The woman arrived at the hospital before dawn with a crushed pelvis. A wall had fallen on her while she dragged a mattress out of a house the river had already entered. She had heard the rain warning on the radio the evening before. She had not understood that it meant her.
That was April 2024. I have spent this week reading what Kenya has done to prepare for a bigger El Niño, and I keep returning to her, because she shows what preparedness is for.
Preparedness has one purpose: that a specific person, in a specific house, does a specific thing before the water comes. The committees, the plans and the pre-positioned supplies all exist to produce that one act. That is not a criticism of any of them. It is the test they would set themselves.
By any comparison with our own past, this year is different. Cabinet activated a national contingency plan on June 30, three months before the rains. The National Disaster Operations Centre has ranked 18 counties by risk. The Ministry of Health activated its own plan on September 3. The Red Cross has 42 rescue boats in position and has trained with the military. Nairobi has hotlines, 1199 and 1508, and bulldozers in the Kangemi trenches. In 2023, all of this began after the water arrived. The people who did this work deserve to hear that it is noticed.
The Red Cross secretary general says we are better prepared than in 2024. He is right. Over 400 people died in 2024, so better than that is the floor, and I do not think he meant it as anything else.
The remaining gap is narrow and it is specific. The household on riparian land has been given warnings: move when directed, report blocked drains, stay out of floodwater. In Nairobi and Kilifi, it has a number to call. What it has not yet been given is the rest of the sentence.
Where to go: the Interior ministry says holding grounds are identified, but the list has not reached the public. Who will say go, and how that reaches a house with one phone and no data bundle at two in the morning? What a displaced family may expect on arrival, and for how long. And, outside two counties, a number to call.
The responders themselves have said as much. On September 3, the Red Cross noted that shelter capacity is short and that some counties are further along than others. Two days earlier its emergency manager said that with current systems Kenya will still see loss of life. I read that as candour, not alarm. It is the agency that pulls people from the water telling us, with six weeks to spare, where the work remains.
Nairobi's governor has asked citizens to do their part, and he is right that blocked drains are largely our own doing. But a household can only meet its side of that bargain if it knows the place, the signal and the help. Give people those three things and most of them will move. Ask them to move without them and we are back at the wall in Mathare.
Every surgeon knows this last-mile problem. The drug in the warehouse treats nobody. The protocol on the shelf saves nobody. Every Kenyan flood review since 1997 reaches the same finding: the forecast existed, the warning went out, and the people who were lost did not know it applied to their house on that night. My patient had heard the forecast. What she lacked was a sentence with her street in it.
The good news is that this gap is the cheapest one in the whole plan to close. Four documents, in Swahili and local languages, before October 1. The evacuation sites in each of the 18 counties, named to the ward, with capacity. One national toll-free number, painted on every chief's office. A single page for households: what to pack, when to leave, where to go, who to tell. And a plain statement of what a displaced family may claim, so a mother arriving at a school hall knows what to ask for. The money questions, the Sh15 billion fund and the Sh58 billion facility, can run on their own timetable. These four need only a decision to publish.
There is one more thing, and it costs nothing. Share the difficult facts as they are. The Seven Forks dams entered this season full. Shelter is short. Some counties are behind. Kenyans have shown, repeatedly, that they prepare harder when they are trusted with hard news.
Kenya has planned and it has warned, earlier and more thoroughly than before. What remains is to tell each household where to go. The whole exercise comes down to that one sentence, and there is still time to write it.
My patient lived. She would like to know which school she should have walked to.
Surgeon, writer and advocate of healthcare reform and leadership in Africa |[email protected]
