Imagine a scenario in which Ebola infections multiply in your country, hospital isolation wards begin to fill up, and health officials need an additional facility to contain the outbreak. A bio-isolation centre stands some 270 kilometres from your capital city, backed by the United States and designed to help prevent the spread of deadly diseases. Yet before your government can turn to that facility, a crucial question arises: can the country activate it independently, or must it first secure Washington’s approval?
It now turns out that Kenya may have to coordinate with the United States before using the US-backed Ebola bio-isolation facility in Laikipia, raising questions about the country’s control over emergency health infrastructure as it responds to its first confirmed Ebola death.
The US government says it has received no request to use the facility and that no patients are being treated there. The statement has fuelled concern over whether Kenya can access the centre and US medical expertise if infections rise and the country’s existing isolation facilities come under pressure.
The issue has taken on urgency after Kenya confirmed its first Ebola death. The United States has said it is ready to support the response as needed, but its statement did not clarify whether Kenya must obtain formal US approval before admitting patients to the Laikipia facility.
A US State Department spokesman said Washington had provided $887 million in direct health and humanitarian assistance to combat the virus since the outbreak began, including more than $10 million in new direct support for Kenya’s efforts to detect Ebola and prevent its spread.
“The US is aware of reports of a Kenyan citizen who died of Ebola in Nairobi after apparently travelling there from the Democratic Republic of the Congo. The Kenyan government quickly responded and is conducting contact tracing on more than 50 individuals. The US remains in close coordination with the Government of Kenya, which has been an effective partner on health-related issues, on how to best respond to this threat and protect US citizens,” said the spokesman.
The spokesman described the Laikipia centre as part of Washington’s wider regional response, saying the “bio-isolation facility in Laikipia is part of the US government’s holistic response to prevent the spread of the disease and lessen health risks for the region as a whole.”
“The Kenyan citizen with Ebola did not use the facility, nor did we receive any requests for the facility to be used for this patient. There are not currently any patients in the facility,” he said.
The statement did not specify whether Kenya needs US permission to use the facility or explain the arrangements governing access to it. That leaves unanswered questions about the terms under which the centre, and potentially US medical personnel, could be deployed during a worsening outbreak.
On Wednesday, Health Cabinet Secretary Aden Duale declined to discuss whether Kenya would need to use the Laikipia facility, saying “the matter is in court.”
Duale sought to distinguish the imported case from a domestic outbreak, saying the government had traced the patient’s journey before he arrived in Nairobi.
“I will emphasise that there is no Ebola outbreak in Kenya. What we have is an imported Ebola incident in Kenya, and we can account for the pathway journey of that patient from Buri to Kisangani to Beni, to Kinshasa to Kampala to Nairobi, and finally to Nairobi Hospital,” said Duale during a tour of the isolation facility at the Nairobi Hospital’s eastern wing.
Duale noted the patient’s blood sample was tested at the National Virology Laboratory and the Kenya Medical Research Institute (Kemri), with results cross-checked by the Africa Centres for Disease Control and Prevention. He said all laboratories had confirmed the results by Sunday and that Kenya notified the World Health Organization on Tuesday, within the applicable reporting period.
The government said it had accounted for 57 contacts and placed them under quarantine, up from 55 initially identified. Ten were undergoing daily symptom monitoring at the National Police Service Hospital in Nairobi, while authorities worked to trace others who may have been exposed.
“The airline that the patient used had 23 passengers and four crew members. Those are 27. They have been contacted, and they should be in a facility by the end of Wednesday or Thursday. We have the names, we have the manifest, and we have the contacts. A multi-agency team of government under the guidance of the Kenya National Public Health Institute is working on that,” Duale said.
He warned that the number of contacts could rise as investigators examined the aircraft’s subsequent flights and identified airport personnel who may have come into contact with the patient.
“The list of contacts will not close. After that flight, how many other flights did that same aircraft make locally or outside? Jambo Jet is giving us that information. Even the people who cleaned the aircraft after it landed on Saturday and immigration and customs officials who served that patient will also be part of the contact tracing. So, the contact tracing number will keep on increasing,” Duale said.
Kenya has designated five hospitals to manage Ebola cases: Kenyatta National Hospital, with eight beds; Moi Teaching and Referral Hospital, with 50; the National Police Hospital, with 49; Portreitz Hospital in Mombasa, with four; and Nairobi Hospital, with 133, including about 45 high-dependency and intensive-care beds, according to Duale.
“The capacity in all these hospitals will increase as we are making sure that public, private and faith-based facilities increase their capacity in the event the situation evolves. In addition, five facilities, namely Malaba Health Centre, Busia Border and Kocholia, have been designated as temporary isolation centres for suspected cases. Alupe Sub District Hospital in Busia County is undergoing renovations to manage Ebola virus disease,” he added.
The government has intensified screening at Jomo Kenyatta International Airport and other points of entry, designating Gate 16 at JKIA for passengers arriving from areas affected by the outbreak. The measures are intended to detect suspected cases while keeping borders open to trade and travel. Authorities have also warned that providing false information on health declaration forms is an offence under Kenya’s Public Health Act.
Health Cabinet Secretary Aden Duale said the government would prioritise emergency spending and redirect funds from other health programmes to the Ebola response before seeking additional assistance from international partners. He said the government had the resources needed to manage the emergency.
Nairobi Hospital Chief Executive Felix Osano said the hospital was prepared to treat Ebola patients, with its isolation and treatment centre operating separately from the main hospital. He said the facility had the infrastructure, medical expertise and specialists required to manage patients, although no patients were being treated there at the time.
Director General of Health Patrick Amoth said officials had put systems in place to limit transmission and urged health workers to follow strict infection-prevention measures.
“Ebola is not spread by aerosols. It is spread by direct contact with a person suffering from Ebola, or a deceased person who has died from Ebola, or touching contaminated surfaces and equipment, for example, linen, towels, and plates. It doesn’t spread through the air,” Amoth said.
He said officials would hold a call with the Democratic Republic of Congo, Uganda and the US Centers for Disease Control and Prevention to establish how the patient passed through screening points in three countries.
The unresolved question over Laikipia is whether Kenya can activate the facility as part of its own emergency response or whether its use depends on decisions by Washington. The US statement confirmed that the centre had not been requested for the current patient, but did not spell out the rules governing its use.
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