Most refugees who flee to Kenya from neighboring countries live in camps, as required by Kenyan law. But a growing number of refugees end up moving to Nairobi and other cities, where they face a variety of problems, such as poverty and lack of medical care.

Abdulkadir Mohamed Karayu relaxes with his wife and two children in the family's cramped bedroom.

The Karayus came to Kenya from Ethiopia almost four years ago. They lived in the northern Kenya refugee camp Kakuma for awhile. "Living in Kakuma is like being engulfed in a fire (it is so hot). Without a doubt my child would have suffered terribly if we continued staying," he said.

The Karayus are one of an increasing number of refugee families and individuals who opt to stay in Nairobi and other urban centers in Kenya.

Refugees arriving in Kenya are required by Kenyan law to live in one of the country's two refugee camps. The Dadaab camp is run by the United Nations' refugee agency UNHCR. It houses some 255,000 people.

Emmanuel Nyabera is spokesman for the UNHCR in Kenya.

He says that, because the law is not enforced, many refugees end up in urban centers because they find camp life stressful and dangerous, and want to improve their lives.

"It always happens that some refugees develop coping mechanisms in urban areas. Mainly these are refugees who are skilled, who can offer their skills in urban areas," Nyabera explains. "These are people who initially, even when they took off from their countries, they were living in urban areas, so coping in a place like a camp becomes a challenge."

But the disadvantage of leaving the camps is that refugees do not get the support and services they receive in the camps.

This is especially the case with health care.

Dr. Samora Otieno is country director of Mapendo International, a U.S.-based organization that helps refugees. The clinic he runs is the only health facility in Nairobi that specifically serves refugees, who commonly suffer from respiratory tract and intestinal infections.

Dr. Otieno says Kenyan police often harass refugees, commonly to extort money. He says police do not recognize documents issued by UNHCR, and can even jail refugees who fail to show identification or passports.

"And that affects their access to a lot of services. So you find refugees who are sick but they fear going out to the hospitals because they think if they go it will be realized that they are refugees and they don't have documentation and they will be arrested," Dr. Otieno said.

Dr. Otieno and his Mapendo International group also assist refugees such as the Karayu family with food and other supplies.

But that type of assistance to urban refugees is rare, says Eunice Ndonga, senior program officer with the advocacy group Refugee Consortium of Kenya, or RCK. "So you will find that they have very serious problems of shelter, they have very serious problems of just basic needs, like food. Even coming to a place like RCK for the legal aid that we give, many of them will not access transport," she said.

She says many of her clients do not know where their next meal will come from and that many refugee children do not go to school because they have nothing to eat.

The UNHCR's Nyabera says his agency is concerned about the situation. "We cannot continue to assume that there are no urban refugees. We are aware that they are there and we are aware that it would be very difficult to have a situation where they are not there," he said. "So we are reaching out to them and coming up with some programs."

The RCK's Eunice Ndonga calls on aid groups to provide more assistance to refugees living in cities such as Nairobi.