Ethiopia: Emergency and humanitarian action weekly update - Week 43 (19 - 25 Oct 2009)

Situation Report
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- WHO field consultants report that the number of reported cases of acute watery diarrhoea (AWD) has decreased in Oromiya, Amhara, SNNP and Afar Regions. The number of affected districts has also dropped. Undiminished risk factors in most of the regions remain a concern for the Government and humanitarian partners.

- The number of reported cases of malaria is increasing in some districts of SNNP, Oromiya and Amhara regions, but the actual figures remain indeterminate. The Federal MOH and the regional health bureaus (RHB) are leading the collaboration with partners for the response.

- The late start of the main rainy season delayed planting in most places, while its early end in crop producing areas of the north, north-east and east raised concerns about harvest prospects. Overall the poor performance of the rains has led to wilting and stunting of crops in several areas of eastern and southern Tigray, parts of eastern Amhara, the southern low-lying areas of SNNPR, nearly the whole of Gambella and many low lands of eastern Oromiya.

- The Government and the UN launched the Humanitarian Requirements Document on 22 October. The document identifies an estimated 6.2 million people in need of assistance, up from 4.9 million in January. The health and nutrition sectors report a funding gap of US$ 28 577 481.


- The overall security situation remains stable. No major security incidents involving humanitarian staff members have been reported.

Food security and malnutrition

- In Oromiya Region, WFP reports that in October, food security has reached critical levels in the low land districts of West and East Harerghe, where most of the maize crop has failed and the sorghum is wilting. Most affected districts are Hawwi-Guddina, Burqa-Dhintu, Daro Lebu, Doba, Hawi Gudina, Deder, Midega Tola, Gole Oda, and Boke. Populations in these areas have started to migrate to other districts and towns in search of better food security and livelihoods. Residents are also selling household assets to cope with the declining food security.

- WFP reports that the Outreach Therapeutic Programme (OTP) is currently supporting around 298 children from Kurfa Chele, 254 from Deder, 219 from Oda Bultum, and 205 from Daro Lebu. This is in addition to the 243 children in Guba Koricha and in 415 in Achar reported last week. The numbers of malnourished people continue to rise. Disease outbreaks have not been reported.

- In SNNPR, WFP reports that food security has improved in the highliands due to the short rainy season harvest. In the low lands food security remains a concern in Humbo, Dam-ot Woyide (Wolayta zone); Kemba, Boreda, Mirab Abaya, Zala, Uba Debre Tsehay districts (Gamo Gofa zone), Gena Bosa, Loma (Dawro zone), and BenaTsemay, Hamer, Dasenech, Nayngato (South Omo zone) due to the total failure of the short rain season harvest, poor main rain season harvest prospect, low livestock productivity and subsequent declining prices and diminished labour opportunities in the agricultural sector.

- In Somali Region's Gode, Afder and Liban zones, a further deterioration of the food security is reported. There are severe water, food, and animal feed shortages in Dolobay, Doloado, Bare and Hargele districts. Diminished fresh milk availability and deaths of livestock were also reported and only few households can afford to purchase milk powder which is aggravating the nutritional status of vulnerable families. Malnutrition continues to rise in the area particularly in children under five. The Administration for Refugees and Return Affairs (ARRA) and Save the Children-US reported 31 cases of severe malnutrition and 72 cases of moderate malnutrition among children under five and a few adults in the refugee transit centre as well as in the Boqolmayo refugee camp. Currently the Dolo Ado Health Centre requires additional capacity to cope with the increasing cases of malnourished people.

Acute watery diarrhoea (AWD)

- AWD continues to be a major health problem in Oromiya, Amhara, SNNP and Afar Regions. WHO field consultants report that the number of reported AWD cases has decreased. Undiminished risk factors in most of the regions remain a concern for the Government and humanitarian partners.

- In Oromiya Region, 48 cases and 3 deaths (CFR 6.2%) were reported in 10 districts this week. Of these, 30% were reported from Arsi Negele district of West Arsi Zone. All Woredas of West Arsi Zone, except Adaba, are affected by an AWD outbreak since 30 April. Shashemene and Arsi Negele districts are particularly affected. Currently, cases are reported from two treatment centres (CTCs) in Sheshemene and Arsi Negele woredas, mainly in two kebeles. Meanwhile in the ongoing outbreak in SNNPR's Konso District is showing person to person transmission.

- Few cases were reported in the Oromiya and South Wollo administrative zones of Amhara Region this week. The Oromiya Zone health authorities reported two cases from Dewa Cheffa and Dewei Harawa woredas, but none from Bati woreda, which had been reporting cases over the last several weeks. In South Wollo, two cases were reported from a rural kebele in Dessie Zuria district. These sites have poor sanitation and water supply facilities. There are no latrines and they share water with animals from a nearby pond. Sporadic cases are also reported from Erer district in the Somali Region neighbouring Oromiya. The number of cases has largely reduced due to successful interventions in the region.


An upsurge of malaria cases is reported in SNNP, Amhara and Oromiya Regions. but the actual figures remain indeterminate. Gaps include:

- Inadequate availability of antimalarial and rapid diagnostic tests;

- Shortage of Insecticide-treated bed nets, those available have already passed their lifespan( procurement is under way for 30 million nets);

- Shortage of spraying equipment;

- Shortage of operational funds;

- Difficult access to information on the current status of malaria;

- Absence of malaria focal points to coordinate the response at regional and district levels.

Influenza A (H1N1) update

- According to the Federal Ministry of Health, no new cases of Influenza A H1N1have been reported this week. So far, six cases have been confirmed. WHO is supporting the FMOH in setting priorities for vaccine deployment.


Food insecurity and malnutrition

Food security and nutritional status are not improving in many districts of Oromiya, SNNP, Afar and Somali Regions. Needs include:

- Additional food/medical supplies and nutritional interventions in OTPs and stabilization centres;

- Extra support for monitoring and supervision;

- Greater support from NGO partners;

- Improved recording in OTPs;

- Support to enhance completeness and timeliness of reporting.

Acute watery diarrhoea (AWD)

- Communities in Daleti & Kearo kebeles reside around an irrigation scheme and Awassa Lake. Lack of safe drinking water, low utilization of latrine, poor personal hygiene and environmental sanitation are the risk factors identified during field visit by WHO field staff.

- The problem of unpaid salary for cleaners, guards and health workers is not yet solved affecting staff performance, particularly in Bulchana CTC (Shashemene woreda), where poor infection prevention was observed during a supervisory mission at the CTC.

- The function of multisectoral committees and Rapid Response Team is still weak and not meeting regularly. In SNNPR, the ongoing outbreak is a threat to other kebeles of Konsso Woreda and other neighbouring woredas. Compounded with malnutrition and rising malaria cases, it could turn into a complex emergency.

- Critical gaps in the response include the absence of clean safe water supply, proper sanitation facilities, medical care and very poor and overcrowded living conditions in the state farms and holy water sites serves.


Needs include:

- Training for Health Extension Workers, community health promoters and kebeles level committee members on the control and prevention of malaria.

- Provision of insecticide-treated bed nets for affected communities.

- Provision of operational cost for intervention/response.

- Provision of antimalarial drugs and supplies.

- Operational cost to support monitoring and supervision.



The following activities are implemented under the leadership of the FMOH and RHB:

- A National Malaria Professional Officer (NPO) is stationed at FMOH to support the malaria response in the affected regions.

- Two consultants are in the regions supporting the response to and identification of high-risk districts, health workers training and supportive supervision.

- Operational research on vector susceptible to insecticide ( DDT)

- WHO and partners provide operational cost for the response.

Food insecurity and malnutrition

The following activities are implemented:

- Technical support on the use of OTP cards for malnutrition by regional health bureau and partners.

- Monitoring and supervision activities in the affected districts by partners and regional health bureau.

- Resource mobilized to support nutrition response by WHO and partners.

- Support coordination activities at district level in collaboration with the nutrition cluster.

- Technical support in the areas of SAM management and related data management.

Acute watery diarrhoea

- WHO supported the SNNPR health bureau in capacity building-training for health professional, kebele and woreda committee members and voluntary workers on health. Participating in nutrition and health data collection as part of the National Belg Assessment and regional level debriefing of the assessment results.

- WHO continues to provide technical, financialand logistic support the RHB based on the gaps identified in the field.

- WHO provided technical support to conduct monitoring and supervision activities in CTCs, including onsite orientation and sensitization of health workers on infection prevention, and to sensitize communities on hand washing practice, boiling water, latrine utilization and safe waste disposal.

- WHO held a meeting on sensitization on 23 October at the kebele health post for about 100 people. The discussion focused on: overview of AWD in the area and transmission; risk factors in the kebele; action points to prevent further spread (construction & utilization of latrine, hand-washing practice, boiling water & safe waste disposal; and health seeking behaviour in case of illness & personal precaution measures).


- WHO participated in the technical officers/UNOCHA, WASH Cluster/Ministry of Water Resources, Nutrition Cluster and Ethiopian Humanitarian Country Team (EHCT)/UNDP meetings in Addis Ababa.

- WHO is supporting and facilitating coordination for the preparedness and response of influenza A by the UN country team and AWD by the FMOH and the RHBs.


- Current humanitarian response interventions are supported by funds from Finland, the Humanitarian Relief Fund (HRF) and WHO internal contributions