paedatric surgeon, Dr Neema Kaseje, trained the team who operate it. Work and income Restrictions on employment deter refugee jobseeking. However, all NGOs in the camp 'employ' refugees, but due to Kenyan laws prohibiting employment of refugees, they are engaged on a voluntary basis and paid an incentive, which is far lower than a wage would be for a Kenyan or international in an equivalent job. Refugees who work for aid agencies are paid around $20–40 per month. The salaries of the local Kenyan or the international staff are 10 to 100 times higher (for the same jobs), e.g. a refugee teacher was paid an 'incentive' of 3,000 KSh in contrast to Kenyan teachers who earned 12,000 KSh. $66,000 is paid to refugees per month in salaries and wages from employment in the humanitarian and commercial sectors. This practice is justified on the grounds that to pay refugees on a par with others would require them to have a work permit issued by the Kenyan authorities. Incentive staff represents only a small fraction of the refugee population. The work opportunities available from the UNHCR, the WFP or partner agencies usually consist of jobs involving physical labour (construction and security) or low-level clerical work, including bookkeeping and nursing. Positions are filled through personal networks and influence. Incentives are vital to the survival of the population – they ensure that some money is injected into the camp economy. For many refugees, the attraction of these jobs is the enhanced and sustainable access to goods and services through proximity to the commercial and relief actors, rather than the immediate cash benefit. Jobs in the commercial sector pay marginally better wages, ranging from $100–200 per month. It is possible for refugees to start small businesses, if the capital is available. Local businessmen have to obtain a trading licence costing 1,970 KSh per year. CARE International began running a credit facility which has since provided cash and materials to a wide range of income generating activities. The international remittances received by refugees total between $100,000 and $150,000 every month. Together with national remittances more than $200,000 flows into Kakuma every month. 20% of families receive remittances of on average $50 per month. 70 to 80% of the refugee population have access to cash through local employment and business activities (both estimated at $66,000), or remittances (estimated at $200,000 monthly). This group tends to sell up