Salma* is HIV-positive and knows she needs life-prolonging antiretroviral drugs, but visiting a doctor could expose her illegal refugee status in Kenya and risk her being sent to a refugee camp, or worse, back to Somalia.
"If I go to the hospital they will tell the police - I would rather just die here than go back to Dadaab or Somalia," she told IRIN/PlusNews in Eastleigh, a suburb of the Kenyan capital, Nairobi.
While most refugees coming to Kenya from neighbouring countries stay in official camps, many travel to urban centres across the country with no documentation. They spend much of their time hiding from the authorities, and struggle to make ends meet, with many women turning to sex work.
After spending her first five months in Kenya in Dadaab refugee camp in the northeast, Salma and some friends came to Eastleigh, to work as sex workers.
"Many of my friends were being raped and others beaten but you can't report [the abuse]. The police will turn on you. When you are raped or beaten you are a victim, when you report you are still a victim," she said. "At times we sleep with people but they don't pay. They tell you prostitution is illegal in Kenya. You end up giving your body for free."
Kenya is home to 374,000 refugees; official estimates put the number of registered urban refugees at 46,000, but according to the Refugees Consortium of Kenya (RCK), this number could be as high as 100,000 in Nairobi alone, most of whom are unregistered.
"Many urban refugees are exposed to HIV infection because young girls turn to prostitution to earn a living; they do not have access to reproductive health services and many refugees, especially those in urban areas who hide, do not get the right HIV prevention and treatment messages," said Simon Konzolo, a programme officer at RCK.
According a recent report by the Overseas Development Institute, Hidden and Exposed: Urban Refugees in Nairobi, many young girls are smuggled into Kenya by other refugees and have to pay for their passage with their bodies.
|When you are raped or beaten you are a victim, when you report you are still a victim|
"While some are treated well and are paid, many work long hours, are not paid and are subjected to physical, sexual and psychological abuse," the report, which profiled refugees from Ethiopia, Burundi, Somalia, Sudan, Eritrea, Congo, Uganda and Rwanda, found.
Afraid of the police, the women have nowhere to turn when they are abused.
"They are literally living on the edge because they say if they come forward, they risk harassment from government authorities like the police," said Sara Pavanello, a research officer with the Humanitarian Policy Group at ODI.
"... it means therefore many do not want to come forward to seek services offered by the government like health and education", she added.
Kenya's HIV policy offers free HIV services to anyone with legal residential status, effectively locking out HIV-positive illegal immigrants.
"The government has a duty to provide protection to refugees and this involves provision of shelter, food, health and medical care and education," said Peter Kusimba, commissioner for refugee affairs at the Ministry of Immigration and Registration of Persons. "These, however, are only provided to refugees with legal immigrant status or are mandated by the UNHCR [the UN Refugee Agency] to be in the camps.
"It would, however, be difficult to provide services to unregistered urban refugees because they wouldn't come out for fear of arrest but we encourage them to come and apply for legal immigrant status so that they receive these services like everybody else," he added.
"It is time the government checked into the realities of the day and changed it [the HIV policy] to [include] groups like refugees who might need this treatment so that they are not left out," RCK's Konzolo said.
* Not her real name