Here in Kenya, rather than declaring a “state of alert”—which is a bit like when they check you with those Star Wars-style plastic lightsabers at the entrance to shopping malls, which beep to make you realize they’re actually for something—people don’t write or talk much about it.
Statistics and numbers, needless to say.
This is a country where people continue to die, mostly from unknown causes.
Unless it’s something sensational—a car accident, a feud between herders and farmers—and it’s not the kind of thing that affects the wealthy, like those who can afford months or years of cancer treatment, here people simply die from one moment to the next after feeling a bit unwell. It doesn’t make the news, and you can’t sue anyone. In fact, people often try to avoid paying for any hospital stay, and every year hospitals have to cremate hundreds of unclaimed bodies, without ever having been paid for their care. That’s why no one ever wants to go to the hospital: it’s not just the antechamber of death, but also that of an unwept and anonymous burial.

That is why an extreme religious sect has gained such a foothold, promising a “clean and dignified” death through fasting, to present oneself in the best possible condition before Jesus.
The latter know this; the former not only live better but also die like lords. And if there is a God who appreciates the bishops’ cars, the monsignors’ robes, the cleanliness of certain churches, and the gold in the Vatican tapestries, He prefers that one present oneself before Him in a fitting manner.
So in Kenya, people simply die.
If you had a fever just before leaving this Earth, you can be sure you died of malaria: in clinics, rural hospitals, and makeshift medical centers, the pseudo-medical record states the easiest and most predictable verdict—the one with the highest chance of being correct.
And thankfully, in the end, the data isn’t collected by some statistics center, as the Americans would like to do with their health agreements in Africa; otherwise, we’d start talking about malaria returning to kill en masse.
For ordinary people—whom it’s redundant to call “poor people”—you simply die.
If only you were diagnosed with fulminant pancreatitis, or an ischemic stroke... it would mean you’re admitted to a facility for the wealthy.
The millions of rats scurrying through the open sewers of informal settlements, squeaking at the edges of ponds where Anopheles mosquitoes buzz and bullfrogs croak, will never have their moment of fame.
Yet Kenya, which dreams of becoming East Africa’s tech hub, the continent’s artificial intelligence capital, and the home of digital startups and fintech, continues to have healthcare as one of its most open and least-discussed wounds. The other, along with education, remains the great invisible divide between the country of international conferences and the real one of rural counties.
Over the past two years, William Ruto’s government has staked everything on the healthcare reform known as SHA, the Social Health Authority, created to replace the old NHIF and finally promise universal health coverage. On paper, it’s a revolution: more digitization, greater access to care, premiums calculated based on income, and specific funds for chronic diseases and emergency care. In practice, for many Kenyans, it’s yet another bureaucratic maze.
Controversy erupted almost immediately. Hospitals not receiving reimbursements, patients turned away because the system doesn’t recognize them, contributions deemed absurd for informal workers who are already barely scraping by. According to several investigations, the new digital system has even overestimated the incomes of the poorest, demanding amounts impossible to pay for families living on little more than a dollar a day.
So it happens that some people must choose between buying medicine or paying rent for their shack, continuing to treat themselves with potions from herbalist shamans. Or whether to pay the preventive health contribution instead of buying a meager portion of cornmeal.
And in the meantime, on Kenyan social media, stories are multiplying of people who died at home after being turned away from hospitals because they were not in compliance with the new healthcare system.
The problem, however, stems from much deeper roots than digital platforms and electronic health cards. Kenya has suffered for years from a chronic shortage of doctors, nurses, and specialized staff. Thousands of healthcare professionals, after completing internships and master’s degrees—often funded through cooperation programs—emigrate to Europe, Canada (though the U.S. is now more difficult to reach…), or Gulf countries, drawn by better salaries and less desperate working conditions. And while the government continues to talk about medical tourism and high-tech hospitals, entire regions of the country have clinics without even a qualified nurse, operating rooms without anesthesiologists, and hospitals without basic medicines.
According to recent government data, the shortage of healthcare personnel could exceed 100,000 in the coming years. In practice, Kenya risks having less than three-quarters of the staff needed to ensure decent healthcare coverage for a constantly growing population.
Then, of course, there is the Kenya of excellence. The private hospitals in Nairobi where transplants, cardiac surgery, and advanced diagnostics are performed. The clinics frequented by politicians, expats, and the emerging middle class. The grand, futuristic projects like Mwale Medical and Technology City, a healthcare hub promising to transform the country into a sort of African medical Silicon Valley.
But as soon as you leave Nairobi, especially the neighborhoods where you can pay in dollars, the system reverts to what it always has been: fend for yourself, pray, wait. And often die without a diagnosis.
This is why Kenyan health statistics bring a bitter smile to those who truly know the country. Because behind the official numbers lies an invisible continent of unregistered deaths, improbable diagnoses, never-identified illnesses, and medical records hastily filled out by exhausted nurses.
After all, this is also what contemporary Kenya is: a country that wants to race toward the digital future with its laces untied. Where you can pay for anything with your phone, but you might not find a doctor within fifty kilometers of home. Where people talk about artificial intelligence applied to healthcare, while too many people still die simply “after a fever.”