Health Without Borders: Eastleigh’s Journey to Migrant-Inclusive, Resilient Health Systems

“At first, people would shut their doors when they saw me coming. Some didn’t trust that I was there to help. But now, they wait for me, they ask questions, they seek advice. They know we’re here for them, no matter where they come from.” — Fatuma, Community Health Promoter, Eastleigh

Often perceived only as a commercial hub or point of resettlement, Eastleigh is, in reality, a home to thousands of migrants, refugees, and asylum seekers from Somalia, Ethiopia, Sudan, the Democratic Republic of Congo, and across East and Central Africa. Many residents live without formal documentation, in overcrowded settlements with limited access to clean water, sanitation, or essential health services. Language barriers, cultural disconnect, and longstanding mistrust of formal institutions have pushed these communities to the margins of the health system. In such a context, health is not just about service delivery, it is about equity, dignity, and survival.

When the COVID-19 pandemic struck in early 2020, Eastleigh quickly became a flashpoint of vulnerability. Public health systems, designed around formal identification and fixed infrastructure, failed to account for the lived realities of undocumented and mobile populations. As a result, many migrants were excluded from testing, treatment, and vaccination. Overcrowded housing, poor sanitation, and widespread fear of discrimination further intensified the risks.

Evidence from the early months of the pandemic revealed a sharp decline in facility-based births in Eastleigh, as fear and lack of migrant-sensitive services drove women to seek unsafe home deliveries. Simultaneously, lockdowns and curfews devastated informal livelihoods, over 70% of migrant and refugee households in Nairobi reported income losses. Nearly half of Somali migrant families described their situation as “much worse,” while remittance support sharply declined. These overlapping challenges, poverty, exclusion, and invisibility, left migrant communities in Eastleigh dangerously exposed during one of the most severe health crises in recent history.

In response, Amref Health Africa in Kenya, in collaboration with the International Organisation for Migration (IOM), the Ministry of Health, and Nairobi County, launched a five-year initiative aimed not only at mitigating the crisis but at transforming the local health system. The goal was ambitious, to rebuild trust, ensure access, and make the health system responsive to the needs of all, regardless of nationality or status.

The intervention began with an inclusive COVID-19 response that prioritised dignity and access. More than 280,000 hygiene kits and face masks were distributed, and vaccination campaigns were conducted in mosques, markets, and through mobile clinics. This effort was led by a trusted network of trained Community Health Promoters (CHPs), refugee youth leaders, and respected community figures who spoke the languages and understood the concerns of the people they served.

Over the next five years, the initiative evolved into a holistic model of service delivery. More than 540,000 individuals were reached through static facilities and mobile health services, with the Eastleigh Community Wellness Centre (ECWC) emerging as a cornerstone of care

Behind the scenes, the project invested in strengthening the health system’s backbone. Over 1,200 frontline health workers and CHPs were trained in integrated service delivery, emergency preparedness, and digital health reporting. Mobile-based tools linked to Kenya’s DHIS2 system enabled real-time patient tracking, improving follow-up, referrals, and response, especially for high-risk conditions such as tuberculosis and maternal complications.

Through more than 1,800 community engagements—including mosque-based dialogues, radio campaigns, and home visits—Amref and its partners worked closely with local leaders to co-create culturally resonant health messages. These efforts were reinforced by migrant-friendly service charters and the active involvement of refugee health volunteers who dismantled stigma and strengthened the bridge between health systems and communities.

As the project concludes in 2025, the transformation is visible. Health workers are no longer viewed as outsiders. Migrant women are attending antenatal clinics. Young people are stepping up as peer educators. Families are actively seeking testing, vaccination, and routine care. The Eastleigh Community Wellness Centre has become a flagship for what inclusive, people-centred urban health can look like in a rapidly changing world.

A Model for Urban Health Equity

What began as an emergency response has matured into a scalable blueprint for inclusive urban health systems. The project has transitioned key digital tools, trained personnel, and operational structures to Nairobi County, towards sustainability and institutional ownership of the progress made. ECWC now stands not only as a healthcare facility but as a model for integrated, migrant-inclusive health programming in complex urban settings.

Amref remains committed to working with counties, communities, and partners to build health systems that are not only resilient but also truly inclusive. In an era of global health uncertainty, epidemic preparedness must begin by reaching those too often left behind. Because protecting everyone, regardless of nationality or status, is the only path to sustainable public health.