Wajir Background For as far as the eye can see, the area surrounding Wajir town is covered in a carpet of loose red soil, dotted with a stubble of hardy thorn trees and leafless bushes. July is the ‘winter’ season in this arid district of northern Kenya, and while the mornings are relatively cool, the temperature rises quickly and by mid-afternoon, it is 36 degrees centigrade and rising.
Wajir County is one of the regions hardest hit by the ongoing drought, with a total of 205,265 people in dire need of food. The area is characterised by long dry spells and short erratic rainy seasons. The rains have failed in the past two seasons, hence the current drought. Beyond Wajir town, most of the county is covered in rocky terrain that is unsuitable for agriculture, and so livestock keeping is the main source of livelihood. This sector, however, is susceptible to many setbacks, including the frequent droughts and diseases. Nutrition status in the district is usually poor, with extremely high cases of malnutrition reported in dry seasons.
Influx of pastoralists and refugees from Somalia, many of them severely malnourished, has exerted severe pressure on local medical facilities. While food scarcity is a major factor in malnutrition, the impact of poor hygiene practices and disease are also contributing to the high malnutrition levels.
Mothers in danger
Steven Mwangi, the nurse in charge of the Maternity Ward at the Wajir District Hospital, a government-run facility, says there is an increase in the number of pregnant women being diagnosed with anaemia as a result of the drought. The combination of living in a harsh environment, and malnutrition, has resulted in an increase in preeclampsia – high blood pressure in pregnancy. Consequently, women are increasingly giving birth prematurely or having babies with low birth weights. This is made worse by the fact that with nothing to eat, the emaciated mothers are unable to breastfeed their babies.
Steven adds that the women who come to deliver in the hospital are just a fraction of those in need of the service; most deliveries happen at home with the help of traditional birth attendants. Habiba Sheikh Mursai lives in El Adow village, 10km from Wajir town, and has been delivering babies for close to 40 years. She is worried about the fact that her clients are very weak, which can cause complications during delivery.
“I am usually able to handle the deliveries on my own, but now I am seeing more and more women who are very frail,” says Habiba. “Since the drought began, I have been attending to more women because families who lost their livestock have moved here from other areas, where they do not get food relief. Here, we get food relief from the government, but it is very little. Because the pregnant women are malnourished, they do not have enough blood, and they do not have the strength to push the babies out. This is not good because it can lead to complications. When I see that I am unable to handle such cases, I send them to the Wajir Hospital. But there are no vehicles from here, so they are taken on donkey carts.”
Hawa Abdi has only recently moved to El Adow village, together with her husband, their six children, and her mother-in-law. Her igloo-shaped stick-and-grass dwelling is at the edge of village, together with those of other recent immigrants. “We came from Gambis - out there in the bush. We owned a lot of animals, but they died because of the drought. Out of our 100 goats, only these two survived. Without our goats, and with nothing to eat, we had to come here.” Hawa’s husband is not home. He has gone to Wajir town to see if he can get some food for his family. The family is not on the food rationing programme, so they have been surviving on handouts from neighbours.
Do they hope to go back to Gambi?
“We came here because we can be able to get a little food. Also, there is water. This is our home now – we will stay here. We cannot go back because we do not have any animals,” Hawa says quietly.
Hawa and her family are what Wajir District Officer 1 Thomas Bett refers to as “pastoralist dropouts”, people who have been forced by the drought to abandon their pastoralist lifestyle and to seek refuge in permanent towns and villages.
Says Bett: “We have had about 10,000 people moving into the outskirts of Wajir town within the last two months, and the numbers are increasing. The town is expanding as they build shelters to live in. They come hoping to find food and water. People in this community share what they have, even when they have very little. One cannot eat alone when the neighbour has nothing.”
According to Bett, the government has been doing its best to alleviate the suffering of the people as a result of the drought. There are 660,000 people in the county. Pastoralist centres have been created where food and water are distributed – but these supplies are few and far between. Since June, the government has distributed 4,000 bags each of maize, rice and beans, as well as cooking oil across the county. Water is trucked to these centres and to villages, but it is a cumbersome and expensive exercise, considering the long distances, rough terrain and high cost of fuel.
Dead means of livelihood Most of the pastoralists moving to the permanent settlements are women and children. This is because when the drought began, the men and boys moved away with most of the animals in search of water and pasture. Left alone with no source of food, the women are eventually pushed by hunger to leave their homes and travel by foot, in their weakened state, to a place where they might get food and water.
Abdia Isak, her daughter and five grandchildren travelled 50 km on foot from Griftu in the western part the county and arrived in Wajir town a month ago. They set up camp near the Makoror dispensary on the outskirts of the town. Abdia’s son later joined them. Abdia is looking after her grandchildren while their parents go into town to look for casual work. “We had to come here so that we could find a way to survive. All our animals died because there was no pasture and there was no water. We depended on them for everything. When we needed to buy food, we would sell a goat. We had camels and cows too for milk. Now we depend on neighbours to share their food with us.”
The arid nature of Wajir County makes it unsuitable for agricultural activity. Livestock breeding is the main economic activity, and it is from animals that the people mainly derive their food and livelihood. But evidence of the devastation that the drought has wrought on the lives of the people here is literally littered all over the landscape - carcasses of and skeletons of goats, cows. With no pasture or water, the animals eventually succumb to starvation. Those that manage to reach Wajir town are so emaciated or diseased that they do not attract any buyers, or are sold for a fraction of what they are worth. Before the drought, a cow was valued at 12,000 (US150) shillings. Now, a pastoralist will be lucky to get Sh3, 000 (US$37) for it. A goat that sold for Sh3, 000 is now Sh500 (US$6).
Occasionally, one will find the remains of a donkey. While they not provide milk or meat, donkeys are a valuable source of livelihood for many families. They are used to ferry firewood for domestic use and for sale, and to carry water over long distances. They are hardier than goats and cows, and are often the only animals left alive. So when the donkey dies, the family is left destitute.
Severe acute malnutrition The Wajir District Hospital has seen rising cases of malnutrition since the beginning of the year, particularly among children. The hospital acts as a referral hospital for an increasingly large catchment population and as patient numbers increase due to the drought. In February this year, there were 4,464 cases of malnutrition in children, lactating mothers and pregnant women, rising to 6,310 in June. While many of these were moderately malnourished children, the number of severely malnourished children has been rising dramatically. From 197 in January, the number shot up to 432 in February, and was 958 in June. The level of severity is measured using the mid-upper arm circumference (MUAC) of the child – the thinner the circumference, the greater the level of malnutrition. If the MUAC measurement is under 11 cm, the child’s life may be in danger as he or she is suffering from severe acute malnutrition.
Cases of severe malnutrition are treated at the outdoor Outpatient Therapeutic Treatment Centre, where the children receive enriched food supplements on a weekly basis. The Ministry of Health has also set up nutritional programmes in 20 health facilities and 22 schools to screen for malnutrition and provide supplementary food. To ensure that the supplements are actually given to the children rather than shared with the whole family, ‘protection rations’ of cereal, pulses and cooking oil are given to families of malnourished children so that the others have something to eat and thus ‘protect’ the supplements for the children. Both rations are minimal, however. Scores of women and children hang around the treatment centre, begging to be given some of the food.
Children with severe acute malnutrition and complications such as malaria, diarrhoea and upper respiratory infections have been on the increase as well. Such cases are admitted to the hospital’s Stabilisation Centre in the Paediatric Ward, where the children receive medical treatment and feeding therapy. The centre admitted seven children in January, one of whom died, while in July there were 18 admissions, two readmissions, and two deaths.
Abdia Mohammed Noor has been in the Stabilisation Centre for two weeks with grandson. The boy is two years old, but has the frame of an eight month old child. She holds him all the time – he will not let her put him down. The boy was first admitted at the beginning of July with severe malnutrition and diarrhoea. He was treated and discharged after a few days, but two weeks later, Abdia brought him back.
“There is nothing to feed the child on at home,” Abdia explains. “We used to get milk from our goats, and we would sell a goat to buy flour for ugali. But now most of our animals are dead. When we try to sell the remaining ones, the traders refuse to take them because they are thin. We just survive on black tea. We have nothing else to give the child.”
Abdia says she will go back to their home when her grandson is better, hoping that somehow things will have changed. On the next bed, Mumina Billow watches anxiously over emaciated her nine-month old son, who was admitted a week ago with vomiting, diarrhoea, malaria and acute malnutrition. This is her only child. He has taken the prescribed dose of antibiotics and malaria treatment, but he is still very weak. He can barely lift his head; it is too heavy for his neck to carry. But for his length, he could easily pass for a four-month-old baby.
“I did not breastfeed him for long. There was no milk in my breasts so he stopped trying to suckle. Then all our goats died, so there was no food. The water became very dirty and salt. When we drink it, we get diarrhoea. I feel so helpless because there is nothing I can do to protect him out there. It is very difficult.”
Risk of water and sanitation The Wajir hospital has seen a rise in the incidence of diarrhoea as the drought progresses. As sources of water become increasingly scarce, hygiene and sanitation are the least of the people’s priority. But even in areas where water is still accessible, the risk of water and sanitation-related illnesses is high. In El Adow village, the water table is quite near the ground surface, so while the villagers may have no pasture for their livestock, they at least have water. But the wells that sustain them with water are a ticking time bomb too. A stagnant pool of water stands close the mouth of one of the wells. The still water is covered with algae, and is a perfect breeding ground for mosquitoes. Moreover, the water can easily be contaminated by the buckets that are used to fetch the water and then set down on the ground.
The village of 600 people has no private toilet – people use the bushes to relieve themselves. The sole toilet belongs to the primary school. The area chief explains that the main reason for not digging toilets is economical – people have no money to dig the toilets. Because of the closeness of the water table, it would not be possible to dig the ordinary type of pit latrine – they would need to construct septic tanks as well where the waste is directed and then emptied regularly.
Protection of water sources and hygiene and sanitation measures are clearly needed to avert a threatening disease crisis.