015,” she said. “This, however, calls for accelerated massive investments in water resources management and expansion of water and sanitation services infrastructure, particularly in poor, underserved areas.”
But so far local investment has not been “massive.” According to Hakijamii, an economic and social rights center, Kenya needs to spend about $40 million USD on sanitation per year to reach the 2015 MDG deadline, but currently only allocates about $13 million USD per year.
Kenya Vision 2030, an economic development plan by the Kenyan government, aims to do more than provide sanitation and water to poorer areas. Last year, President Mwai Kibaki said the next step was to rid the country of these low-income neighborhoods altogether.
“Our vision is to get rid of slums from our country by the year 2030,” he said in a statement.
Kibaki pledged special attention to developing urban areas undergoing rapid population growth like Kibera.
But Kenya has made false promises about this issue before, including the insufficient development of the Kibera-Soweto pilot project in 2004 and the Nyayo Highrise, a project in the 1990s.
Makare says that the lack of secure land tenure is one of the major constraints in improving conditions in Kibera. Many residents are either temporary residents or have informal arrangements with the community around them, so permanent improvements are not pursued.
Makare says he wants to be optimistic that with a new constitution, approved last year, the government will no longer give empty promises. But still, he says he is concerned.
“If the social, economic and environmental problems bedeviling informal settlements are not solved now and mechanisms of dealing with future challenges [aren’t] put in place, the hardships of slums dwellers may reach catastrophic levels,” Makare says.
