Kenya has increasingly normalised the term goonism to describe the recruitment and deployment of groups to disrupt political activities, intimidate opponents, confront protesters or influence political outcomes through violence. What we saw in Homa Bay last weekend, and recently in the Ol Kalou by-election should make us think about goonism as more than just public order and fierce political competition.

Recruiting young people into organised political violence does not occur independently of Kenya’s unemployment and economic exclusion. Young people with limited economic opportunities can be mobilised relatively cheaply because the immediate payment may be significant to someone without a reliable income.

The costs of political goonism are typically measured in fatalities, injuries and damaged property. The actual price is much greater. Beyond immediate damage, it takes a toll on hospitals, family finances, healthcare facilities, and earning potential. Organised political violence has a detrimental effect on the long-term health of the youth who join.

A useful way of understanding the cost of goonism is to separate its direct costs from its indirect and long-term costs.

Direct costs

The most visible burden is trauma care. Victims may require ambulance transport, emergency surgery, blood transfusion, diagnostic imaging, medicines, hospital admission and, in the most severe cases, intensive care. Beyond the immediate expenses, these treatments impose opportunity costs on a healthcare system already strained by demand. A theatre occupied by a patient requiring emergency trauma care is not available to perform another procedure. Neither is an intensive care bed, an ambulance, a unit of blood or the time of a specialist surgeon. The cost is, therefore, not just what is spent on treating victims of violence, but also on routine and planned services that are delayed, displaced or foregone because finite resources have been diverted to treating injuries that should have been prevented.

Premature death adds a wider economic burden. When a person dies, the loss extends beyond the immediate costs of emergency care and forensic services. Years of potential income, tax revenue and economic contribution are lost as well. At household level, the death of a breadwinner can have catastrophic consequences for dependants’ nutrition, education, child development and healthcare. These consequences may increase dependence on publicly financed services, and deepen inequality.

Goonism is also a significant driver of sexual and gender-based violence, creating a substantial and lasting health burden. Survivors require emergency treatment, HIV post-exposure prophylaxis, emergency contraception, forensic examination and, in some cases, surgical management of serious injuries. During the 2007–2008 post-election violence, Kenya experienced a severe maternal and reproductive health crisis as sexual violence increased and health services were disrupted. Evidence has linked this period to sharp increases in sexual violence, higher HIV risk, fistula and other reproductive injuries, as well as deaths associated with unsafe abortion. The consequences of sexual and gender-based violence continue to persist due to chronic pain, reproductive health complications, depression, anxiety and post-traumatic stress. These conditions require sustained clinical and psychosocial care and can also reduce labour force participation, increase absenteeism and weaken household income.

Goonism damages health infrastructure itself. Ambulances, clinics, pharmacies and other public facilities may be damaged, looted or rendered inaccessible. The cost is, therefore, not limited to repair or replacement. Service delivery is interrupted, patients may be unable to obtain care, and facilities operating in areas affected by recurrent violence may need to spend more on security and protection of staff and property.

Indirect and longer term costs

The effects of violence are not limited to those who sustain physical injuries. Witnessing violence, losing family members, experiencing displacement or living with persistent insecurity can produce anxiety, depression, post traumatic stress and other forms of psychological distress. Children may also experience consequences that affect education, development and later economic participation.

Political violence affects movement. Roads become inaccessible, public transport interrupted and both patients and healthcare workers avoid areas considered unsafe. For many patients, continuity of care is medically important. Dialysis, cancer treatment, antiretroviral therapy, insulin, antenatal care and management of non communicable diseases is suspended. A patient who misses routine care may subsequently present with a complication requiring more intensive and expensive treatment.

Youth vulnerability and criminalisation

Beyond this, persistent involvement in goonism might pave the way for entry into organised crime syndicates, drug abuse, and various other violent crimes. We're already observing worrying increases in young people engaging in criminal acts, particularly in areas marked by joblessness, political engagement, and insufficient social support.

As we mobilise and misuse young people for political ends, we must recognise that goonism is not merely a security problem. It is an economic, social and public health problem. Its costs begin with the person who is assaulted, but they extend far beyond the immediate victim.

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Dr Bosire is a medical doctor and lawyer. stebosi51@gmail.com