Ethiopia

Humanitarian assistance to populations affected by malnutrition, epidemics, climatic hazards, conflicts and displacement

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Location of operation: ETHIOPIA
Amount of Decision: EUR 3,000,000
Decision reference number: DG ECHO/ETH/BUD/2006/01000

Explanatory Memorandum

1 - Rationale, needs and target population

1.1 - Rationale:

Despite improvements overall in 2005, the over-riding humanitarian outlook in the country remains bleak. It is characterised by pockets of persistent malnutrition, continued outbreaks of epidemics, there are serious gaps in the provision of health care, drought-induced destitution and conflict-displaced populations. Vulnerability is high in the country, especially among drought-affected populations, and there is considerable risk that minor shocks (climatic, livelihood or otherwise) land the vulnerable populations in a state of emergency.

Even with the good harvests in 2005, some 2.6 million acutely food insecure people will require emergency food assistance. In addition, some 7.2 million chronically food-insecure people will require food assistance through the Productive Safety Nets Programme.

Notwithstanding this very ambitious Programme, aiming to solve the long-term food security issue, the country will continue to suffer for pockets of acute malnutrition in some crisis periods which humanitarian aid has to cope with.

In some pastoralist areas, consecutive rain failures have had an impact on the livelihoods of the communities. Alarming living conditions were reported in the south and south-eastern parts of the country, where widespread human and livestock migrations as well as an overall deterioration in livestock body condition and many livestock deaths were reported. The failure of the 2005 secondary "Deyr" season rains (October to December) has resulted in a serious food security and livelihood crisis for southern Somali and Oromya pastoralist regions. The situation is worst in the districts that had poor rains during the preceding "Gu" season (March to May), including Afder, Liban, parts of Gode and Borena zones. March/April 2006 rains provided some short-lived relief, but did not reverse the livelihoods crisis of the affected communities, as the rains fell unevenly across the pastoralist areas. One of the negative effects of such rains is the fact that when they do fall, they bring with them the risk of increase in epidemics and disease, for humans and livestock alike.

In early 2006, emergency food aid was concentrated in the critically drought-affected pastoral and agro-pastoral areas in the south-eastern parts of the country, in the Somali region and the Borena zone of Oromya region. Some of these areas have reached critical levels of food insecurity as from January 2006 and will need time to stabilise prior to entering the recovery phase.

It is against this background that the population's resilience to sustain shocks is extremely weak, generating acute needs and increasing humanitarian risks, requiring emergency interventions. During the second half of 2005, a peak of 3.3 million people required relief assistance due to the consequences of climatic events, notably floods (June 2005) accompanied by outbreaks of malaria and diarrhoeal diseases (which remained the major causes of morbidity, disability and mortality in 2005), and longer than usual dry spells (until April 2006), causing significant livelihood damage and displacement in the north-eastern and south-eastern lowlands.

Paradoxically and unfortunately, heavy rains in the Ethiopian highlands coupled with the start of the rains on the lowlands in the eastern part of Ethiopia (Afar and Somali regions), raise high risks of flooding along the rivers Shabele and Juba in Somali region and Awash in Afar. On 17th of April 2006, UNOCHA reported floods in the Dubti woreda of the Afar region affecting 7,000 people and in Ayisha woreda, Somali region, affecting 3,000 people. With the continued abundant showers observed across the eastern lowlands during the first part of April and sustained good rains all over Ethiopian high lands, the floods could take on extreme dimensions in the near future.

Rapid population growth remains a major barrier to poverty reduction. The increase of about 2 million persons per year puts a tremendous strain on Ethiopia's resource base and carrying capacity. The World Bank estimates that the population is currently growing at 2.2 percent per year, although others estimate a higher rate of 2,7%, which implies Ethiopia's population may reach 85 million by 2010 and 106 million by 2020. The UNFPA is projecting the Ethiopian population to 170 million in 2050, compared to 78 million in 2005.

Poverty in Ethiopia is pervasive, deep and persistent. At present, a national average gives close to 45% (circa 33.75 M) of the population living below the absolute poverty line of US $ 1/day and in some areas, mainly rural, this rate reaches up to 80%.

Ethiopia's life expectancy is 43 years whereas the average for Sub-Saharan Africa and lowincome countries is 47 and 59 years respectively. The infant mortality rate is 107 per 1000 live births, close to 47% (about 12.7 million children under five years of age are suffering from various forms of malnutrition).

Food insecurity has become chronic and between 6 and 13 million people in Ethiopia are in need of food aid every year (1). The increase in the structural food deficit is highlighted by the fact that the country needs to produce an extra 750,000 tons of food every year to keep apace with population growth. Recurrent drought, soil exhaustion and erosion, and overcrowding of human and animal populations in areas of scarce resources are thus among the major causes of food insecurity.

The preliminary Demographic Health Survey of 2005(2) shows high child malnutrition rates in Ethiopia and represents a significant obstacle to achieving better child health outputs. Ethiopia still has one of the highest malnutrition rates in Sub Saharan Africa. Moderate to severe stunting is 51%, while severe stunting is 26%, denoting a population that is permanently affected by the consequences of a combined poor nutritional and health status. The January 2006 Save the Children US & UK joint nutrition survey indicates a rate of 20,1% of Global Acute Malnutrition (GAM) and 1,6% of Severe Acute Malnutrition (SAM) among children under 5 years of age in the Afder and Liben zones of Somali region. WHO thresholds with regard to emergency situations are 10-15% GAM and 1% SAM.

Under-five mortality rates (U5MR) are high in all regions, principally in the climatic affected areas. Last surveys from January to March 2006 conducted in Somali region show U5MR ranging from 2.4 to 6.7, when the threshold for humanitarian assistance is 2/10,000/d.

In Ethiopia, diarrhoea (24%) and Acute Respiratory Infections (28%) are the main causes of early death among children, higher than in neighbouring countries (3). The use of oral dehydration therapy is much lower than in other poor countries, largely explaining the high level of mortality due to diarrhoea.

Malaria is the leading cause of total morbidity and mortality in Ethiopia. About 68% (more then 46 million people) of the total population is at risk of contracting malaria infections(4). The majority of Ethiopia's population lives in the over-crowded highlands mainly due to the high prevalence of malaria and other dangerous tropical diseases in the lowland regions. Despite these high risks, especially during the high transmission period from June to September, bed nets, which can act as a preventative measure, are still largely unused in Ethiopia. Even in high malaria prevalence areas, such as Afar and Gambella, only 32% and 12% of households respectively have a bed net and less than 5% of women in endemic areas are sleeping under a bed net.

In a time of increased need for health services, the system is actually weakened due to lack of staff and supplies as people have moved in search of food and water, for survival purposes. Additionally, the high concentration of humans and herds in limited areas with limited resources increases the risk of human disease outbreak and epidemics. There is a very high risk of a measles epidemic; measles and acute malnutrition are highly correlated for children under-five and quickly contribute to higher under-five morbidity and mortality. With limited milk and meat access, it is also likely that dietary intake will change, negatively impacting on both the health and nutritional status of pastoralists.

Note:

(1) Plan for Accelerated and Sustainable Development to End Poverty (PASDEP), 2005.
(2) Ethiopia Demographic Health Survey 2005, Central Statistic Agency, November 2005.
(3) The Lancet, 2005
(4) Ethiopia Rollback Malaria Consultative Mission Report, 2004.