PHIG’s Kenya training experience in Dadaab and Kakuma refugee settlements offers lessons for the South Caucasus — two regions that appear distant but share structural challenges in delivering health services to displaced populations at scale.
“Dadaab taught us that scale and complexity are not the same thing. Georgia’s IDP settlements are smaller than Kakuma. They are not simpler.”
Pkhakadze G. Kenya Training Debrief Report. Tbilisi: PHIG; 2024.[1]
Introduction
Dadaab and Kakuma refugee settlements in Kenya are among the world’s largest, hosting approximately 280,000 and 230,000 refugees respectively as of 2024, primarily from Somalia, South Sudan, the Democratic Republic of Congo, and Ethiopia.[2] PHIG conducted NCD management training at both sites in 2023–2024, working with UNHCR and WHO EMRO to train 180 primary care providers in the management of diabetes, hypertension, and chronic respiratory conditions in resource-constrained humanitarian settings.
This article reflects on the lessons from East African refugee health that are applicable to South Caucasus displaced population contexts — a cross-regional learning exercise that PHIG believes is underutilised in international public health.
| Indicator | Dadaab (Kenya) | Kakuma (Kenya) | Georgian IDP settlements |
|---|---|---|---|
| Population | ~280,000 | ~230,000 | ~280,000 (dispersed, 1,800 sites) |
| Settlement type | Fenced camp | Open camp | Urban, peri-urban, collective centres |
| Primary health system | UNHCR/NGO parallel | UNHCR/NGO parallel | Integrated with Georgian UHC |
| NCD management capacity | Limited — severe resource constraints | Moderate — improving | Partial — supply gaps |
| Mental health services | Very limited | NGO-led | Nascent community MH teams |
| Malnutrition screening | Systematic (MUAC) | Systematic | Not systematic |
| Vaccination coverage | ~88% (UNHCR campaigns) | ~91% | ~94% (Georgian EPI) |
Sources: UNHCR Kenya 2024; PHIG Kenya Training Report 2024; MoLHSA Georgia.[1,2,3]
Key Lessons from East Africa for the South Caucasus
PHIG’s training teams identified six cross-applicable lessons from the East African refugee health context that are directly relevant to improving displaced population health services in Georgia and the broader South Caucasus.
1. Community health worker integration. Both Dadaab and Kakuma use trained community health workers (CHWs) as the primary case-finding and referral mechanism for NCD patients. CHWs identify uncontrolled hypertensive patients in the community and bring them to clinic — a model that the WHO HEARTS programme endorses globally and that Georgia’s primary care reform has not yet incorporated for IDP communities.[4]
2. Simplified treatment protocols. MSF’s simplified hypertension protocol — fixed-dose combination therapy with amlodipine/enalapril, monthly dispensing, standardised monitoring — achieves 46% blood pressure control rates in Kakuma compared to Georgia’s IDP rate of 28%, using simpler resources.[4,5]
3. Trauma-informed primary care. All clinical staff in Dadaab and Kakuma receive basic trauma-informed care training, recognising that the majority of patients have experienced conflict-related trauma. Georgian primary care physicians working with IDPs have received no equivalent training.[1,3]
Figure 1. NCD Management Outcomes: East African Refugee Settlements vs. Georgian IDPs 2024
Sources: PHIG Kenya Training Evaluation 2024; MSF Kakuma NCD Programme Report 2023; PHIG Georgia IDP survey 2024.[1,4,5]
| East Africa Model | Current Application | South Caucasus Adaptation | Feasibility |
|---|---|---|---|
| CHW-based NCD case-finding | Systematic in both camps | Train IDP community health workers; link to UHC | High — existing CHW cadre in Georgia |
| Fixed-dose combination hypertension | MSF protocol, Kakuma | Adopt for UHC IDP NCD package | High — medicines available |
| Trauma-informed care training | All clinical staff, camps | Integrate in Georgian PHC CME for IDP-serving clinicians | Medium — needs curriculum |
| Mobile clinic for dispersed populations | Used in Dadaab | Pilot mobile clinic for rural IDP settlements in Georgia | Medium — funding needed |
| Malnutrition screening (MUAC) | Systematic under 5 | Introduce for IDP children under 5 in Georgia | High — simple, low-cost |
| Mental health task-shifting | CHWs deliver basic PSS | Train Georgian IDP-serving nurses in basic PSS | Medium — curriculum needed |
Sources: PHIG Kenya Report 2024; UNHCR; MSF.[1,4,5]
Figure 2. PHIG Kenya Training — Pre/Post Knowledge Test Results: NCD Management in Humanitarian Settings (n=180)
Source: PHIG Kenya NCD Training Evaluation 2023–2024 (n=180 participants; Kirkpatrick L2).[1]
Conclusion
The lessons from refugee health in East Africa are not exotic — they are adapted global best practices for resource-constrained, high-need displaced population contexts. Georgia’s IDP population is smaller than Dadaab but no less deserving of systematic health service quality. The six adaptations PHIG identifies — CHW integration, fixed-dose combination protocols, trauma-informed care, mobile clinics, malnutrition screening, and mental health task-shifting — could be piloted in Georgia’s IDP communities with modest investment and PHIG technical support, drawing on the competency development and training design experience built in Kenya.
References
- Pkhakadze G. Kenya Training Programme Report: NCD Management in Humanitarian Settings 2023–2024. Tbilisi: PHIG; 2024.
- UNHCR. Kenya Country Operations Report 2024. Geneva: UNHCR; 2024.
- Ministry of Labour, Health and Social Affairs of Georgia. IDP Health Services Report 2024. Tbilisi: MoLHSA; 2024.
- WHO. HEARTS Technical Package for Cardiovascular Disease Management in Primary Health Care. Geneva: WHO; 2021.
- MSF. NCD Management in Humanitarian Settings: Kakuma Programme Report 2023. Geneva: MSF; 2023.
Public Health Institute of Georgia
