(Nairobi) – Kenyan authorities are potentially facilitating transmission of the Covid-19 virus while forcefully quarantining tens of thousands of people in facilities that lack proper sanitation, protective equipment and food, Human Rights Watch, Kenya Human Rights Commission, and Journalists for Justice said today.
The authorities have also held crowds of people in the arrivals area at the Nairobi airport for more than four hours with no social distancing, sanitizers, or masks; ferried people in packed buses with little ventilation; and, at the quarantine facilities, failed to enforce quarantine guidelines issued by the Health Ministry. The authorities also have forced people into quarantine for violating curfew or for not following orders to wear face masks.
“Kenyan authorities are exposing people to a risk of infection in poorly managed and ill-equipped quarantine facilities,” said Otsieno Namwaya, senior researcher at Human Rights Watch. “Despite credible accounts of people with traumatizing experiences in forced quarantine, conditions have not improved.”
Between mid-April and mid-May, researchers spoke to a total of 26 people, including 22 people in 11 quarantine facilities across the country – among them the Kenya School of Government and Kenya Medical Training Institute in Nairobi – as well as three front line doctors and a senior nurse. Those forced to quarantine were incoming travelers, people who had contacts with travelers, and, in some cases, people who violated the curfew imposed on March 27 or orders to wear masks in public.
On March 15, 2020, President Uhuru Kenyatta announced the closure of all schools and colleges to curb the spread of the virus. On March 22, the health cabinet secretary, Mutahi Kagwe, banned international flights in and out of Kenya, except for cargo flights, and announced a mandatory 14-day quarantine for all incoming travelers and those who may have been in contact with them. However, the authorities did little to prepare facilities and staff on how to handle those in quarantine.
As of May 26, Kenyan authorities said they had quarantined and tested 64, 264 people. About 2 percent – 1,348 – tested positive for Covid-19, about 50 have died, and about 405 have recovered and been discharged. On May 4, the authorities said they had started mass testing in the capital, Nairobi, and in Mombasa’s old town, where residents were reluctant to present themselves for testing out of fear of being forcefully quarantined, media reported.
The authorities in Nairobi had earlier said that travelers at the airport could choose between paying to stay in a hotel or staying without charge in a government quarantine facility. Unlike in most other countries with a significant number of people in quarantine, in most cases people were not allowed to self-quarantine in private homes where feasible.
People interviewed described poor conditions of the quarantine facilities, including lack of bedding, water, food, and cleaning supplies, including soaps and detergents. They said they weren’t told of test results and that staff did not adhere to the government’s own protocols, such as wearing face masks or other protective equipment, to ensure that those quarantined do not become exposed to the virus.
A 22-year-old man who was quarantined at the Kenya Industrial Training Institute (KITI), in Nakuru, Rift Valley, following his arrival from France on March 23 said: “When I checked in, I found there was no electricity, no bathing water, no food and no water to drink. The beds had no mattresses or beddings. I slept on the spring bed with no mattress and nothing to cover myself. They told me I had to pay for water.”
Many others described similar conditions in other facilities across the country and said that the authorities sometimes extended quarantine periods from the initial mandatory 14 days, to more than 30 days, even when people tested negative several times. All those interviewed were asked to pay for accommodations, food, and other costs before being allowed to leave. Many of those who could not pay were held for additional days and, in one instance at Kenya School of Government, police were called in to beat those who persisted in pleading their inability to pay, victims and witnesses said.
On May 14, Human Rights Watch, Kenya Human Rights Commission, and Journalists for Justice wrote to the health cabinet secretary, Mutahi Kagwe, requesting information on the abuses in quarantine centers, and the government’s response to the complaints of those in quarantine, conditions in the facilities and the issue of payment for quarantine. Secretary Kagwe has not responded.
“The situation in quarantine facilities is chaotic and it’s shocking that authorities have exposed thousands to the risk of infection and trauma,” said Kwamchetsi Makokha, Program Advisor at Journalists for Justice, a Nairobi based organization. “Officials failure to ensure proper sanitation or to implement safety guidelines may have turned quarantine facilities into infection centres."
Among those forced into quarantine for breaching the Covid-19 curfew was Carolyne Akumu, a 35-year-old mother, together with her month-old child. Akumu, said that Busia county officers arrested her on May 1 as she rushed home at 7:10 p.m., 10 minutes after the curfew time. Police forced her to go to what she described as a derelict and dusty quarantine facility in Nambale, 40 kilometers from Busia, where she slept on a cold floor with nothing to cover herself and her child. Akumu said she tested negative the following day, and was released on the second day, following intervention by civil society groups.
The authorities should urgently take measures to improve conditions in public quarantine facilities, including regular cleaning and fumigation, change of bed linens, provision of meals in all facilities, and adequate psychosocial support and medical care where need be, Human Rights Watch, Kenya Human Rights Commission, and Journalists for Justice said.
In addition, the authorities should ensure adequate care and access to communication, including in accessible formats, with the outside world for those in quarantine, and waive fees associated with quarantine and related medical care for those who cannot afford them. Individuals should be assessed for self-quarantine, provided that they are able to maintain social distancing and proper support from a caregiver.
Under the International Covenant on Economic, Social and Cultural Rights, which Kenya ratified in 1972, everyone has the right to “the highest attainable standard of physical and mental health.” Governments are obligated to take effective steps for the “prevention, treatment and control of epidemic, endemic, occupational and other diseases.” However, any restrictions they impose for reasons of public health or national emergency need to be lawful, necessary, and proportionate and be carried out in accordance with the law. They cannot be imposed in an arbitrary or discriminatory manner.
“President Kenyatta should demonstrate to the world that Kenya can implement its quarantine policy in a humane and accountable manner,” said George Kegoro, executive director at Kenya Human Rights Commission. “The president should ensure that government meets all quarantine-related costs, as cabinet secretary for health Mutahi Kagwe promised on May 6.”
For detailed findings, please see below.
Dusk to Dawn Curfew
On March 25, President Kenyatta announced a nationwide dusk-to-dawn curfew starting March 27. On April 3, the authorities made it mandatory for everyone to wear masks in public places and introduced mandatory quarantine for those who did not wear masks or breached curfew, but parliament rejected that requirement on April 21. Researchers spoke to three people who said the police had arrested them days before the law was presented to parliament and placed them in mandatory quarantine for breaching curfew or failure to wear a mask in public.
Kenyan media have also reported several other incidents in which police forcefully quarantined people for breaching curfew without evidence that they had been exposed to the virus. Kenyan activists have gone to court to challenge government quarantine policy. On April 18, Kenya Legal and Ethical Issues Network on HIV and Aids (KELIN), Mombasa-based Muslims for Human Rights (MUHURI), and seven Kenyans who had served various periods in quarantine filed a petition seeking to have the government cover all expenses incurred by people in quarantine facilities or in isolation at government health facilities. The petitioners alleged that the government carried out quarantine measures in an abusive, degrading, and unconstitutional manner.
Mandatory quarantine for breaching curfew or not wearing a mask is problematic. It is not the least restrictive measure possible, it can amount to detention that has been imposed without warning, and the conditions in quarantine may be undermining public health, compared with self-quarantine at home, by increasing exposure to the virus.
Failure to Provide Sanitary, Humane Conditions
On March 27, five days after Kenya imposed mandatory quarantine for international arrivals, the Health Ministry published a quarantine protocol describing the standards for quarantine facilities. The protocol requires the facilities to be well ventilated, ensure social distancing, have regular cleaning and disinfection of laundry, dedicated linen and eating utensils for each person in quarantine, and for the facilities to regularly provide detergents for cleaning.
Researchers found that the facilities did not uphold the protocols. Three people interviewed – who were quarantined at the Kenya School of Government, Pride Inn, and a 29-year-old man at KMTC Nairobi – described dusty and neglected facilities and said they were responsible for cleaning their own rooms and bathrooms but often were not provided with cleaning supplies.
Some of the facilities outside Nairobi had neither beds nor bed linen, and those admitted there had to spend nights on cold floor. For example, Kisoko Girls High School had no beds, linen, or healthcare staff to look after those admitted other than security guards at the gate.
In the Kenya Industrial Training Institute (KITI) in Nakuru county, those quarantined were given bed linen two days after admission but said it was neither washed nor replaced for the whole quarantine period – sometimes more than 14 days. In at least four facilities – KITI, Kenyatta University Conference Centre, Cooperative University Retreat Centre, and Kenya School of Government – those interviewed said that the Health Ministry did not provide detergents and that those in quarantine had to either buy the detergents or use what may have been left by previous occupants.
At KITI, four of those who had been quarantined said they had to buy food, water, and soap and clean the facility themselves. A 22-year-old man quarantined at the facility recalled:
“There was no electricity, no bathing water, no food and no water to drink. The entire place was dusty. The beds had no mattresses or beddings. I slept on the spring bed with no mattress and nothing to cover myself for two days when they brought us beddings. They told me I had to pay for water.”
Failure to Protect People Against Infection
Two arriving travelers said they believed they may have been infected either at the airport arrivals lounge where the authorities held crowds of people from various parts of the world for hours or inside fully packed and poorly ventilated buses that ferried them from the airport to quarantine centers.
Buses used to ferry the arriving travelers to the facilities were both poorly ventilated and, in some cases, packed beyond capacity, and police officers failed to observe social distancing measures or wear protective equipment on the buses, those interviewed said.
Four people said they believed they could have contracted the virus in quarantine facilities, as the authorities failed to enforce safety measures, including social distancing and not sharing cutlery, and dispensing tea from shared dispensers without using gloves.
In nearly all facilities, staff seemed unaware that people would be quarantined there and some were exposed to infection in the facilities. At the Lenana school facility in Nairobi, a 29-year-old staff member who later tested positive for Covid-19 said he was not informed when the facility received its first batch of people for quarantine on March 24. He was then made to quarantine there himself. The staff member said:
“They arrived at 1 a.m. and since I am the one who was at the gate, I checked them in and showed them where to sleep. No one bothered to tell me who they were. After I finished, my boss told me to join them in quarantine since I had been exposed.”
Failure to Allow Self-Quarantining for People at Risk
Despite the protocol allowing those with preexisting conditions or pregnant women to self-quarantine at home, researchers found that facilities admitted pregnant women or people with diabetes and hypertension. At-risk people or people with disabilities were held for several days at Kenyatta University Conference Centre before they were released or transferred to other facilities following complaints.
At Busia’s Kisoko Girls High School, on May 1, police and county health officials forcefully quarantined a 35-year-old woman, Carolyne Akumu, together with her one-month old baby for breaching the curfew, contrary to quarantine protocol. In another incident on the same day, police and county enforcement staff forcefully quarantined a pregnant woman at the same facility in Busia for violating curfew, even though guidelines have included pregnant women among the vulnerable that should not be quarantined.
Extensions of the Quarantine Period
Some of those interviewed said that government officials extended the quarantine beyond the initial 14 days for another 14 days or for indefinite time periods whenever someone in the same quarantine facility tested positive for the virus. People interviewed who were quarantined in KITI, the Kenya School of Government and Kenyatta University Conference Centre, said they suspected that the extensions of quarantine periods could have been out of the knowledge that there was a failure to enforce social distancing or provide protective equipment inside the facility. In any case, the unsanitary conditions in the facilities may have contributed to continuing exposure to the virus and thus extension of the quarantine. In other instances, the authorities also extended the stay for people who could not pay the cost of quarantine, even though some arriving travelers were promised that government facilities would be free.
A 29-year-old man who had been in quarantine at Kenya Water Institute in Nairobi said he was transferred to the Kenyatta University Hospital for isolation after he tested positive for Covid-19. After seven days in isolation, he said he was told he would be allowed to go home but in fact was held six days more because he could not pay the quarantine and isolation costs.
The indefinite extensions caused anxiety in those quarantined, ranging from fear of losing their jobs or delay in seeing loved ones. One interviewee said:
“I don’t have money because I had lost my job in Dubai, but I am now in forced quarantine in a government facility. We had been told quarantine would be 14 days and free, but I have been here 30 days. I have twice tested negative since I arrived, yet I am still here, and I have to pay Ksh 2,000 (US$20) for each day I have spent here.”
A 28-year-old man who was at Pride Inn hotel in Nairobi quarantined together with his family of four said he was told at the end of 14 days he had to pay Ksh 420,000 ($4,200) for himself and four other family members to leave. The authorities extended their stay by another 14 days after someone in their facility tested positive. “I called relatives who chipped in, but I am not sure how I am going to pay for the extended period.”
At Kenyatta University, four men who had tested negative after two tests on the eighth and twelfth day, were to have been allowed to go home on the 14th day. But, since they could not pay, the authorities held them for an additional eight days, a total of 22 days. The men were so distraught that they threatened to take their own lives, following which they were allowed to leave.
Lack of Adequate Medical Care, Counseling
Those who tested positive for Covid-19 said that the authorities transferred them to isolation wards at various hospitals where they did not receive any medical care. They told researchers they felt neglected by hospital staff and Health Ministry officials who did not make any attempts to manage the virus or provide them with medication.
A 34-year-old man who had been admitted at Kenyatta University hospital after he tested positive said he was forced to send for painkillers and lemons outside the hospital after he got a headache. A 35-year-old woman who tested positive and was admitted at Mbagathi hospital said the hospital only provided her with food and water, but no medication during the eight days she was in an isolation ward.
The authorities did not provide psychosocial counseling or mental health services for people in quarantine, though one person died by suicide and five others attempted to take their own lives. Media reported how on May 27, staff at KITI found the body of a 27-year-old South African, Elizabeth Holloway, who had been forcefully quarantined there, hanging from the ceiling of her room with a piece of cloth.
Two people who quarantined with her told researchers that she had called management the day before about the unsanitary conditions there and asked to be transferred, but that the management had ignored her pleas.
Two days after Holloway took her own life, a Kenyan woman at the same facility attempted suicide. A 22-year-old man who was in the facility told researchers: “There were no counselors, and so those of us who were there with her started talking to her until she dropped the idea of committing suicide.”
Insensitivity in Testing, Communicating Results
Those who tested positive said the testing, management, and communication of results lacked transparency and failed to meet the required professional standards. Most said they were told their results verbally, by an unidentified person calling them by phone, and never given lab results. A 32-year-old man admitted at Kenyatta University hospital at the end of March said the hospital staff became hostile when he requested documentary evidence of the lab results.
A medical practitioner admitted at Mbagathi hospital said the hospital staff ignored his repeated requests for lab results. Another medical practitioner recalled:
“They told me it was positive but didn’t show me any paper. It was always a verbal communication.… It was that way the whole time … no documentary evidence. Many people were not convinced they were being told the right results.”
Many of those who tested positive also told researchers that the insensitive way officials relayed results and lack of information about what would happen to them caused them enormous stress and anxiety.
Most people interviewed said that quarantine facility staff treated them poorly. A 36-year-old woman who attempted suicide at KITI in Nakuru said: “I got a panic attack after one of our colleagues committed suicide. I called for help, but the doctor just laughed at me.”
People at the facility told researchers that the surrounding community and many of the staff at the facility would reject their money when they tried to buy food, on suspicion the money was contaminated. A 29-year-old man who had been quarantined there said:
“We didn’t have food inside the facility. We wanted to buy food from vendors over the fence, but they would decline our money. Staff who we thought would help would also not take money from us. We would wait for one nurse who would accept to help buy for us food from outside, but we had to send the money to her via mobile money.”
At one quarantine center, interviewees said, on occasion kitchen staff declined to serve those in quarantine, compelling a security guard to bring the food. At a hospital in Nakuru, a 34-year-old woman who had been admitted there pending Covid-19 testing said that hospital staff avoided her even after she tested negative. She said: “They would not talk to me. They would drop meals at the floor at the entrance of my ward and run away without telling me. I would discover the food cold on the floor at the door, sometimes hours later.”