Kenya, Dadaab: Return of refugees to Somalia in current conditions "inhumane and irresponsible"
As the announced closure of the world's largest refugee camp draws closer, and thousands begin the return to war-ravaged Somalia, MSF is calling for other alternatives to be urgently considered by the Government of Kenya and the UNHCR, supported by donor countries.
In a report released today by MSF, Dadaab to Somalia: Pushed Back Into Peril, more than eight out of ten refugees surveyed say they do not want to return, with the main concerns cited including fear of forced recruitment into armed groups, sexual violence and the non-availability of healthcare. 
In the report, MSF also highlights the severe medical consequences of such a massive return.
"It is clear that refugee camps are not the best way to manage a protracted 25-year crisis, but closing them now without offering other durable solutions pushes people back to a conflict zone, where medical care is dangerously absent," says Bruno Jochum, MSF General Director. "This decision is yet another blight on refugee protection globally, where again we see a total failure to provide safe haven for people in danger. The UN itself has recently declared that five million people are at risk of hunger inside Somalia. Sending back even more people to suffer is both inhumane and irresponsible."
Somalia: an acute lack of medical care
In Dagahaley, one of the five camps that make up Dadaab, MSF medical teams have seen children arriving from Somalia who have not been vaccinated against a range of preventable diseases, a telling sign of a health system torn apart by more than two decades of war where even basic care barely exists. Pregnant women have access to minimal care, putting their lives and that of their unborn babies under threat. People with chronic medical conditions are also at risk – whether they are diabetics who need life-saving insulin, or people with hypertension who need ongoing treatment.
Additionally, mental health patients are in danger. In Dagahaley, 70 per cent of MSF's mental health patients are on medication. "If a patient with psychosis is forced to come off their medication, their cognitive function and behaviour development goes into reverse. Stuck in a country where mental health services are basically non-existent would put their lives in severe jeopardy," says Liesbeth Aelbrecht, Head of Mission for MSF in Kenya.
A call to Kenya, the UNHCR and donor countries: other solutions urgently required
Eighty-six percent of surveyed refugees in Dagahaley do not want to go back to Somalia. Fears around insecurity were acute with nearly all – males and females – stating that the risk of sexual violence is high. MSF is therefore questioning the 'voluntary' nature of the returns that the UNHCR is helping to facilitate.
"The fears that the refugees tell us about are real," says Aelbrecht. "It is crucial that any return is voluntary, and refugees must have all necessary information about the services and conditions that will meet them in Somalia."
MSF reiterates that setting up Dadaab-style camps across the border is shifting responsibility and abandoning the protection of refugees. Other more durable solutions, such as smaller camps in Kenya, increased resettlement to third countries, or integration of refugees into Kenyan communities, should be urgently considered. Additionally, MSF appeals to the international community to share the responsibility with the Government of Kenya.
"It is unacceptable that – without any other solution being offered – thousands are essentially being pushed back into conflict and acute crisis: the very conditions they fled," concludes Aelbrecht."Kenya should not shoulder this burden alone. Funding from donor countries needs to be directed to providing sustained assistance in the country of refuge, not to supporting what will essentially be a forced return to a warzone."
MSF does not accept any government funding for its project in Dadaab – all funding is provided by private donors.
MSF first started working in Dadaab in 1992 and is currently the only provider of medical care in Dagahaley camp. Staff are working in the 100-bed hospital in Dagahaley camp and at two health posts, providing outpatient and mental health consultations, surgery, and antenatal, HIV and tuberculosis care. Overall in 2015, teams carried out 182,351 outpatient consultations and admitted 11,560 patients to the hospital.
 Some 30,000 refugees have returned to Somalia since a tripartite agreement on voluntary repatriation between the Governments of Kenya and Somalia and the UNHCR was signed in November 2013. The majority of these – 24,000 – have left during the course of 2016.
 To understand the refugees' concerns and needs, in July and August 2016, MSF conducted a series of discussions and interviews, and a household survey, with refugees in Dagahaley camp about their current situation and the prospect of a return to Somalia. Focus group discussions involved 75 people (42 male and 33 female) in Dagahaley camp. Interviews were carried out with 31 people including patients, MSF incentive workers and community members. The survey polled 838 heads of households (53% male and 47% female) in Dagahaley camp, with households totalling 5,470 individuals.