Through much of August, Dr. Kefa Otieno was the only physician working at the hospital in Kakuma. (Photo by Brian Otieno for ProPublica). 

Off to one side of the maternity ward was a small, stark room with a bench along one wall and two wheeled, metal beds. Otieno called it the kangaroo room. Inside were moms and premature babies too small to safely return home. The hospital had no functional incubators, so medical staff ascribe to a method called kangaroo mother care, where moms hold their babies against their skin to keep them warm and help them grow.

There, I met 21-year-old Monica and her baby, Mary. 

Monica is funny, with a dry, sharp wit. She met her husband, Ramazani, at church, when she was singing in the choir. They’d dated for a couple of years before she found out she was pregnant in December last year. They were both scared and excited to be parents, but the timing of the pregnancy was unlucky: As Monica’s belly grew, food rations shrank. 

Monica began struggling with anemia and high blood pressure. Otieno told me the roots of these complications were undernourishment. 

First-time mother Monica Sumaili, 21, holds her baby girl, Mary, at the only hospital in Kakuma, Kenya, the world’s third-largest refugee camp. (Photo by Brian Otieno for ProPublica). 

Monica doesn’t remember going into labor. Ramazani found her collapsed on the floor when he returned from one of the camp’s community showers. She was having seizures, and it took a few hours before they got her to the hospital. Medical staff rushed her in for an emergency cesarean section; she was in such dire shape that staff thought they were going to lose both Monica and her baby. When we met three weeks later, Monica still struggled to speak, her tongue contorted and swollen from biting on it for so long during the seizures. 

Still, she was able to tell me about her pregnancy, including a time when she was about five months along and hadn’t eaten for two days. She went to a nearby vendor to beg for a samosa on loan, promising to pay him back later in the day. She then hid in her house for several days, pretending no one was home when he came by to collect the few cents she owed. (Ramazani eventually paid him back.)

Binti and her son Nuru were also in the kangaroo room. 

At age 28, Nuru was Binti’s third child. She’d had no complications with her previous pregnancies, but with Nuru, she barely gained weight. Binti had come to Kakuma in 2016 after fleeing violence in the Democratic Republic of Congo. When she first arrived at the camp, there was always food. 

“I had other kinds of stress, but never with food,” she said one afternoon while sitting on the floor sewing curtains for the sparse hospital room.

Binti, right, sews curtains with a health promoter from the hospital. (Photo by Anna Maria Barry-Jester). 

But during this pregnancy, she said, food was all she thought about. She was so anemic and hungry that she resorted to eating clay, digging out the top layer of earth to get to the cleaner soil below, and charcoal. Her chart showed she gained fewer than 10 pounds during her entire pregnancy. Nuru was born at 33 weeks, weighing about 3.5 pounds. 

Otieno wanted the babies to weigh 4 pounds before they went home, enough that they’d have a fighting chance against infection. Hospital staff put the babies on a scale every two days, and before each weigh in, Binti would get herself hyped up: “I can feel it, today is the day we are going home,” she said one afternoon. Monica tried not to think about what the scale would say. Both she and Mary had dropped weight in the preceding weeks. After so much loss, she didn’t want to get her hopes up. 

But while Binti and Monica were desperate to get out of the hospital and home to their families — Binti to her other children and Monica to her two younger siblings — leaving would come at a cost. If and when they went, they’d be cut off from food again. 

At the hospital, staff brought around three simple meals every day, typically lentils and rice or sorghum porridge. Outside the hospital, they’d have almost nothing. 

Facing dwindling supplies, WFP, which provides food for the camp, made the dramatic decision to only give rations to about half the camp’s residents in August. Families were placed into groups based on rough estimates of need. Even though Monica and Binti were stuck in the hospital precisely because they didn’t have enough to eat, Binti and Ramazani had both been placed in categories that meant they would get no food. Monica and her younger siblings were set to receive just 420 calories a day each.

In the meantime, Binti and Monica bonded: They told stories and held each other’s babies while they showered or went to the bathroom. They took turns sleeping on the bench so the babies could have one of the beds. Monica and Ramazani, who spent almost every night at the hospital, made sure that a tiny copy of the Bible was always placed next to baby Mary’s head.

One Saturday morning, Otieno came in to weigh the babies. Binti bounced back and forth on her feet like a boxer preparing for a bout. Nuru weighed in at just under 4 pounds. Binti raised her arms in victory: They could go home.

Then it was baby Mary’s turn. “This baby is refusing to gain weight,” Otieno mumbled, trying to still her wiggly legs to get an accurate measurement. Mary had gained 10 grams, equivalent to two-thirds of a tablespoon of water. After days of losing weight, it was perhaps a small victory, but not one that Monica would celebrate. She picked up Mary, held her against her chest and sat back down on the bench.

Monica and Otieno weigh baby Mary. (Photo by Brian Otieno for ProPublica). 

I asked Monica about her hopes for the future. She said all she wanted was to be resettled in the U.S with her siblings and Mary, so they could all go to school and have enough to eat. “Fill your notebook with that,” she said. “It’s the only thing I want.”

At the end of September, the administration gave WFP’s Kenya operations $66 million, 40% less than the U.S. gave in 2024 and nine months into the year. WFP has said the funds will be enough to provide food to the camp through March, though rations are still far below what humanitarians consider the daily minimum of calories. 

In response to a series of questions, a senior State Department official told us that the U.S. still gives WFP hundreds of millions a year and the administration is shifting to investments that will better serve both the U.S. and key allies like Kenya over time. 

The official also said that the Office of Management and Budget, not the State Department, has ultimate authority to approve new foreign aid money. When we asked OMB about the delays, communications director Rachel Cauley told us: “That’s absolutely false. And that’s not even how this process works.” She did not clarify what was false.