MALNUTRITION: Somalia: MSF Stepping Up Malnutrition Intervention As Horn of Africa Food Crisis Worsens

July 8, 2011


Somalia 2011 © MSF: Women and children seeking care in Dinsoor, Somalia.

Organization Hopes for Further Expansion in Al-Shabaab Territory
The announcement by Al Shabaab, one of the main armed factions in Somalia, that foreign relief organizations would be welcomed in territories under their control has raised hope that it will be possible to mount a desperately-needed scale-up of assistance inside the country, said the international medical and humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).
The announcement comes at a time of great urgency, when many lives hang in the balance. The eastern regions of the Horn of Africa have experienced consecutive poor rainy seasons, resulting in one of the driest years in decades in many pastoral zones. The impact has been exacerbated by high local cereal prices, high livestock mortality, ongoing conflict, and restricted humanitarian access in some areas. All this is happening against the backdrop of a 20-year civil war that has ravaged large parts of Somalia, displaced hundreds of thousands of people, and made it ever more difficult to reach the few places where food aid and health care is available.
“MSF has been working continuously in Somalia for over two decades running large-scale medical programs,” says Joe Belliveau, MSF operational manager. “We have managed to maintain our programs under Al Shabaab, but restrictions on supplies and international support staff have prevented us from scaling up further. We hope that the Al Shabaab statement leads to a lifting of these restrictions.”
MSF teams already present in various locations inside Somalia are extended nearly to their limits, while others are assisting exhausted refugees crossing Somalia’s borders into Ethiopia and Kenya.
“Most of our therapeutic feeding programs in Somalia are running over capacity, with more than 3,400 children currently enrolled in our nutritional programs,” adds Belliveau. “We are running emergency nutritional projects in several locations in the Lower Juba valley region, in Galgaduud, Mudug, Lower Shabelle, and Bay regions. [During] the past weeks we’ve seen a sharp rise in cases with some people traveling hundreds of kilometers to get access to health care and treatment for their malnourished children.”
For example: ‘Ader Mohammud, 19, travelled around 250 kilometers [150 miles] to bring her weakened 11-month-old daughter, Najmo, to MSF’s treatment center in Galcaayo. The long journey was almost too late and too long for the baby girl. “I could not afford the transport cost [approximately $8]," her mother says. "I have no support in Galcayo; I survive only with what other patients and caretakers give me.” Though her daughter is getting treatment at the moment, ‘Ader does not know how she will get home; she thinks she may have no choice but to sell the food rations she’ll get upon departure to pay for transport.
The situation is equally dire elsewhere in Somalia. “In the town of Marere [in southern Somalia] we noted a sharp increase in cases of severe malnourishment amongst people coming from all over the Juba valley,” says Belliveau. “The majority of the hospital beds in Marere are currently occupied by malnourished children in need of intensive care, and additional staff has been recruited to assist.”
Meanwhile, tens of thousands of Somalis have been fleeing to Kenya and Ethiopia in search of assistance. Waves of people continue to arrive every day at the sprawling Dadaab refugee camp in eastern Kenya. With the camps already badly overcrowded—originally built to hold 90,000 people, they now house four times that number—many are forced to seek shelter in the surrounding desert. In an assessment on the outskirts of one of Dadaab’s camp sites, MSF teams found extremely high malnutrition rates among new arrivals. There was a 37.7 percent rate of global acute malnutrition (GAM) and a 17.5 percent rate of severe acute malnutrition (SAM) among those surveyed. And 43.3 percent of children aged five to 10 were malnourished. As a consequence, MSF admitted 320 children in their Inpatient Therapeutic Feeding Center in June alone—three times as many as in the same month last year.
In addition, MSF is very concerned about delays in provision of assistance to the newly-arrived refugees. Since June 30, refugees received food for 15 days upon their arrival, but then told to wait as long as 40 days for the second food ration. “Families arriving in Dadaab are seeking a safe haven, and it is unacceptable that they should be made to wait this long to receive even the most basic form of assistance, food and water,” says Emilie Castaigner, the MSF’s Acting Head of Mission in Kenya.
In Dolo Ado, in southeastern Ethiopia’s Liben zone, in Somali Regional State, around 1,400 refugees cross the border every day—2,700 on June 28 alone. Dolo Ado already hosts almost 100,000 refugees in camps originally designed for 45,000 people. MSF screened children under 5 years old upon their arrival and found that 37 percent were malnourished. MSF is currently treating more than 6,800 children in these nutritional programs.
“MSF is increasing its capacity [in these camps] but the operational limits are being reached”, explained Alfonso Verdú, head of MSF operations in Ethiopia. "The engagement of other organizations to the nutritional crisis is essential while the present ones should uphold their responsibilities to avoid the deaths of many vulnerable people.”
MSF has worked continuously in Somalia since 1991 and currently provides free medical care in eight regions of southern Somalia. Over 1,300 Somali staff, supported by approximately 100 staff in Nairobi, provide free primary healthcare, malnutrition treatment, support to displaced people, surgery, water and relief supply distributions. MSF does not accept any government funding for its projects in Somalia, all its funding comes from private donors.
http://www.doctorswithoutborders.org/news/article.cfm?id=5427&cat=field-news

MALNUTRITION: Somalia: 100 children die in Somalia daily

Abdi Hajji Hussein :  July 9, 2011

Some 100 children die of malnutrition in Somalia every day while 60,000 people are displaced inside the Horn of African nation daily, an official of the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) said Friday.
Abdi Yusuf Nur, an official from OCHA’s office of information, said in an interview with state-run Radio Mogadishu the drought situation is worsening day after day and has reached a very serious point.
“I am requesting local charity organizations who are involved in helping drought-hit people, Somali government and its people to work with international aid agencies and exchange drought-related information in a bid to facilitate helping those who are in dire need for emergency humanitarian aid,” Nur said.
He admitted that there are delays in humanitarian services, saying that the United Nations relief organization didn’t receive the needed funding to tackle this “unfolding drought catastrophe.”
Nonetheless, the official noted the aid agencies will begin providing assistance in Somalia as soon as possible.
Recently, the United Nations High Commissioner for Refugees launched an urgent appeal, telling the international media that a “human tragedy of unimaginable proportions” is about to unfold if more help is not provided.
Because of an extreme drought ravaging civil war-torn Somalia, as much as a quarter of the country’s population is now displaced or on the move, walking hundreds of miles to refugee camps in Ethiopia and Kenya.
The UN comments come as Mogadishu overflows with hundred of families who have been displaced from the southern Somalia region that is tightly controlled by the extremist militants of al Shabaab.
On Monday, at least 10 toddlers died of hunger and malnutrition in Mogadishu.
 http://www.allheadlinenews.com/articles/90053808?UN%20official%3A%20100%20children%20die%20in%20Somalia%20daily#ixzz1SOItoMEG

Somalia drought: UN aid for camps under Islamists

17 July 2011 Martin Plaut

 Somalis are seeking aid in Kenya and Ethiopia, as well as in camps inside Somalia Continue reading the main story

The UN Humanitarian Co-ordinator for Somalia, Mark Bowden, says aid is being provided to camps controlled by the Islamist group al-Shabab.
Mr Bowden told the BBC that aid was being given through al-Shabab's drought committees, which run the camps.
Mr Bowden said this could be done as long as the aid was delivered according to humanitarian principles.
He described the situation as so severe that it was vital to scale up aid operations inside Somalia.
The UN's refugee agency estimates that nearly one-and-a-half million Somalis have been forced from their homes but remain in the country.
But until very recently helping them has been very difficult indeed.
Al-Shabab, which rules over large swathes of south and central Somalia, had imposed a ban on foreign aid agencies in its territories two years ago, accusing them of being anti-Muslim.
It lifted the ban 10 days ago as long as groups had "no hidden agenda".

'Humanitarian principles'
Mark Bowden said that aid was being delivered to camps run by committees under the supervision of al-Shabab, despite the movement's known allegiance to al-Qaeda.
But he made it clear that this could only proceed as long as humanitarian aid was delivered free of any political connotations.
"The Shabab have, as I understand it, through their drought committees been distributing assistance to vulnerable groups of the population, so they have taken an interest and expressed concern.
"It is of course important to also recognise that the work that we do in these areas will be conducted under humanitarian principles and based on need and without any political association attached to the assistance," said Mr Bowden.



On Wednesday the UN has made its first aid delivery to drought victims in areas of Somalia controlled by the militants, since they lifted an aid ban.
UN children's organisation Unicef said al-Shabab had given UN workers unhindered access and hoped this would encourage other agencies.

'Close to famine'
Unicef airlifted food and medicine to malnourished children to the central town of Baidoa, more than 200km (about 125 miles) north-west of the capital, Mogadishu.
Extended drought is causing a severe food crisis in the Horn of Africa, which includes Kenya, Ethiopia, Djibouti and Somalia. Weather conditions over the Pacific means the rains have failed for two seasons and are unlikely to return until September.
Food shortages are affecting up to 12 million people. The UN has not declared a famine but large areas of the region are now classified as in crisis or emergency, with malnutrition affecting up to 35-40% of children under five.
The humanitarian problem is made worse by ongoing conflicts, which means that until July militant groups had only allowed aid organisations limited access to large parts of southern Somalia and eastern Ethiopia.
Since the beginning of 2011, around 15,000 Somalis each month have fled into refugee camps in Kenya and Ethiopia looking for food and water. The refugee camp at Dadaab, in Kenya, has been overwhelmed by 370,000 people.
Farmers unable to meet their basic food costs are abandoning their herds. High cereal and fuel prices had already forced them to sell many animals before the drought and their smaller herds are now unprofitable or dying.
The refugee problem may have been preventable. However, violent conflict in the region has deterred international investment in long-term development programmes, which may have reduced the effects of the drought.
Development aid would focus on reducing deforestation, topsoil erosion and overgrazing and improving water conservation. New roads and infrastructure for markets would help farmers increase their profits.
The result of climate conditions, conflict and lack of investment is that 6.7 million people in Kenya and Ethiopia are currently existing on food rations, and relief agencies estimate 2.6 million in Somalia will need assistance a new emergency operation.


The Unicef representative for Somalia, Rozanne Chorlton, said al-Shabab had assured the agency it could operate without undue interference.
"They gave assurances that our access for humanitarian purposes would be unhindered and that we would be able to reach the people who need support most," Ms Chorlton told the BBC.
Unicef paid no fees to al-Shabab, and that the success of the mission meant it would be repeated in the near future, she added.
She warned the situation was close to famine.
On Sunday the first in a series of UN refugee agency emergency flights arrived in Nairobi with 100 tonnes of tents.
The cargo was immediately off-loaded for transport by road convoy early in the week to the sprawling Dadaab refugee camp complex near the Kenya-Somalia border.
The flight was the first of five scheduled for Nairobi on alternate days this week from the UNHCR regional stockpile in Dubai.
http://www.bbc.co.uk/news/world-africa-14178953

MALNUTRITION: ETHIOPIA: Somalis living from drought to drought

BISLE (SOMALI REGION), 12 July 2011 (IRIN)
 Photo: Jaspreet Kindra/IRIN
Shokuri Abdullai, like most mothers in Bisle, feeds her family boiled wheat in the Somali region's Shinile zone

Every day, 500g of boiled wheat is divided up between two adults, four children, a calf, a goat and a donkey in the Farah household. It is the only food they have had after rains failed for the past two seasons.
The 15kg sack of wheat is provided to about 1,200 people in the Bisle area, which has four settlements, under the government-run Productive Safety Net Programme (PSNP) as payment for work, such as digging water holes.
"It is boiled wheat for breakfast and for the main meal – we don't have anything else – no milk, no meat, no vegetables, no oil," says Maria Farah, the mother. Not surprisingly, two of her children are severely malnourished.
The calf and goat that share their "ari" - a collapsible egg-shaped hut made of sticks and covered with sheeting – are emaciated. It is too hot for them outside, in temperatures that soar beyond 40 degrees Celsius.
There is no water in their settlement, about 54km north of Dire Dawa town in the Somali region, one of the worst hit by drought in Ethiopia. More than a million people have been affected.
On 11 July, the Ethiopian government launched an appeal for US $398 million to help 4.5 million people, up from 3.2 million in March, who are in need of food aid due to the drought.
Launching the July-December 2011 Humanitarian Requirements Document in the capital, Addis Ababa, Agriculture Minister Ato Mitiku Kassa said of the total revised 4.5 million beneficiaries, 41 and 32 percent are in Oromiya and Somali regional states respectively.
For Farah's family in Bisle, the worsening drought continues to threaten their livelihood. Their donkey, tied to a post, used to help carry water from the nearest waterhole about four hours. But he is frail. "He is too sick to move now," Farah said.
These pastoralists have lost scores of animals in the past three months.
"What will you do – you are just taking notes, are you going to help us?" asks Ali Abdi, a 60-year-old pastoralist. This is the worst drought he has seen in his lifetime, he adds.
An unrelenting battle with failed rains over eight years has left them with no sense of a future nor any hope of a better life.
The eastern Somali region depends on two rainy seasons, known as the gu (April-May) and the deyr (October-November). The gu rains provide 60 percent of the water needs for the region, and the deyr 30 percent.
Both rains failed in 2010 because of a particularly strong La Niña. Some parts of the region received rainfall in May but not enough to replenish reservoirs. Bisle received none at all.
Shokuri Abdullai, a mother of six, sends two of her children to school, which is free in Ethiopia. But she has not given much thought to what will become of them. They moved to this settlement from their village about eight years ago when they lost all their animals to drought.
The settlement is among the most accessible in the harsh Somali region during the dry season. "So NGOs drop by with some food now and then and there is a health post," said Abdullai, explaining their choice to make their home in Bisle, which has only become drier.
Maria Guled, a mother of five, the eldest 11, lies awake at night worrying about them. "I don’t have any other family anywhere else to send them to." Her children are unable to go to school because "they are too hungry".
The UN Children’s Fund (UNICEF) is supporting Save the Children-UK in running a new community-based therapeutic programme at the health post in the settlement. Thanks to the ready-to-use therapeutic food (RUTF), Farah's children have some additional rations.
"But all the food we provide for the malnourished children - a bottle of oil and 25kg of corn soya blend - is consumed by the entire family so the child still remains malnourished," a community health worker said.
There are others who are even less fortunate than the residents of the settlement. A woman with a severely malnourished child at the health post said she had walked two nights from her village for help. She left 10 of her children – the eldest a 15-year-old - alone at home. “I have no choice – my husband left for Djibouti two years ago because of the drought to look for work.” She is too distraught and angry and refuses to be photographed. "What will you do with all this? Are you going to help me?”
But the feeding programme is only three months old, with funding for another three. "It is not a sustainable solution – we need to address the causes,” Katy Webley, director of programmes at Save the Children-UK, said.
Daniel Maxwell, a food security expert and former aid worker in the Horn, said in an email that "underlying livelihoods crisis and threats to food security have to be dealt with in a much more systematic manner, including social protection programmes for the most vulnerable groups even in years when there is not a major humanitarian crisis, and greater emphasis on resilience and reduction of risk”.
He cited Ethiopia’s unique PSNP as the best example of an ideal social programme.

How PSNP works
The PSNP targets people facing predictable food insecurity and offers guaranteed employment for five days a month in return for transfers of either food or cash.
The PSNP has two–pronged benefits in a harsh arid zone such as Somali: cash or food builds resilience; while projects such as reforestation to stem land degradation and water harvesting would help the land recover in the long term.
"But in these conditions [cycles of drought] – there is not much we can do – there has been no room for recovery,” says Abdi Farah, manager of the PSNP in the Shinile woreda [district], where Bisle is located. “The PSNP has become a food aid operation; we need to get to at least 10,000 people in Bisle alone but we don’t have the resources.”
Shahid Haji, of the World Food Programme (WFP), which supports the PSNP with food, said: "We are stuck in the emergency mode – people need aid. They have not had the chance to build any resilience."



 Photo: Jaspreet Kindra/IRIN
Maria Farah outside her ari

Farah Wayis Ali, an elder from the settlement, explained to Valerie Amos, the visiting UN Emergency Relief Coordinator, that they could not work in the PSNP programmes as they needed water. “To collect the water we have to walk four hours – so when do we do the work?”
The government recently started trucking in water. “It is not a lot – we have big fights over water,” says Ali Abdi.
But supplying water is an extremely expensive exercise. Amy Martin, acting head of the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Ethiopia, said the operation to supply water in the drought-affected parts of Ethiopia from January to March alone had cost at least US$11 million.
Amos said the government was exploring the option of tapping deeper into the water table for a sustainable supply, but this too was costly.
The PSNP also has the option of providing cash but high food prices have rendered the exercise meaningless. Ali Abdi said a 50kg bag of wheat cost 400 birr (almost $24) compared with 150 birr (about $9) for a goat. “The life of our livestock has become so cheap.”
Maxwell said it should be noted “that much of this activity [PSNP] is still donor-supported [and hence subject to the same budget-cutting]”.

Security concerns
Humanitarian access has also been restricted in parts of the Somali region. In June 2011, two WFP workers were detained in the region.
Shadrack Omol, UNICEF's chief of operations and emergency in Ethiopia, said because of “conflict and security issues a number of health posts are frequently not able to provide essential services, [let] alone nutrition programmes”. As a solution, the agency is deploying mobile health and nutrition teams.
Amos said she had met Ethiopia's deputy Prime Minister Hailemariam Desalegn to discuss a plan to ensure safe access for aid workers to the country’s volatile areas.
http://www.irinnews.org/report.aspx?reportID=93200

MALNUTRITION: Somalia: Child malnutrition at dire levels - ICRC

By Stephanie Nebehay : 13 Jul 2011 : Source: reuters // Reuters

Somali refugees and their children wait to enter a camp in the Ethiopian town of Dolo Ado, about 1 km north of the border with Somalia, July 9, 2011. REUTERS/Stringer

GENEVA, July 13 (Reuters) - One in 10 children in parts of drought-hit Somalia is at risk of starving to death, twice as many as recently as March, the International Committee of the Red Cross (ICRC) said on Wednesday.
Malnutrition rates were believed to be significantly higher in other conflict-torn parts of central and southern Somalia, where few aid groups have been allowed to bring food relief.
"Levels of malnutrition have reached a new peak and are currently the highest in the world," the ICRC said in a statement.
The independent aid agency, one of very few with access to Somalia's worst-hit areas, said that even in the Bay and Lower Shabelle regions, the traditional breadbaskets, nearly 11 percent of children under five had severe acute malnutrition.
This meant they were at risk of starving to death. Rates were believed to be significantly higher in other areas.
"In some parts of Somalia, the number of children with severe acute malnutrition has almost doubled since March."
The disturbing findings were based on data from 39 clinics and 18 therapeutic feeding centres run by the Somali Red Crescent with its support. The ICRC said it was opening 10 new feeding centres in Bakool, Gedo and the Afgoye corridor.
The United Nations said on Tuesday it was struggling to keep up with an exodus of hungry Somali refugees. Emaciated children were dying of malnutrition along the way or after arriving in neighbouring Kenya and Ethiopia, it said. [ID:nLDE76B1JU]
More than 11 million people in the Horn of Africa now need assistance to survive the crisis sparked by the worst drought in decades, U.N. Secretary-General Ban Ki-moon said.

SECURITY GUARANTEES
Somalia has had no effective central government for two decades, worsening the impact of recurring droughts. Islamist al Shabaab rebels have refused to allow food aid to be delivered in areas under their control, saying it encourages dependency.
The world body is looking into security guarantees to return to southern Somalia following an unexpected announcement by al Shabaab last week that it was lifting its ban. [ID:nN1E765198]
The World Food Programme (WFP), in a statement on Wednesday, said it could return to the south "if conditions allow and if the necessary security clearance from the United Nations is granted".
The U.N. food agency withdrew from areas under al Shabaab control in southern Somalia in early 2010 "because of threats to the lives of our staff and the imposition of unacceptable operating conditions, including the imposition of informal taxes and a demand that no female staff work for us there", WFP said.
The WFP said it had continued to provide food to 1.5 million people in Mogadishu and central and northern Somalia.
In the south, the hardest hit groups are rain-fed farmers and pastoralists unable to gain access to alternative pastureland, Andrea Heath, the ICRC economic-security coordinator for Somalia, said.
"Significant crop failures, very high livestock losses, increased food prices, recurrent fighting and the absence of humanitarian aid are the main reasons that an already desperate situation has become even worse," she said in the statement.
http://www.trust.org/alertnet/news/child-malnutrition-in-somalia-at-dire-levels-icrc/

MALNUTRITION: Somalia: Famine warning for southern Somalia

JOHANNESBURG, 5 July 2011 (IRIN) -  Photo: Marcus Prior/WFP :
Somali women and children particularly vulnerable (file photo)

Localized famine could be witnessed in some of the worst drought-affected areas in southern Somalia in September, warns the Famine Early Warning Systems Network (FEWS-Net). Using the Integrated Phase Classification (IPC) five-point scale, this would be phase five: "catastrophe/famine".
The scale, developed by the Somalia-focused Food Security and Nutrition Analysis Unit (FSNAU), led by the UN Food and Agriculture Organization, is used by FEWS-Net and most other aid agencies in their analysis of the drought and food situation in the Horn of Africa.
The IPC scale ranges from "generally food secure" to "famine/humanitarian catastrophe", based on a range of data relating to rainfall, market prices, agricultural production, food security and nutrition.
Large areas of southeastern Ethiopia, southern Somalia and northeastern Kenya are already in phase four, the “emergency” phase.
Nicholas Haan, the food security scientist who developed IPC and its global manager, said the present climatic, price and conflict conditions in the Horn justified the classification as well as the warning of the possibility of phase five.
Specifically, phase five conditions would emerge “if one or more of the following were to happen: (1) if prices of key commodities [such as staple cereals maize and sorghum] spike further in the coming months, (2) if conflict [in southern Somalia] worsens in key areas that further reduces humanitarian access and/or prohibits trade and market routes, (3) if the harvest and livestock conditions turn out to be worse than these current predictions, or (4) the next rainy season fails [which will be evident by late October/November]".
The IPC scale uses a number of indicators to pronounce a famine, including acute malnutrition in more than 30 percent of children, two deaths per 10,000 people every day, a pandemic illness, access to less than four litres of water a day and 2,100 kilocalories of food, large-scale displacement of people, civil strife, and complete loss of assets and source of income.
An aid worker involved in some of the analysis said: “I would not call the situation as bad as the famine in 1984; unlike now, there were no warnings then, but in this instance alerts have been issued since August 2010.”
FEWS-Net is among several agencies that issued warnings after poor rains in one of the driest 2010 October-December seasons recorded in 60 years. Some of the pastoral and cropping areas recorded their second or third consecutive poor rainy season.
Haan said humanitarian aid such as cash and or general food distributions, programmes to provide more access to water, interventions to feed, treat or slaughter livestock before they are too emaciated for sale, and high-level political negotiations to ensure humanitarian access, especially in southern Somalia, would normally have already begun when a situation deteriorates into phase three.
He explained, “If the situation in some parts [of the Horn of Africa] does evolve into phase five famine, this would be a call for imperative action that comprehensively meets the basic requirements of increasing numbers of people in need. If a situation deteriorates to phase five famine, the ability of households to meet even their most basic food, health, water, sanitation, protection, and other needs all disintegrates - thus the need for all-out comprehensive humanitarian assistance.
“If need be, for situations with limited humanitarian access or otherwise political interference, there will be a call for extraordinary measures to ensure humanitarian assistance is delivered.
“If famine were to emerge, any financial, political, logistical or other constraints need to be wiped aside and the full cooperation of humanity needs to be focused on saving lives and preventing social collapse. This is the humanitarian imperative that should kick in even at phase three crisis IPC levels, let alone phase five famine."
The Responsibility to Protect (a concept legitimizing international intervention on humanitarian grounds endorsed by the UN Security Council in general terms) to improve humanitarian access especially in southern Somalia should kick in, he said.
"Of course it would be much better for all concerned - vulnerable populations of course, but also national governments, in terms of development plans, and international donors in terms of the cost-benefit of investing in preventative measures - to avoid such situations by heeding early warning signs and tackling chronic issues.”

Cluster talks
Humanitarian assistance during emergencies is deployed through “clusters” - groupings of UN agencies, NGOs and other international organizations around a sector or service.
Graham Farmer, coordinator of the new global food security cluster, which aims to combine food aid with efforts to address the causes of food insecurity in the long term, said discussions with aid agencies in Ethiopia and Kenya were continuing over where support could be provided.
Somalia has NGO-led national and local clusters in place, while emergency responses in Ethiopia and Kenya are led by the respective governments.
http://www.irinnews.org/report.aspx?reportID=93151

MALNUTRITION: KENYA-SOMALIA: Drought decimates livestock, hits incomes

NAIROBI, 4 July 2011 (IRIN)

 Photo: Umuro Godana/PISP : Pasture, grazing land and migration routes traditionally used in emergencies are no longer available (file photo)

A severe drought ravaging the arid and semi-arid parts of the Horn of Africa region is threatening the livelihoods of pastoral communities, with massive livestock deaths recorded amid an increase in deadly conflict over resources.
Pastoralists depend on livestock for all their basic needs and any losses undermine their economic and food security. Livestock sales are often used to buy grain and lack of milk and meat contribute to high malnutrition levels.
"The value of livestock – people’s main assets in many of the worst affected areas – has plummeted and livestock markets have collapsed, so people have much less purchasing power than before. People’s livelihoods have already been decimated, but there is now also a real risk of large-scale loss of life,” warns Oxfam in a 1 July statement, adding that in some parts of Kenya and Ethiopia, at least 60 percent of the herds have perished.
The perception that emergency relief often does not appreciate the importance of saving livestock assets in emergencies has prompted the development of initiatives such as the Livestock Emergency Guidelines and Standards (LEGS), the equivalent of SPHERE in humanitarian circles. LEGS aims at improving relief programming with communities that rely heavily on livestock for their social and economic well-being.
According to a December 2010 International Livestock Research Institute (ILRI) report, interventions to support livestock, such as supplementary feeding and commercial destocking (among recommended actions in LEGS), should be implemented before livestock are so weak they die.
In the 2008-2009 Kenyan droughts, truckloads of dead and dying heads of livestock were common.
“Supplementary feeding needs to target breeding stocks with sufficient time so that they stay healthy," states the ILRI report. "Conflict resolution to enable pastoralists to move to key grazing areas needs to be done in advance, before large numbers of animals need pasture. Late interventions are costly and unhelpful."

Falling prices
The weak condition of livestock has meant that the surviving cattle, for instance, have a far lower market value than normal – up to 40 percent less in parts of Kenya, says Oxfam, adding that “pastoralists in Somalia have also reported that their animals are now worth less than half of their value in late 2010”.
An oversupply of cattle in parts of Somalia due to destocking and restocking of small ruminants through cattle selling in Garissa, Kenya, meant that cattle prices were still 21 percent less in Somalia than in 2010, stated a 20 June Food Security and Nutrition Analysis Unit – Somalia (FSNAU) brief.
Increased camel exports - 7 percent of total livestock from January to May compared with 2 percent over the same period in 2010 at the Bossaso port - is an additional indicator of stress selling in drought-affected pastoral areas, notes FSNAU.
Northern Kenya, Somalia and southern Ethiopia, which are predominantly pastoral regions, are among the areas most affected by the drought. In Somalia, at least 65 percent of the population depends on the livestock sector; because of the effects of the drought, more people are sliding into food hunger and poverty.

 Photo: Mohamed Gaarane/IRIN
In some parts of Kenya and Ethiopia, at least 60 percent of the herds have perished (file photo)

FSNAU estimates that at least 2.85 million people are facing food insecurity in Somalia, a 19 percent increase from January. In Kenya, the food-insecure population is estimated at 3.5 million.
Large livestock migration from northeastern Kenya and Somalia's arid areas of southern Gedo to Juba and Bay regions in southern Somalia may lead to early depletion of pasture and water in these regions, according to FSNAU.

Destocking
According to the UN Office for the Coordination of Humanitarian Affairs (OCHA Kenya), subsidizing livestock markets, commercial livestock destocking and destocking for meat sales remain priority concerns in northern Kenya.
A government-run buy-back programme has been halted in some parts due to a lack of funds.
"The amount of money allocated was small considering the large population of livestock in Isiolo, Marsabit and Moyale," Zachary Nyanga, the Upper Eastern director of livestock, told IRIN.
Nyanga said KSh37.7 million (about US$419,000) allocated in April had been used to buy 13,000 goats and sheep from herders but the funds ran out in May. He said the programme would resume once additional funding, which has since been allocated, was received.
According to a local aid worker, who requested anonymity, government and aid organizations’ activities in livestock emergency response had to be coordinated. "The whole [off-take] programme was a failure from the beginning; the government was buying animals at a higher price than us,” the aid worker said.
The government was offering about KSh3,000 ($34) for a goat/sheep, while NGOs were offering half that.
In addition, the programme did not target cattle, which are worst affected by the drought.
"My intention was to sell my 40 [head of] cattle, save the money in a bank and then buy livestock [with the money] after it rains," said Peter Lepertet from the Wamba area of Samburu in the north. “I was also only allowed to sell four goats but I have more than 150 [sheep and goats]; it is meaningless.”
Wario Jirma, a resident from Marsabit district, northern Kenya, said: “We are losing livestock, [our] source of livelihood. The issue is very serious.”
In some areas, pasture, grazing land and migration routes that have traditionally been used in emergencies are no longer available, having been sold off, or allocated for tourism and large-scale agriculture. This has undermined pastoralists’ ability to cope with recurrent drought, notes Oxfam.

Clashes and displacement
In Kenya, at least 113 people were killed in clashes over resources between January and end-May, against 106 deaths in the same period in 2008, 138 in 2009, and 68 in 2010. According to OCHA Kenya, the high 2008 and 2009 killings occurred during above-normal dry conditions, similar to the present situation.
Conflict- and drought-related displacement has also affected education. At least 10 schools in Isiolo, Samburu and Turkana areas in the north have been closed.
"Hundreds of children have quit learning, many have moved with their parents to look for pasture, some have been displaced by a lack of water,” said Dade Boru, the Isiolo Teachers’ Union Executive Secretary. Livestock deaths and the resultant financial losses have meant parents are unable to raise school fees.
A local leader from the Oldonyiro area of Isiolo, Nicholas Lesokoye, said insecurity had affected business activities too and there were fears of more conflict. "We have received reports that a large number of armed herders have arrived and are still streaming in towards Isiolo," he said.
With drought known to be an ever-present hazard in the dry lands of East and Central Africa, relief programming should focus on the whole drought cycle, including normal and recovery periods, rather than just alert and emergency, states the ILRI report. This is because “any given area or community is... always in some phase related to current, recent or impending drought”.
http://www.irinnews.org/report.aspx?reportID=93142

MALNUTRITION: SOMALIA: "I watched four of my children die of hunger"

NAIROBI, 4 July 2011 (IRIN)

 Photo: UNDP
Drought has forced thousands of Somali families to migrate to urban areas (file photo)

With 100 heads of cattle, Halima Omar's family were considered fairly well off in their community in Da'ara village in Somalia's Lower Shebelle region. However, after three years of consecutive drought, the herd has been reduced to nothing and the family has been displaced.
Omar, 30, has buried four of her children, who died of hunger, and is now one of thousands of drought-displaced people migrating to urban centres in search of help in southern Somalia.
Omar's home is a makeshift shelter in a camp for internally displaced persons (IDPs), with more than 3,000 families (18,000 people) near Kurtunwarey district, 140km south of the capital, Mogadishu. A community leader in the camp told IRIN that trucks were picking up emaciated families by the roadsides and dropping them off at the nearest urban centres.
Omar survives on the good will of the local community. She spoke to IRIN on 4 July:
"We were very comfortable when we had our animals. We were one of the better-off families in Da'ara. But this changed when we lost our last cow five months ago. They died one by one. We could not even sell them.
"The cows were all we had. My husband went looking for food every day in the bush but there was not much to hunt. It was like the whole country was dying. Some days, he will come with enough from the bush to eat for one meal; other days we will go hungry. We went hungry more days than we ate. My children started dying slowly.
"I lost four of my six children to hunger. We felt helpless. There is nothing in the world worse than watching your own child die in front of your eyes because you cannot feed him.
"We finally left the village two weeks ago to try to save the last two. Now we are in this camp in Kurtunwarey with many other families like us. I am breastfeeding both of my children because I have nothing else. There is nothing left in my breasts but I have to give them something.
"Many children in this camp are so weak they can no longer control their bodily functions. The community here has been good but there too many of us and they are not much better off anyway.
"I keep wondering how long we will survive like this. I am worried about my last two children; I pray to God for help to come before it is too late for many of us.
"Every day we are burying someone here; you wake up in the morning and find that somebody’s child has passed away or you are woken up by the wail of a mother who just lost a child.
"I am losing hope; I don't know whether or not the situation will ever get better. Every day, I keep wondering whether we will eat today or not. I will do anything to keep my children alive but don’t know what to do. There is nothing here, no job, no food.
"Maybe this is our fate or maybe a miracle will happen and we will all be saved from this nightmare."
http://www.irinnews.org/report.aspx?reportID=93141

MALNUTRITION: The vital statistics of hunger

4 July 2011 (IRIN)

 Photo: Action contre la Faim
Aid workers and health officials measure a child's height and weight in western Chad

 Louise Masese-Mwirigi, an analyst recording nutrition data in southern Somalia with her team, have on occasion had to turn away from a village because the local authority that consented to the survey a week ago is no longer in charge or may have changed their minds when they arrive. Fighting between the government, its allies and various armed groups in parts of Somalia has severely restricted humanitarian space.
“The situation is uncertain in Somalia and access is a problem - especially in the last two years in central and southern Somalia,” said Masese-Mwirigi, who works for the UN Food and Agriculture Organization’s Food Security and Nutritional Analysis Unit (FSNAU) for Somalia.
Armed with an electronic weighing scale and a metre-long board to measure the height of children, Masese-Mwirigi and her team, led by Mohamed Moalim, along with Action Contre la Faim (ACF), a food relief NGO, have carried out a survey in the Mogadishu region, where the capital is located.
The survey is the first in seven years. “It took a month of planning… we could access six districts but had to let go of the remaining three because of security concerns.”
A rapid assessment by FSNAU in Mogadishu in December 2010 picked up high levels of malnutrition based on the measurement of the middle upper arm circumference (MUAC) - a quick, easy and cheap approximate measure of malnutrition in children younger than five years. "We felt we needed more information through a comprehensive nutrition survey, given the rains had performed poorly and the MUAC results were indicating high levels of malnutrition in the town."
The MUAC measurement uses a long strip of plastic with a series of colour-bands that is put around a child’s bare upper arm. The colours show the level of malnutrition: green indicates a 135mm circumference, which is normal; yellow - 125mm to 134mm - shows a risk of malnutrition; orange - 110mm-124mm means moderate malnutrition; red, for measurements less than 110mm, is an indication of severe malnutrition and risk of death.
In the past two years FSNAU have had to depend entirely on MUAC in parts of the conflict-hit areas. “It is less resource-intensive, and quick and ideal for emergency situations, but ideally we would like a more thorough survey,” Masese-Mwirigi said.

Detailed data
A thorough survey would take into account four variables - age, weight, height and gender - as well as the MUAC. Crude mortality rate (usually measured in deaths per 10,000 people per day in emergency situations), rate of disease prevalence, child care and feeding practices, household food security, and water and sanitation indicators, are also taken into account to understand the overall nutrition situation.
When two of the anthropometric variables are used together they are called an index. Three indices are commonly used to assess the nutritional status of children: weight for age (WFA), height for age (HFA) and weight for height (WFH).
These indices are then compared to a reference standard to get a sense of the severity and distribution of the nutritional problem in a country.
The survey is the first in seven years. It took a month of planning… we could access six districts but had to let go of the remaining three because of security concerns
The WFA of a child compared to a reference population will tell if the child is normal, overweight or underweight. HFA indicates whether the child’s height is normal for his or her age. If the child is not as tall as expected then he or she is stunted, reflecting a long-term, chronic problem - stunting is a good indicator of chronic malnutrition.
WFH is commonly used in acute emergencies to determine the scale of the crisis. It is often used when the child’s age is not known, and in countries like Somalia, where hardly any public records of births and deaths exist. WFH is regarded as a good indicator of acute or short-term exposure to a negative environment, such as a drought, as it reflects recent weight loss or gain. WFH is a measure of acute malnutrition.

Room for error
With so many measurements involved there is always a lot of room for error.
For instance a baby can often be not held properly to measure its length, or perhaps the child is not standing straight. Aid organisations are constantly trying to improve the skills of surveyors involved in taking measurements by organising training workshops periodically.
Determining the correct age can also be problematic. “We use the calendar of events to accurately determine a child’s age,” explained Masese-Mwirigi. Events like major natural disasters or elections can indicate when a child was born.
The other contentious issue in measuring malnutrition is what is considered average. The World Health Organization (WHO) provides a reference of growth standards, against which surveys calculate their deviations from the norm.
Yet the WHO growth standards might not be the norm for a particular ethnic population that is naturally long-limbed, like Kenya’s Maasai, or short-limbed, like the Gurkhas of Nepal. Even though the WHO standards were recently updated to better reflect human genetic diversity some experts feel country- or region-specific growth standards should be developed.
Prominent experts like Mark Myatt, Senior Research Fellow at the Division of Epidemiology, of the Institute of Ophthalmology, University College, London, feel MUAC is a much more accurate measure.
But that is not all. There are different scales of malnutrition. For individuals malnutrition can be moderate acute or severe acute.
To work out levels of malnutrition, WFA, HFA and WFH measurements are used to calculate and classify using what is known as the “percentage of the median” and “Z-scores”.
For instance, in expressing the WFH as a “percentage of the median”, a child’s weight is divided by the average weight for a child of that height, as provided in the WHO growth standards, and then multiplied by 100 percent. Fortunately, there is computer software that does the calculation.
The “Z-score” represents the difference between the observed weight and the median weight of the reference population, expressed in standard deviation units. When the percentage of the median is less than 70 percent, and the Z-score is less than -3, or oedema is present, the child is said to be suffering from severe acute malnutrition.

GAM or SAM?
Populations are described as severe acute or global acute. “Global acute malnutrition (GAM) refers to the total cases of moderate acute and severe acute malnutrition (SAM) in a population,” Médecins Sans Frontières (MSF), the medical NGO, notes in their useful manual, A Beginner’s Guide to Malnutrition.
GAM is calculated with the Z-score defined as a weight-for-height index less than -2 standard deviations from the mean weight of a reference population of children of the same height.
A GAM value of more than 10 percent generally identifies an emergency. Commonly used thresholds for GAM are less than five percent (acceptable), between five and just under 10 percent (poor), between 10 percent and under 15 percent (serious), while anything more is critical.
Clinical signs such as bilateral oedema - swelling in the feet, legs or face caused by an extreme shortage of protein - are a separate indicator of severe malnutrition in children.
“We recorded a GAM rate of 15.2 percent for Mogadishu in our survey,” said Masese-Mwirigi. In Somalia the FSNAU has been recording GAM rates of 15 percent and above for a long time, GAM rates of over 15- 20 percent indicate a critical nutrition situation, while rates over 20 percent are seen as very critical. The GAM rates reported in Mogadishu town are high, also given that there are a large number of feeding interventions in the town.
Prices of the staple grains - maize and sorghum - have gone up by between 52 and 95 percent in most markets. FSNAU reports that in some areas prices have doubled and even tripled since 2010.
In 2011 the major rainy season began late and was poorly distributed across time and place in southern Somalia - the second bad season consecutively, as the first harvests in January failed.
A smaller cereals harvest, low stocks and poor access because of continued conflict to Bakara, the main market in Mogadishu, have made basic foodstuffs harder to get and more expensive.

http://www.irinnews.org/report.aspx?reportid=93128

MALNUTRITION: Somalia: MSF is Denied Access to Drought-Affected Areas

8 June 2011
After weeks of negotiation, Médecins Sans Frontières (MSF) says it has been blocked last April by the local authorities from conducting emergency medical activities in Buurhakaba district in the Bay region of South Central Somalia, where drought affected population needed nutritional support and clean water.
MSF's planned emergency response included water trucking, nutrition screening for children under the age of five, and food distribution for malnourished children. However, the authorities have not allowed MSF to access the area.
Buurhakaba district is highly populated, with estimated 125 000 people. At the moment, there is no other actor providing nutrition support to this population.
MSF is an independent medical organization with projects in eight regions of Somalia. Over 1,500 Somali staff, supported by approximately 100 staff in Nairobi, provide primary health care, malnutrition treatment, health care and support to displaced people, surgery, and water and relief supply distributions in some locations.
MSF offers assistance to people based only on need, irrespective of race, religion, gender, political or clan affiliation.
MSF does not accept any government funding for its projects in Somalia, all its funding comes from private donors.
http://allafrica.com/stories/201106081186.html

MALNUTRITION: Somalia: Aid groups warn of worsening food crisis

Peter Mutai

One in four children are now suffering from acute malnutrition in the southern parts of Somalia which is the worst affected
 More than 30 international aid agencies on Friday warned of worsening food crisis and malnutrition in Somalia.
In a joint statement issued in Nairobi, the agencies said 2.4 million Somalis, almost a third of the country’s population, are currently living in crisis due to one of the worst droughts in recent memory as well as the ongoing conflict.
"We are urging the international community to increase and diversify humanitarian funding to save lives, and to provide longer term funding for development, and to rebuild livelihoods lost to the drought," the agencies said.
According to a coalition of 31 aid agencies, the recent drought has impacted the already volatile food security situation, killing livestock in huge numbers and leading to skyrocketing cereal prices in the country.
Rains expected in Somalia this year have so far been late, and inadequate for communities to recover from the drought’s impact.
Although East Africa is prone to recurrent droughts, this year’ s recent drought has been unusually severe. Precipitation for this season is forecasted to be below normal.
Aid agencies warn that many Somalis risk losing their lives and livelihoods as the impact of the drought intensifies.
Dependent on the rainfall, crop production has been massively affected, as last season’s harvest failed.
The next harvest expected in July and August, is likely to be below normal as farmers are dependent on good rainfall for cultivation. With poor households depending on locally produced cheaper cereals, another poor harvest would lead prices to skyrocket further.
This would increase the price of survival, making the purchase of food extremely difficult for the vast majority of Somalis that live on less than a dollar a day.
"I have lost everything," said Mohamed Ali, a pastoralist in Lower Shabelle Region along the coast.
Only four months ago, Mohamed was a wealthy pastoralist with 250 cattle. His herd provided nutritious milk for his children, and income for his family. Today, the fields around his home are littered with dead carcasses.
"With a major funding shortfall, aid agencies have insufficient resources to address the needs of those affected. While access remains a challenge, many agencies are still managing to provide life saving assistance to those in need," he added.
He is one of thousands of pastoralists that have lost their livelihoods, and become destitute.
Recently, he slaughtered his last cow to sell its hide for 2 dollars.
This is his last opportunity to raise income to feed his children.
One in four children are now suffering from acute malnutrition in the southern parts of Somalia which is the worst affected.
In some areas, malnutrition is affecting 30 percent of the population.
"This is one of the highest rates of malnutrition in the world, and double the threshold of an emergency.
There are now 241,000 children acutely malnourished across Somalia, of whom 57,000 are severely malnourished.
The price of food continues to soar, and this trend is likely to continue for the coming months.
In Bay region, cereal prices have soared by 135 per cent since the same time last year.
People are struggling to buy basic supplies as prices skyrocket.
For the poorest in Somalia, the worst affected by this drought, the situation is becoming unsustainable.
Over 55,000 people have been displaced by the recent drought and many others are migrating to urban areas in search of food and water.
For farmers and pastoralists, it will take many seasons for their livelihoods to recover from the devastating impact of the drought.

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EARLIER REPORTS:
United Nations Security Council voices "grave concern at continued instability" in Somalia
The UN Security Council on Wednesday reiterated its "grave concern at the continued instability" in Somalia and called for "a comprehensive strategy to encourage the establishment of peace and stability" in the Horn of Africa country.
The 15-nation Security Council, in a presidential statement adopted at the end of an open debate on the situation in Somalia, said that the instability in the African nation "has led to a multitude of problems, including terrorism, acts of piracy and armed robbery at sea off the coast of Somalia, hostage taking and a dire humanitarian situation."
The Security Council "reiterates the need for a comprehensive strategy to encourage the establishment of peace and stability in Somalia through the collaborative efforts of all stakeholders," the statement said.
Gerard Araud, the French UN ambassador who holds the rotating Security Council presidency for May, read the adopted presidential statement to the members of the UN body.
The Council "reiterates the importance of political outreach and reconciliation in Somalia, and stresses the importance of broad-based representative institutions reached through a political process ultimately inclusive of all," the statement said.
Somalia’s long-standing 20-year civil war has resulted in the loss of thousands of lives and an ongoing drought threatens nearly 2.4 million people, according to UN estimates.
As the mandate of the Somali Transitional Federal Government ( TFG) is set to expire in August, the Council noted that the primary responsibility to achieve peace, security and reconciliation in the country belongs to Somalis themselves.
Meanwhile, the Council expressed regret at the decision taken by Somalia’s Transitional Federal Institutions (TFIs) to extend their mandates unilaterally and urged restraint from further similar action.
"The Security Council notes with concern that many core transitional tasks remain outstanding and urges the TFIs to demonstrate tangible results on the completion of these tasks before the end of the transition, prioritizing progress on reconciliation, the constitution and facilitating the delivery of basic services," said the statement.
While acts of terrorism, piracy and armed robbery at sea off the coast of Somalia continue to threaten the country, the Council called upon "all opposition groups to lay down their arms and join the peace process."
http://www.coastweek.com/3419_somalia.htm

MALNUTRITION: Somalia: malnutrition rates high among Somali children

 24 April 2011
The United Nations says children in Somalia are suffering some of the highest malnutrition rates in the world as drought continues to affect the country.
The UN Food and Agricultural Organisation (FAO) says there was a complete crop failure in southern Somalia affecting about 2.5 million people. One in four children are malnourished.
A FAO official says UN agencies have raised only a third of the food aid required by Somalia and other aid groups are also short of funds.
As well as the current drought, Somalia has experienced more than 20 years of conflict between Islamist insurgents and the transitional government, backed by African Union peacekeepers.
http://www.radionz.co.nz/news/world/73600/malnutrition-rates-high-among-somali-children