When Schools Become Hospitals: Teachers bear the burden of learners’ medical emergencies

The disturbing reports that at least eight learners have died in schools this term, as raised by the Elimu Bora Working Group, have thrust into the public eye the pressing issues surrounding safety, health preparedness, and emergency response in Kenya’s education system. While the circumstances of each case vary — from sudden illnesses and accidents within school compounds to drowning and transport mishaps — a consistent and alarming pattern emerges: schools are expected to safeguard learners’ health without having adequate resources, clear protocols, or sufficient financial allocations to do so. Perhaps most concerning is that, in emergencies, teachers frequently become the de facto custodians of learners, especially when parents are unreachable.

The tragedy of learner deaths cannot be examined in isolation from structural and systemic weaknesses within schools. Across the country, particularly in remote and interior regions, schools operate under severe constraints. Primary and ECDE institutions located far from hospitals face unique challenges that urban schools rarely encounter. While capitation funds cover tuition, operations, and occasionally minor infrastructure needs, there is no dedicated, ring-fenced health budget specifically meant for first-aid supplies, medical equipment, or emergency transport. Health emergencies are often managed through improvisation and the reallocation of already stretched operational funds, creating an environment where timely intervention may be impossible.

Distance is a critical factor in emergencies. In rural areas, the nearest dispensary or health centre can be 10 to 20 kilometres away, and roads may be impassable during the rainy season. Transport options are limited or nonexistent, and ambulances are rarely available. When a child collapses during assembly, suffers a severe asthma attack, or develops acute malaria symptoms, every minute matters. Yet, in many schools, a learner’s survival depends on the availability of an improvised motorbike ride or the teacher’s ability to arrange transport on the spot. By the time a learner reaches a health facility, precious time is often lost, and in critical situations, this delay can be fatal.

ECDE centres face even greater vulnerability. Children between four and six years old are physiologically more fragile. Conditions such as dehydration, febrile convulsions, choking, allergic reactions, respiratory infections, and injuries from falls escalate quickly and require immediate attention. However, many ECDE centres operate without sick bays, without stocked first-aid kits, and without staff trained in emergency response. Teachers in these centres are often forced to juggle instructional responsibilities with improvised medical care, creating a scenario where both education and health safety are compromised.

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The discontinuation of the national student health insurance framework has compounded the problem. Previously, schemes such as Edu-Afya provided learners with structured coverage for medical emergencies, ensuring that schools could seek timely intervention without worrying about financial constraints. Without such coverage, schools are left to bear the uncertainty and risk associated with emergency care. The Elimu Bora Working Group has consistently argued that this gap has left learners vulnerable, especially in remote areas where delays in parental notification and emergency response can be life-threatening.

One of the most challenging realities in these situations is that parents are sometimes unreachable when their child needs urgent care. During admission, schools collect parent or guardian contact details; however, many of these numbers are outdated, disconnected, or belong to individuals who are not immediately available. In remote regions, mobile network coverage is often unreliable, making immediate communication impossible. Even in urban settings, socio-economic dynamics may result in guardians frequently changing numbers or relocating without updating school records. When an emergency strikes, the teacher becomes the custodian of the learner, navigating hospital procedures, medical consent, and sometimes financial responsibilities on behalf of the child.

This situation places teachers in an ethically and legally complex position. While they are neither biological guardians nor formally designated medical decision-makers, they are compelled to act in the learner’s best interest. They must sign preliminary hospital forms, authorize emergency stabilization, and communicate with medical personnel under immense pressure. In some cases, they may also have to coordinate payments, even though schools often lack contingency funds to cover emergency medical bills. The emotional and professional burden on teachers in these scenarios is immense and largely unrecognized.

The challenges are further exacerbated in interior schools. Transporting a learner to the nearest hospital may take considerable time, and when combined with unreachable parents, it can significantly delay critical medical intervention. Life-threatening situations — severe asthma attacks, allergic reactions, head injuries, or acute infections — require prompt action. Any hesitation or delay can make the difference between life and death, underscoring the need for well-resourced health preparedness within schools.

Addressing these issues cannot fall on teachers alone. The recent learner deaths highlight the urgent need for a collective approach involving all stakeholders. Parents must ensure that contact information is current and that alternative emergency contacts are clearly listed. Schools need to routinely verify these contacts and establish functional communication systems. County governments should facilitate partnerships with health facilities to provide emergency transport, medical guidance, and mobile clinics. The national government must allocate dedicated health budgets for schools and reinforce legal frameworks that protect teachers acting in emergencies.

The Elimu Bora Working Group has repeatedly emphasized that systemic preparedness must include clear referral protocols, emergency response training, and financial support. Meanwhile, the Ministry of Education continues to conduct compliance and safety audits, but stakeholders argue that compliance alone is insufficient. Without allocated funds for medical emergencies, stocked first-aid kits, and legally recognized protocols for emergency consent, teachers remain exposed to both moral and professional risk.

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The financial constraints faced by schools are critical. Without a clear health budget allocation, schools cannot systematically stock first-aid supplies, fund emergency transport, or organize regular training for staff. Teachers are forced to improvise with limited resources, often relying on personal funds or community support. Urban schools may occasionally mitigate these challenges through parental contributions or proximity to hospitals, but in rural and marginalized areas, such solutions are neither practical nor equitable. Geography should not determine a learner’s chance of survival, yet in practice, it often does.

Beyond health emergencies, infrastructure and environmental factors further compromise learner safety. Water scarcity, poor sanitation, and inadequate nutrition weaken immunity and increase vulnerability to illness. Children in drought-prone or arid regions may arrive at school dehydrated and fatigued, heightening the risk of medical emergencies during the day. Teachers often act as the first line of defense, attempting to monitor, stabilize, and care for learners with limited support, tools, or training. The responsibility is monumental, and without systemic support, teachers are left to bridge gaps that the education system should adequately address.

Addressing these issues requires a coordinated, multi-stakeholder approach. Every primary and ECDE school, regardless of location, should have a functional first-aid station equipped with essential medical supplies, including thermometers, antiseptics, bandages, oral rehydration salts, and emergency contact information. At least two staff members per school should undergo certified first-aid and basic life support training each year. County governments should establish formal partnerships between health facilities and clusters of schools, ensuring structured emergency transport arrangements. Mobile health clinics can periodically visit remote schools to conduct routine check-ups, vaccinations, and preventive care, while community health promoters can serve as critical links between schools and health facilities.

Policy reform is equally important. Schools need legally recognized frameworks that protect teachers acting in good faith during medical emergencies. Structured emergency consent protocols must allow life-saving interventions when parents or guardians are unreachable. Contingency funds should be allocated for urgent hospital admissions, and mechanisms should exist to ensure that financial concerns do not impede timely care. Coordination between the Ministry of Education, county health departments, school administrations, and parents is essential to streamline responses and mitigate preventable deaths.

The eight learner deaths reported this term are a sobering reminder that safety in schools extends far beyond classroom discipline and infrastructure. True safety encompasses health preparedness, effective communication, trained personnel, emergency transport, and financial readiness. Every layer of protection must function seamlessly to prevent tragedies. When these systems fail, the burden falls on teachers — who become advocates, guardians, and decision-makers under extreme pressure. It is a responsibility they should never have to bear alone.

Ultimately, safeguarding learner health is not an optional component of education policy; it is foundational. A school cannot be considered safe if emergency response is improvised, parents are unreachable, and teachers are left to navigate legal and ethical responsibilities without institutional support. Geography, socioeconomic status, or school location should never determine a child’s chance of survival. Every learner, whether in an urban centre or a remote village, deserves an education environment that is not only intellectually enriching but also physically secure.

The current learner deaths highlight urgent gaps that must be addressed with coordinated, funded, and practical interventions involving all stakeholders — parents, teachers, school administrators, county and national governments, and community health actors. Health budget allocations, systematic first-aid training, reliable communication with parents, mobile health support, and clear emergency protocols are all necessary to ensure that teachers are supported, learners are protected, and tragedies become preventable. Only through deliberate policy action, adequate resourcing, and shared accountability can schools fulfill their dual mandate: to educate and to safeguard the lives of children entrusted to them.

The loss of eight learners this term should serve as a catalyst for national reflection and reform. It is not sufficient to reactively mourn these losses; the country must act to prevent recurrence. The safety and health of learners must be embedded into the very fabric of the education system. Teachers should not be forced to carry the weight of emergency decisions alone. Learners should not pay with their lives for systemic gaps. Every layer of protection — financial, structural, communicative, and procedural — must be operational, ensuring that schools remain spaces of learning, nurturing, and protection.

In conclusion, the tragic realities unfolding in Kenyan schools this term are a stark call to action. Protecting learner health, particularly in primary and ECDE schools in interior and remote regions, requires a multi-faceted, well-funded, and carefully coordinated response involving all stakeholders. The teacher, who often becomes the unexpected custodian in emergencies, must be empowered and supported. The child, whose life depends on timely care, must not be at the mercy of geographic or systemic limitations. The time to act is now, and it requires commitment from parents, schools, county health authorities, and the national government to ensure that no learner dies due to preventable gaps in the system.

By Hillary Muhalya