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Can You Reach a Clinic When It Floods?  Jane Njoroge It was 8 a.m. It was heavily raining in Mombasa’s Matopeni settlement. A young woman who has a walking disability had shida za mafua or chest complications in  Kiswahili. She needed to see a doctor soon. But, it was impossible to use crutches in almost knee deep water. Her mother and brother had to carry her out of the house to go to the doctor. There were no ambulances, or bridges.  During Mombasa’s rains, people living in its informal settlements have to brave the water, and the storm to reach any healthcare institution. They inevitably put off medical care because of the rains, and are often stranded and cut off from life-saving care.  This woman spoke to me and my colleagues from Slum Dwellers International-Kenya (SDI-Kenya) during a Focus Group Discussion in the Urban Shade project where we are trying to understand access to healthcare during events like these in four coastal settlements in Mombasa, and Kilifi counties, including Matopeni.  Matopeni settlement is located near the Kongowea market, perhaps the  biggest market within Mombasa Island, where people mostly work. The settlement is on land owned by the local Municipal Council, with private players staking claim to it. During the April-May qualitative data collection, it was raining heavily. It emerged in our discussions that this lack of functional infrastructure exposes the residents of Matopeni to climate-related disasters. This limits their accessibility to healthcare facilities, with pathways impassable. The focus group discussions with various stakeholders revealed that this challenge is harder felt by vulnerable populations within the locality. Children, especially pre-primary children cannot cross these flooded pathways due to the high possibility of being carried away by the force of flash floods.  As one resident put it, “During heavy downpour, the same pathways we use to access healthcare facilities are the same pathways used by water.” Matopeni during floods. Photo Credit: Muungano wa Wanavijiji, Matopeni. The disabled woman mentioned earlier said that her house tends to flood during heavy rains. As a result, she often catches flu and other ailments, and needs to see a doctor in her neighbourhood clinic. The adjacent pathways to her house are uneven and flooded, forcing her to rely on her mother and brother to carry her to the hospital. She said, “Flooded pathways are hard to navigate. I have to depend on my family to take me to the health facility. It is very hard to use crutches during flooding since the roads are covered by water, making visibility difficult, since the roads are not even and have potholes.” Uneven pathways that are not disability-friendly. The situation is further worsened when they become flooded, worsening visibility.  It’s not just residents who can’t reach clinics, sometimes, healthcare providers themselves are unable to report to work due to damaged infrastructure, effectively shutting down essential services when they’re needed most.  One respondent said, “When it rains heavily in the settlement, Kongowea dispensary also gets flooded. It is located on a flood plain. Sometimes even the medicines are carried away by the water. The government does not seem to bother, and nothing seems to change.” Kongowea Dispensary  Health consequences are felt by the community during and after flooding. For instance, stagnant floodwater becomes breeding ground for mosquitoes, increasing the spread of malaria and other waterborne diseases.   Stagnant water which act as breeding grounds Delays in treatment and care often lead to deteriorated health outcomes for the affected community members, especially for the most vulnerable groups. The community often crowdsources funds to arrange for a vehicle to take people who need urgent medical care, especially the elderly, disabled persons and people with underlying conditions to Tudor Sub County hospital. While this is heartwarming, it is neither always feasible or sustainable as a solution. There is a need to change this current situation in our informal settlements. The communities voiced thoughtful solutions during our focus group discussions. One such recommendation is the introduction of mobile clinics closer to the community to reduce accessibility time. At the moment, the communities have to travel for long distances, 3-5 kilometers, to get crucial and quality healthcare service. Transport to access this service has financial implications.  There is a need for some major infrastructural changes in the community, especially in relation to the drainage system. An effective drainage system, and regular sanitation work to unclog waste can ensure more accessible pathways even during heavy rains. Flooded pathways and common areas in Matopeni Some of these problems can be taken care of by the community. A government initiative- National Hygiene Program dubbed Kazi Mtaani, a social protection programme that employs youth to help in clean up programmes in these settlements. The initiative started during 2020 in the thick of the COVID-19 pandemic in response to its major economic impact, especially on vulnerable communities. It is designed to help the youth living in informal settlements by providing them labour-intensive work for daily wages that can help create public goods for the community they live in including clearing garbage and opening clogged drains etc.  A youth community member, actively involved in Kazi Mtaani scheme, said, “I have worked in that area during the Kazi Mtaani programme. I suggest an initiative to the youth to start collecting wastes at 20 shillings per household.” Policymakers, urban planners, non profits and communities need to connect climate change with health-related impacts, and prioritise inclusive, climate-resilient urban planning that ensures everyone, regardless of where they live, can access essential services, even during disasters. Infrastructure is not just about concrete and roads. It is about dignity, safety, and survival. No one should suffer life-altering health complications simply because they can’t reach help when it rains. Jane Njorage is an intern in the research department at SDI Kenya, and is currently pursuing Masters in GIS and Remote Sensing