Somalia

Monthly Nutrition Update for Somalia Dec 2002


OVERVIEW
A number of areas in Somaliland have been identified as being of particular concern and a nutrition and food security assessment of Awdal Region is currently underway. The report from this assessment will be available in the January 2003 Nutrition Update. Cross border movements from the drought affected areas of Ethiopia will be monitored closely in the coming months.

In Mogadishu, ACF continues to support therapeutic feeding centres for severely malnourished children. However, in other parts of the country, the expertise and resources to manage severe malnutrition are largely absent. This is a particularly serious issue in much of the south where between 1 and 3% of the under five population are likely to be in need of this lifesaving treatment at any time.

The urban poor and displaced people in major urban centres continue to give rise to concern. This issue highlights the situation of these vulnerable populations in Kismayo town.

Next month, the Nutrition Update will also present a report on a rapid assessment in Gardo, Dangoray and Eastern Hawd of Jarriiban in Puntland in addition to an overview of the situation in Jowhar and Middle Shabelle.

KISMAYO AND LOWER JUBA

Lower Juba, with about 380,000 people WHO NID figures, Oct 2002, has encountered a protracted period of insecurity, severely restricting access for humanitarian organisations to the region thus limiting the possibilities for both implementation and surveillance. Hagar and Afmadow Districts had poor crop harvests in both the Deyr 2001/2002 and the Gu 2002 seasons; and some agro-pastoral areas of Badadhe encountered significant damage as a result of stalk borer and birds attacks. In addition, some portions of the roads linking Lower Juba with Mogadishu were inaccessible during the Gu season causing some increase in the prices of imported commodities. However, coping mechanisms during times of stress remain relatively strong and varied and include petty trading, casual work and bush product collection. Charcoal is one of the most prominent commodities exported through Kismayo port offering a significant source of income to Kismayo urban dwellers but damaging the environment in the hinterlands. The export of charcoal has helped to revive Kismayo port activities which also receives imports of food stuffs including sugar, wheat flour and rice.

Kismayo

About 60,000 of the estimated Kismayo District population of 88,000 (WHO NIDs figures, Oct 2002) live in Kismayo town. Among the residents are many internally displaced persons (IDPs) who have settled in over twenty camps Most camps consist of between 60 and 100 households. within Kismayo town since 1992/93. These IDPs fled some high potential areas of Mareley, Sanguni, Mugambo, Jowhar, Mahaday, Brava and Bay Region due to insecurity.

Many of the displaced now live in or close to destitution with the main sources of income consisting of casual work (farm labour, household chores, loaders/porters at the port) and bush product collection (firewood and charcoal burning). Although the unskilled labour rates in Kismayo (less than 25,000Ssh/day) are lower than in other areas of Lower Juba, they remain well over those in other areas of Southern Somalia. Unlike the local residents, IDPs have no kinship support and tend to be engaged in less regular and lower status occupations. On the other hand, the urban poor of Kismayo are involved in petty business, sale of water and farm labour.

With the urban poor and IDP population purchasing most of their cereal needs, access to adequate quantities is often low. Some wild vegetables are available in the peri-urban and rural areas. Many adults in these households report consuming one meal a day with children generally having two meals. The meals mainly consist of ugali Cooked compact mixture of maize flour and water. Children are given a little less dense ugali mixed with kable Wild green vegetable collected from the bush and in plenty during wet season and rasoo Wild green vegetable collected from the bush and that grows with little rains and sometimes beans. Milk is occasionally purchased for children. The better off households in Kismayo have access to a wider variety of foods including meat, rice, beans, pasta, fruits and imported commodities. Many IDPs reside in dilapidated buildings with poor ventilation while others live in simple structures that fail to provide adequate shelter. Poor sanitation is an issue in most of the IDP camps and maintaining basic hygiene is a problem. Few IDP households have the potential for home gardening. Drinking water is sourced from the unprotected wells within town and the chlorination activities are not regular. In Kismayo town, three MCH centres are functioning, supported by Muslim Aid, SRCS and Direct Aid. Private pharmacies are also available. In early 2001, MSF ceased its support to the hospital due to insecurity.

Between 23rd and 24th November FSAU carried out a rapid assessment using measurement of Mid Upper Arm Circumference (MUAC) in four IDP camps of Kismayo town. MUAC measurements were taken on all children aged 6-59 months found in the camp at the time of the visit and were taken to the nearest 0.1 cm.

About 13.3% of the children screened in four IDP camps of Kismayo town could be considered either severely or moderately malnourished. MUAC<11.0cm; oedema and 11.0cm =<MUAC <12.5cm respectively as the categories cutoffs. A further 23.2% were categorised as being at risk (MUAC between 12.5cm and 13.4cm). The younger children (6-23 months) appeared to be significantly worse off and more likely to be malnourished. Children in the older age groups appeared to be under-represented in the screening and on follow-up of this observation it was suggested that significant numbers of these children accompany their parents while searching for income or independently undertake casual labour activities such as shoe shining, and begging.

The IDP population in Kismayo town remains in a highly vulnerable situation. Access to food of adequate quantity and quality is low. The higher levels of malnutrition among younger children suggest that environment (water, sanitation and child care), in addition to exposure to and inadequate treatment of communicable diseases are equally significant in the overall nutritional outcome for the population. Ultimately, access to adequate income opportunities for these households is crucial.

SOMALILAND

In October, new restrictions and taxes on cross border trade between Ethiopia and Somalia were introduced by the Ethiopian Government. This has resulted in shortage of grain, charcoal, milk collection and has limited the flow of many other non-food items. The new regulations have affected the vendors and petty traders of Somaliland and reduced the purchasing power and trade activities among the communities on both sides. Remittances are reported to have increased during the month of Ramadan and this has improved food access for many households. However, a number of areas in Somaliland are giving cause for concern at present.

The delay of the Hais/deyr rains and the unfavourable weather conditions are affecting the availability and accessibility of water in the Coastal and Sub-coastal belt of Awdal and west of Berbera town. The pasture/grazing conditions in the coastal areas are below normal resulting in poor livestock body conditions and deaths of shoats. The people and their animals are reported to be in poor condition and food insecure. An increased incidence of malnutrition has been reported and FSAU is currently undertaking further nutrition and food security assessments of the area.

Salahlay district area of Hawd of Hargeisa faces some food insecurity related to migration of the majority of aninals from the area because of a prolonged dry period. This has resulted in lack of milk and meat for those left behind and reports of increased malnutrition among the children. Special attention will be given in monitoring the situation.

The resettlement areas in Hargeisa especially the temporary ones are also facing malnutrition and health problems according to health workers and the MCHs that serve them. The temporary makeshift resettlement areas in the Northwest region, (Statehouse, Independence garden and Stadium) as well as the permanent ones like Ayaha are having serious sanitation and public hygiene problems. Some of the returnees in the temporary resettlement areas in Hargeisa district are experiencing extreme economic hardship and the MCHs near these areas see children with severe malnutrition. Even though health education is given to these families and the children are referred to a doctor/hospital, follow-up and out-reach service systems are weak or absent and so the outcome for these children is unknown.

The drought in Shinile district in Zone five of Ethiopia is causing influx of people and livestock to Awdal region. This could lead to overgrazing and depletion of pasture. The situation is currently being further assessed.

Togdheer agro-pastoral communities are expected to face food insecurity due to failure of Gu harvest. This has caused the people and animals to migrate with the milking animals and could lead to increased malnutrition for the children. Due to heavy rains in Hawd of Togdheer, many people with their livestock migrated to these areas and malaria - like cases were reported. Doctors and health workers are currently visiting the area to follow-up.

MOGADISHU - ACF report on Therapeutic Feeding Centres and other activities

The TFC’s of Mogadishu are running normally with an increase in the number of admission during the rainy season, as recorded in previous years. Cases of measles and whooping cough are decreasing.

On 1st December 2002, ACF opened two fixed posts of vaccination, one in Mogadishu North and one in Mogadishu South for children under five and pregnant women.

ACF is also responding to reports of cholera in Mogadishu. During November, 38 stool samples were examined - 4 were positives and 34 negatives. A further 22 are currently being examined.

Admissions

Discharges

Measles cases in TFC’S

Morbidity related to TB per 100 beneficiaries in the TFC

Morbidity related to whooping cough

BELETWEYNE

Extended and Expanded Selective Feeding commencing in Belet Weyne

In an effort to address the acute food insecurity that resulted in an increase in malnutrition rates in Belet Weyne, partners met in September 2002 and agreed on both long term and short term intervention strategies (see October, 2002 Nutrition Update). In the short term, it was agreed that an extended and expanded SFP approach would be established in Belet Weyne. At present, plans are in place to carry out the initial SFP distribution on 21st December, 2002. Screening of malnourished children is ongoing in both the SRCS and IMC MCH’s and malnourished children are then referred to IMC MCH for further screening. Two distribution sites have been identified at which Save the Children UK will avail water and sanitation facilities. Training of staff is in progress and supplies are in place. The issue of management of severely malnourished children has yet to be resolved.

Food for work activities by WFP have been ongoing with a total of 440 MT being distributed in Hiran region during the months of September 2002 and October 2002. The food consisting of maize, pulses and oil was distributed through local NGO’s as follows: 120 MT in Belet Weyne, 100 MT in Mahas, 120 MT in Buloburti and 100 MT Jalalaqsi Districts.

ISSUES FROM NUTRITION WORKING GROUP

The Nutrition Working Group within the Health Sector of the Somalia Aid Coordination Body continues to meet on a monthly basis to share information on food security and health as well as activities and plans; discuss technical issues related to nutrition, and to support the development and use of standard guidelines on nutrition.

During the December 2002 meeting, the group discussed the need to adapt the current nutrition survey guidelines to include the collection of mortality data. Information on mortality is increasingly seen as important in assessing the status of a population. During the first quarter of 2003, guidelines will be developed and tested in the planned surveys.

GLOBAL ALLIANCE FOR IMPROVED NUTRITION

The Global Alliance for Improved Nutrition (GAIN) is an alliance of public and private sector organisations supporting activities that will reduce micronutrient malnutrition in developing countries, particularly through increased consumption of micro-nutrient-rich foods. GAIN’s objectives will be accomplished by supporting developing countries in food fortification efforts, undertaken in the context of broader micronutrient strategies. Currently, GAIN is requesting proposals for National Food Fortification Program Implementation and Strengthening Grants. More information is available at the GAI website at www.gainhealth.org

TRAINING

During December 2002, the FSAU Nutrition Project strengthened its team and is now developing plans to support partners in the analysis, interpretation and use of information on nutrition. While the project has, up to now concentrated on the development of systems for the collection, analysis and dissemination of information, many partners have requested technical support in undertaking analysis and further interpretation of the information in order to develop a better understanding of the situation in their own project areas. A review of the previous support to health facilities will also be undertaken after which the future support requirements of personnel involved in the collection of data for the nutrition component of the Health Information System will be identified.

CALENDAR

FSAU and UNICEF are finalising a poster type calendar targeting health facility personnel with some key messages related to nutrition. The messages are being translated into Somali language and it is hoped that circulation will be undertaken in the coming weeks.

TRANING COURSES & ANNOUNCEMENTS

The institute of Food, Nutrition & Family Sciences, University of Zimbabwe, is offering a course on "Nutrition care and support for people with HIV" at UZ/IAC, Zimbabwe from January 20 - 31, 2002. For more details contact the project coordinator, Strengthening of food and nutrition training in Southern Africa on Email: foodscience@science.uz.ac.zw

Helpage International, is offering a course on "Ageing in Africa" targeting Senior programme managers, Social workers, Senior government officers/planners, Health care professionals or one with an interest on ageing issues from 17 - 21 March, 2003 in Nairobi ,Kenya. For more details contact Helpage International on helpage@africaonline.co.ke

Foot note

1. WHO NID figures, Oct 2002

2. Most camps consist of between 60 and 100 households.

3. WHO NID figures, Oct 2002

4. Most camps consist of between 60 and 100 households.

5. Cooked compact mixture of maize flour and water. Children are given a little less dense ugali

6. Wild green vegetable collected from the bush and in plenty during wet season

7. Wild green vegetable collected from the bush and that grows with little rains

8. MUAC<11.0cm; oedema and 11.0cm =<MUAC <12.5cm respectively as the categories cutoffs.

WEBSITES

This ‘Nutrition Update’, along with other relevant materials, is available on:

UN Somalia Website. http://www.unsomalia.org/FSAU/nutrition_updates

ReliefWeb. http://www.reliefweb.int/w/Rwb.nsf/vLCE/Somalia?OpenDocument&StartKey=Somalia&Expandview

FSAU is currently updating the Somalia section of the Nutritionnet website. From early 2003 therefore, the monthly ‘Nutrition Update’ will be posted at www.nutritionnet.net

RECENT REPORTS

  • Monthly Food Security Report for Somalia, FSAU.
  • Greater Horn of Africa Food Security Bulletin. Issue No.7. November 30, 2002. FEWS NET/LEWS/RCMRD/USGS
  • Kenya Vulnerability Update. November 11, 2002. FEWS NET and WFP.
  • Kenya Food Security Update. November 8, 2002. FEWS NET and WFP.
  • Greater Horn of Africa Food Security Update. November 11, 2002. FEWS NET/CARE
  • Ethiopia Network on Food Security. Issue No. 11/02. November 8, 2002. FEWS/NET/EU-LFSU

The FSAU Nutrition Surveillance Project is funded by USAID/OFDA

SURVEILLANCE PROJECT PARTNERS INCLUDE MOHL SOMALILAND, MOSA PUNTLAND, FAO, UNICEF, WHO, SRCS/ICRC, SCRS/IFRC, WVI, GEDO HEALTH CONSORTIUM, IMC, MSF-S, COSV, AAH, MUSLIM AID-UK, INTERSOS, CISP, ZAMZAM FOUNDATION, COMMUNITIES OF WABERI, HAMARWEIN AND HAMAR JABJAB, IRC, ACF, COOPI, MSF-H, MSF-B.