Ethiopia

Why we need inclusive humanitarian responses

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Analysis
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Originally published
Samuni Milkesso © Helpage International

By Sisay Seyoum and Kidist Negash

Comprehensive humanitarian responses focusing on people of all ages, if developed by multiple agencies could go a long way to lessen pain and loss of lives in emergency situations.

The Press has reported Ethiopia among countries in the region seriously hit by the ongoing drought and related food insecurity.

According to UNICEF, 7.8 millions of people face food insecurity especially in the Oromia and Southern Nations Nationalities and Peoples' Region (SNNP) regions as a result of poor agricultural production, loss of livelihood, water and deteriorating pasture.

Among the worst hit are households headed by older persons, who often are taking care of their orphaned grandchildren, unemployed adult children, or those living by themselves and more so if they live with some form of disability. As often happens during the droughts, younger and energetic people leave their original remote homesteads in search of employment or, water and pasture for livestock, considered as the most precious asset for most communities.

While the energetic people leave, the older persons, and persons living with disabilities are left behind to take care of the homesteads. However, when unsupported by their family members, older people are vulnerable to poverty, food insecurity, malnutrition, limited access to social and health services, and limited options for livelihoods and security, regardless of where they live.

As is so often in planning for humanitarian responses, older people and people living with disabilities are often invisible as they hardly participate in the various needs assessments and community decision-making meetings during periods of emergencies.

Poor nutrition

At times of emergencies, older people are at an increased risk of malnutrition. The latest rapid nutrition assessment conducted by HelpAge International in Adami Tulu Jido Kombolcha Woreda of Oromia region in Ethiopia in August 2016 revealed that the Global Acute Malnutrition (GAM) rate among older people (age 60 and above) was 10.2%. This was before the peak of the current drought and HelpAge is therefore planning to conduct another assessment in August 2017; however, estimating the current malnutrition rate on the basis of the one of children (whose admission trend for severely malnourished children which says 147% rise in admission from 119 in September 2016 to 294 in January 2017 according to the FEWS.net), it is likely that current GAM rates for older people may be higher.

Despite the growing evidence related to older people’s challenges in meeting their nutritional needs in emergencies, few specific nutrition interventions targeting older people in humanitarian situations exist.

The importance of having of nutrition programs tailored for older people is also to assure the basic humanitarian principles affirming that everyone has the right to humanitarian assistance, after the principles of impartiality and non-discrimination.

During the 2015/16 drought, as the only international organization primarily working for and with older people, HelpAge International provided emergency nutrition response in support of older people in Ethiopia’s Adami Tullu Jido Kombolcha and Girar Jarso Woredas of Oromia region.

The project was financially supported by United Nations Office for the Coordination of Humanitarian Affairs-Humanitarian Response Fund (UNOCHA-HRF) and was implemented in partnership with local organizations in the two woredas. HelpAge is planning to implement a similar, lifesaving project in the drought affected woredas of Borena zone through the Disaster Emergency Consortium of the UK.

Samuni Milkesso, 85 and a father of 25 from Abeyi Deneba Kebele (village), Adami Tullu Jiddo Kombolcha District, East Shewa Zone, Oromia National Regional State says his once-green productive land filled with trees has now turned into harsh, unproductive and patchy tract, thanks to drought. “All my wealth has diminished. These have worsened over the past ten years," he said.

Gamechu Dori, 70, Bitte Kebele (village), Ziway Dugda District, Arsi Zone, Oromia National Regional State, said in the past five years, the weather has become less predictable. “Drought has become more frequent and water has become a major problem. We have to trek for three hours to get water at the seasonal Bite pond which is never clean making me suffer diarrheal diseases often,” he said.

Thanks to the donor and to the HelpAge International partners Rift Valley Women and Children Development Organization (RVWCDO) Milkeso, Dori and others were identified and provided with nutrition support and agricultural input as well as access to clean water and awareness on hygiene and sanitation practices.

HelpAge and its partners in Ethiopia have over the last three months supported Milkesso and his villagers with nutritious supplementary food baskets, composed by Corn Soya Belnd (CSB), vegetable oil, and haricot beans monthly. Posters with instructions and pictures to follow were also disseminated to assist the older person in cooking the food provided. This nutrition response was also complemented by seed provision to the most affected households to improve their food production.

"I received 6kg of teff (endemic grain used to make traditional flat bread) and 6kg of maize seeds, fertilizer and training on how to cultivate. This support was just what I needed. I bought the recommended tools from the market and planted the seeds as soon as the time was right. I was filled with hope when the rainy season started as expected. But soon, the drought took its toll and I watched as my seedlings withered in the heat. I felt horribly disappointed. If it were not for HelpAge's support, we would be in serious trouble. There are no other organisations that cared to give this type of support to older people in this area,” said Milkesso.

Challenges

These success stories should however not belie the extreme challenges faced by older persons during emergencies. Individuals above the age of 60 receive little attention and priority in any given emergency compared to children and women, particularly when it comes to life saving interventions. In Ethiopia, as in most Countries, there is no nationally adopted guidelines for management of acute malnutrition among older people in emergencies, which contributes to donors and partners’ resistance to include older people as part of the vulnerable groups when planning for humanitarian responses.

To worsen the matter, data collection and reporting on older people is scarce, inaccurate or too generic (e.g. grouping all older people into one single category of 60+) and this is issue is mirrored in most health facilities reporting tools, which tend to exclude age details for the older people. The lack of reliable data has affected, for example, the quality and availability of data needed to calculate important performance indicators such as cure rate, default rate and death rate of the beneficiaries enrolled in nutrition programs.

**Lessons learnt **

Engagement as well as creating awareness among the decision makers on the magnitude and seriousness of older people malnutrition level has been crucial.

In Ethiopia, a decision was taken by the Health Facilities Administrators to use the available medical resources and admit the critical Severe Acute Malnourished (SAM) cases for medical treatment even tough that was not budgeted in the project. It has been observed that, even though they are regularly not prioritized, the nutritional needs of older people are specific and complex and require immediate and dedicated attention, particularly at times of humanitarian situation.

Older people are among the most vulnerable groups at times of emergencies. Despite that, often they are the most neglected and/or less prioritized ones. The nutrition surveys conducted by HelpAge indicated a very high level of malnutrition (10.2%) warranting an emergency response targeting older people. The humanitarian principles of humanity, neutrality and impartiality should always be considered in addressing the needs and in the spirit of the sustainable development of leaving no one behind.

Older people play very important roles in households and communities due to their years of accumulated experience, hence they should be supported to live quality and dignified lives. They are often the ones responsible to support mothers raise children and in many cases they also look after orphans or children that are left when parents migrate or leave temporarily the households in search of food, water and income.

Their healthy living means ensuring wellness for the rest of the community. They should always be considered as a vulnerable group of priority for the provision of support, as well as a critical resource in all cycle of project management.

Recommendations

  • Older people also have the right to the necessary support as the other groups to guarantee their survival and good quality of life. This should be assessed and measured by humanitarian actors on the basis of humanitarian principles; humanity, neutrality and impartiality.
  • HelpAge commits to increase visibility and raise awareness among all local and international humanitarian agencies on older people’s needs and priorities in emergencies, as well as encourage to use age and gender disaggregated data, capturing with more precision the needs of older people, including those living with disability
  • The urgent need of revising a national guideline on management of acute malnutrition is critical to ensure that older people are included in all aspects of humanitarian response, from assessment to service delivery.
  • HelpAge International has developed a guideline on emergency nutrition intervention for older people, which can easily be adapted to the local context of Ethiopia. We recommend that agencies (both of government and non-state actors to include the needs of older people and treatment protocols in the national guideline for management of acute malnutrition.
  • Support and encourage four key components to the community management of acute malnutrition (CMAM) approach to discuss the malnutrition in older people: Community Mobilization, Supplementary Feeding Programme (SFP), Outpatient Therapeutic Programme (OTP), Stabilization Centre (SC)
  • Within the health care system, ensure that the diseases most prevalent among older people (e.g. NCDs) are fully integrated into patient triage, clinical evaluation, treatment, emergency medical response system and access to specialty care for all SAM cases.
  • Ensure that nutritional guidelines for food distribution suitable for older people are integrated into health planning and response plans.
  • Future programs should integrate strong Monitoring and Evaluation (M&E) systems that facilitate the capture of detailed age disaggregated data for integration in the existing Health Management Information System (HMIS).

The Authors are the Country director, HelpAge International, Ethiopia and Africa Regional Health and Nutrition Program Manager, HelpAge International

About HelpAge International

HelpAge International is a global network of organisations promoting the rights of older men and women o to lead dignified, healthy and secure lives.

Contact us

HelpAge International Ethiopia Arada sub-city, Woreda 07, House No. 086, P.O. Box, 3384, Addis Ababa; Email: helpageinternationaleth@helpage.org; Tel: +251(0)111261535/37