Somalia

Monthly Nutrition Update for Somalia Jan 2003

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OVERVIEW
In Somaliland, an interagency rapid nutrition and food security assessment has identified a number of temporary settlements where approximately 6000 people are seriously food insecure and already showing evidence of this with a high proportion of malnourished children. Both short term emergency and longer term interventions are recommended.

In response to requests for training from partners and to increase the utilisation of nutrition information in decision making, FSAU is currently preparing training materials for use in a series of training activities over the coming months. Further information will be available in the next Nutrition Update.

On the back page, we present a calendar for 2003. This has been prepared as a collaborative effort between FSAU/FAO and UNICEF and aims to highlight messages related to nutrition in the health and food security sectors, specifically targeting health facility personnel but useful for all interested in nutrition in Somalia. Wall poster sizes will be distributed.

AWDAL ASSESSMENT (10-13 Dec. 2002) WITH SITUATION UPDATE (4 Jan. 2003)

The Guban, the coastal belt of Awdal and Sahil Regions in North West Somalia can be literally translated as 'burnt' and stretches between the Red Sea and Golis ranges. The area had three successive years of poor rains since 1999 and with the pastoral communities accounting for at least 80% of the total inhabitants, the resulting effect of extreme pasture depletion and water scarcity has been severe. Grazing animals (sheep, donkeys and cattle) have been more severely affected than browsing animals (goats and camels); with significant deaths reported since October 2002. By December, most of the remaining animals had moved to the adjacent mountainous belts and milk production had dried up. The coastal ecological zone relies on the purchase of staples (mainly rice and pasta) from Djibouti and Hargeisa towns but the current terms of trade are extremely unfavourable to pastoralists - three shoats for a 90kg bag of rice. Slaughtering for domestic consumption has not considered worthwhile due to the poor condition of the animals.




Throughout November and December, water for human consumption and domestic use had become extremely scarce with residents of some villages situated between Jidhi, Gerisa and Ceel Gaal experiencing a total drying up of their normal sources from shallow wells and riverbeds. The loss of donkeys during the drought has also made it difficult to transport water.

Between 10th and 13th December 2002, FSAU, UNICEF and Ministry of Health and labour (MOHL) conducted a rapid nutrition assessment in coastal belt of Awdal and Sahil Regions aimed at evaluating the consequences of the drought on the population. A total of 513 children were randomly assessed from the selected villages in the area. Results of the assessment, using measurement of midupper-arm-circumference (MUAC), showed a high total malnutrition rate of 16.4% (MUAC <12.5 cm) and 2.1% severe acute malnutrition (MUAC <11cm). A further 21% of the assessed children were 'at risk'. However, more significantly, the results show that malnutrition was significantly higher (35% using MUAC <12.5cm) among children from small and temporary pastoral villages than those from large and permanent pastoral centres (about 8% using MUAC <12.5cm). These malnutrition rates reflect a situation similar to that seen in the November 2001 nutrition survey in the Awdal coastal Region that indicated an unacceptably high Global Acute Malnutrition rate of 27% (W/H Z scores)1 The 2001 survey indicated inadequate water and food access and availability, sub-optimal childcare practices and frequent episodes of common childhood illnesses as the main causes of malnutrition in the region. During the current assessment, the surveyed children showed disproportionately high levels of anaemia and the data from Lughaya MCH in the area showed that anaemia, ARI and diarrhoea are the most common illnesses among children. Uptake of health services is low in the population.

Rapid nutrition assessment in Coastal Belt of Awdal and Sahil Regions, December 2002.

Total
Severe-MUAC < 11cm
Moderate-MUAC 11-12.4cm
GAM-MUAC < 12.5cm
At risk-MUAC 12.5-13.4cm
Normal-MUAC > = 13.5
Large/permanent villages
360
5 (1.4%)
25 (6.9%)
30 (8.3%)
88 (24.4%)
242 (67.2%)
Small/temporary settlements *
153
6 (3.9%)
48 (31.4%)
54 (35.3%)
21 (13.7%)
78 (50.6%)
Total
No oedema detected
513
11 (2.1%)
73 (14.2%)
84 (16.4%)
109 (21.2%)
320 (62.4%)

* The small/temporary settlements included here are Jidhi; pastoral settlements in the triangle between Jidhi, and Ceel- Gaal, Ashado, Karurra, Barisle, Ceel-Sheikh and Bulahar. The large/permanent villages include Lughaya, Zeila, Lowyado, Gerisa, and Togoshi. While the large/permanent villages have better access to water and are involved in small business undertakings, the small/temporary villages have limited water and trading opportunities.




Triangulation of qualitative information collected during the assessment and discussions with humanitarian actors in the region confirm the compromised status of the coastal ecosystem of Awdal and Sahil Regions mainly attributed to the prevailing food insecurity. These findings showed consumption of animal produce including milk dramatically reduced to a frequency of once a week in comparison to daily consumption of either milk or meat or both during normal times. Consumption of rice and oil has considerably increased in the pastoral families. Currently, rice, tea, Somali pancake and oil were reported as the common infant foods, being fed 1-2 times per day. Some better off households in the large pastoral villages purchase small amounts of powdered skimmed milk. Use of pulses and vegetables appeared to be negligible. As noted in other areas experiencing food and water insecurity, time spent on child care has reduced with mothers spending a greater proportion of their time in search of food and water.

Migration from Ethiopia to Somalia was not considered substantial at the time of this assessment but is being monitored.

Inter-agency planned response

An inter-agency response group comprising the UN, relevant Somaliland government departments and INGOs aims to develop a common strategy to mitigate the effects of the current drought and severe food security reported in the region.

Short-term emergency responses as well as medium-long term interventions are recommended.

Recommendations following consultation with UNICEF and MOHL

  • Targeted general ration to populations in small temporary settlements (identified above) for a period of 3 months. During this period, the situation will be re-evaluated.
  • Decentralised supplementary feeding programmes (SFP) with separate strategies for permanent and temporary settlements.
  • Immediate rehabilitation of Karurre borehole that has not operated since May 2002.
  • Immunisation services expanded for the vast areas of the belt not covered by static health services.
  • Examine means to strengthen primary health care services as well as morbidity and nutrition surveillance in the area.
  • Promote longer term interventions to address water and food insecurity (see FSAU Food Security Monthly Report)


Update on rains and expected outcome

  • Reports from Awdal indicate that the Hais rains have now begun and are extremely heavy.
  • As expected when this occurs, deaths of sheep and goats due to pneumonia have increased substantially.
  • For the affected and vulnerable populations, the arrival of the rains implies an anticipated improvement in food security in approximately two to three months.
  • Continuation of extremely heavy rains will on the other hand be detrimental.


Update on interventions

  • The Ministry of water in collaboration with UNICEF has begun rehabilitation of Karurre borehole.
  • WFP has planned to embark on food distribution.

Assessments are conducted in this area on an annual basis; all reflecting the need to implement longer term interventions to address the chronic problems of water and food insecurity. Unfortunately, effective strategies have not been developed and the necessary longer term interventions have not been effectively implemented. Until they are, it is likely that the need for emergency life saving activities will be required periodically.

JOWHAR/MIDDLE SHABELLE

Middle Shabelle is one of the high potential areas of Somalia, generally considered as food secure and with a Household Food Economy Group breakdown as shown on the table on the right. The majority of agropastoralist households had good cereal stocks following the Deyr 2001/2002 harvest in mid January 2002. However, the region experienced the seasonal decline in pasture, water and wild vegetables availability during the Jilaal season between January and March. 'Hand irrigation' activities in riverine areas provided casual labour opportunities during the Jilaal season.

Food Economy Group
%
Coastal Deeh Pastoral (sheep)
18%
Southern Inland Pastoral (Camels and Shoats)
17%
Central Region Agro-pastoral (cowpea, shoats, cattle)
7%
Southern Agro-pastoral (camels, cattle, sorghum)
31%
Shabelle Riverine (Irrigated maize)
14%
Urban
13%
Total
100%

With the onset of Gu 2002 rains, pastures improved triggering normal livestock migration away from the riverine areas to avoid tsetse flies and other livestock diseases. Demand for farm labour increased and Gu crop establishment was good. Unfortunately, parts of Jowhar and Aden Yabal experienced inadequate rains followed by crop attacks by stalk borer and birds between June and August, negatively affecting the crop performance and harvest. Low river water levels also inhibited the more economical and convenient irrigation methods using gradient. The erratic rains in some parts of Aden Yabal also affected pasture availability forcing the pastoral households, especially those having cattle, to move in search of pastures. In addition, abnormal migration of pastoralists occurred from Cadaley and Ceel Baraf (Aden Yabal area) towards Jalalaqsi District of Hiran Region in June, at a time when water and pasture were favourable in some of the areas, following inter clan skirmishes. The overall impact of these negative influences was small and only some of the very poor with little or no land and who fail to get casual labour may be considered vulnerable.

Among the poorer agro-pastoralist and riverine households, there is a strong reliance on wild vegetables like kable as an accompaniment of cereal (maize and sorghum) based foods which are common among the poor while middle and better off wealth groups have access to rice, pasta, fruits, meat and cowpeas. With sponsorship from UNICEF, Farjano (a local NGO) supply water at subsidised fee (17,000Ssh/200litres) to the estimated 30,000-35,000 Jowhar town residents. However, some people still depend on the river and wells (protected and unprotected) for water in town and the neighbourhood.

Data from three urban health facilities were examined and were seen as representing households with mixed riverine/urban livelihoods. With a monthly attendance of around 200, both Bulo Sheikh MCH and Kulmis MCH detected malnutrition in around 5% of children screened in the past three months.

On the other hand, Jowhar MCH/OPD (Intersos) recorded a relatively high proportion of malnourished cases among the children screened in 2002. As indicated in the graph, about 30% of the children screened between July and September were malnourished. The number of visits related to malaria2 was particularly high during May and June with the morbidity data suggesting a high proportion of revisits as well as children being diagnosed with more than one condition. A high proportion of children are also diagnosed with anaemia.




The main catchment area for this MCH (Hanti Wadag section of Jowhar town and Moiko village) has poor sanitation. During the recent cholera outbreak3 (November/December), about half of the 70 patients treated at the cholera treatment centre came from Hanti Wadaag.

In Gololey MCH, on the other hand, about 20% of 69 children screened in September and 14% of 66 children screened in October 2002 were malnourished. The consistently low monthly attendance (<100 children) in the MCH is partly explained by the distance between it and the surrounding agro-pastoralist population. Only very sick children are taken to the MCH and mothers appear to delay before seeking assistance there.




International organisations support water chlorination, a cholera treatment centre, cholera awareness campaigns, sanitation improvement and distribution of mosquito nets in the area. However, early weaning and poor sanitary practices such as waste disposal in the river are likely to undermine the impact of other primary health care activities. Above all, security remains paramount in view of recent skirmishes that led to interruption of MSF-Spain health activities in October and November at Aden Yabal District.

BELETWEYNE

In May 2002, a nutrition survey in Belet Weyne District4 documented a significant deterioration in the nutrition status of the children under five in the population largely as a consequence of an acute episode of food insecurity in the district. At the beginning of September, humanitarian organisations met to discuss interventions and agreed on a strategy (See the September 2002 Nutrition Update). A programme involving supplementary feeding of malnourished children and provision of family ration to their households was due to commence on 21st December in two sites within Belet Weyne town, one in the East bank and another in the West, to cater for the two conflicting sub clans living on opposite sides of the river. The extended and expanded SFP approach used in Bakool and Bay Regions was adopted in Belet Weyne and aims at reducing risk for death and/or further deterioration of the malnourished children's status.

A number of factors have led to the significant delay in implementing a response, largely related to local hostilities and insecurity. These included difficulties in identifying local implementing partners and lack of local agreement within Belet Weyne on the location of distribution points. Trainings scheduled for October were interrupted by a security incidence and two training sessions had to be organised one on each side of the river following security threats to some staffs on crossing to the West bank for training. The intervention is supported by UNICEF, WFP and Save the Children UK and is being implemented by IMC and Somali Red Crescent Society (SRCS). During a screening of children at the two MCH centres in Belet Weyne town, supplementary feeding referral slips had been issued to 180 children with weight for height (W/H) nutrition status index of <80% of median as of 16th December. The first supplementary feeding/family ration distribution was scheduled to take place on 21st December. The total number of beneficiaries is likely to be less than the earlier anticipated figure of about 2000, which was calculated following the survey, seven months ago. A facility for the management of severely malnourished children has not been identified although the Belet Weyne Hospital management is reserving about 30 beds for the severely malnourished. Other ongoing relief activities in the district include food-for-work through WFP distributing 60MT per month to 575 individuals, each getting 90kg maize, 10.8 kg pulses and 3.6kg oil in Belet Weyne in September and October. Some of the projects undertaken were rehabilitation of canals, water catchments, rural markets and roads. CARE also continued with the food for work activities in Belet Weyne, distributing sorghum and pulses.

ADRA Somalia has established an agricultural programme in Belet Weyne District. It focuses on training of farmers (riverine mainly) on improved farming practices, setting up of demonstration farms, canal rehabilitation, training of women on health issues and nutrition, community mobilisation and sensitisation to improve food production. Another major aspect of the programme which complements the ongoing short term intervention is the home gardening promotion, with a bias on vegetable production, consumption and sale. This is a longer term initiative hoped to positively contribute to reduction of food insecurity and malnutrition among the riverine group and the district at large.

Food security situation improves in Belet Weyne District

As agencies commence a response to the episode of acute food insecurity in Belet Weyne, the food security indicators have also shown improvement. The deyr 2002 rains received in October and November led to replenishment of water points and fast recovery of pastures and in turn led to return of livestock into the area. Milk availability and access has improved with prices returning to normal levels having risen to over double the normal last July. The poorer households benefited from the available agricultural employment as well as self employment with the collection and sale of grass as fodder. In addition, following relatively good crop prospects, traders have released more cereals from their stocks into the market. This led to stabilisation of cereal prices.

As the current deyr crop matures it will be essential to monitor the riverine and the agro-pastoral households who have in the recent past been highlighted as vulnerable due to their reduced food access and minimal household food stocks. On the whole, food security indicators appear to be steadily improving and it is likely that the short tem crisis will soon be over.

PUNTLAND. Rapid assessment in Gardo, Dangarayo and Eastern Haud of Jariban

Like the other areas of Sool Plateau, Gardo and Iyah ecozone (Dangarayo area) received scattered and patchy rains during the last Gu season. Following this, the long dry Hagaa season resulted in the drying up of much pasture and many water points. However, in Gardo area and Iyah ecozone of Dangarayo the deyr rains started as early as September while in Eastern Haud of Jariban the deyr rains commenced at the end of October.

Following the rains, the pasture has been replenished in most areas and other food commodities are available and accessible to the majority of the populations in these areas. The berkads and balleys have been refilled and milk is available. In eastern Haud of Jariban, the last place to receive deyr rains, pastoralists have also started to return.

Access to Puntland has been very limited in the past year and so normal surveillance activities have been limited. It has therefore been necessary to undertake a number of rapid nutrition assessments in accessible areas of concern. In early December, an FSAU team carried out rapid nutritional assessment using Mid Upper Arm Circumference (MUAC) in Gardo (Sool Plateau Bari), Dangarayo (Iyah area) and Villages in Eastern Haud of Jariban (Balanbal, Qalanqal and Malasle).

In the four sections of Gardo town 50 children were selected by spinning a pen at the centre of each and following the direction of the pen until 50 children were measured. In Dangarayo and eastern Haud of Jariban an exhaustive exercise was conducted by measuring all the children present by the time of the assessment. A total of 200, 106 and 122 children were assessed in Gardo, Dangarayo and Eastern Haud of Jariban.

Location
Oedema
<11.0 cm
? 11.0/<12.5 cm
? 12.5/<13.5 cm
? 13.5 cm
Total
Dangarayo
2 (1.6%)
13 (10.6%)
20 (16.4%)
87 (71.3%)
122 (100%)
Gardo
20 (10%)
24 (12%)
156 (78%)
200 (100%)
East Jariban
2 (1.9%)
12 (11.3%)
18 (17%)
74 (70%)
106 (100%)

As the table shows, the situation was generally similar in all three areas assessed with around 12% of the children screened children screened malnourished in Dangarayo, 10% in Gardo and 13% in eastern Haud of Jariban. No cases of oedema were seen. The results are quite similar to those of the assessment in Bari Region in May 2002, indicating a population affected by a moderate level of malnutrition with longer term underlying causes.

GEDO

Gedo Region continues to experience insecurity with the inevitable negative effects on trade, economic and humanitarian activities and both human and livestock movement. However the deyr rains have been good, with resultant improvement in pasture availability, animal body condition and milk production. Milk prices in Luuq have reduced by 33% between April and November. Cereal prices in the region have also reduced slightly. In November sorghum, oil and pulses were distributed by CARE to households in Belet Hawa (1470 MT) and Elwak Districts (470MT). In Luuq District5, CARE made a double ration allocation of relief food, totalling 2248MT in November. CARE completed their 2002 food stocks by distributing the remaining 16.9MT (4.5MT oil and 12.4MT of pulses) to the internally displaced persons in Belet Hawa District in December.

Available reports indicate that following suspension of ACF therapeutic and supplementary feeding activities in Luuq on 31st of October, the by then estimated 120 TFC inpatients had little option but to vacate the premises (follow up on these patients has not been possible). The remaining ACF stocks have been distributed by CARE in Luuq and Elbon (104MT of consisting of maize, lentils, oil and blended food was distributed to 7172 beneficiaries.

Data from the Belet Hawa TFC indicate monthly new admissions that ranged between 50 and 60 children in the period between August and November 2002. On the other hand, the recovery rate in the TFC has been high (94% of 69 exiting children in September, 97% of 61 in October and 96% of 52 in November) resulting to relatively low number of beneficiaries (about 40 or less) in the programme at any one time. It is notable that the new admissions in May (117) and June (70) were higher than in the past few months, a period (May-June) when there was food insecurity and inter clan fighting.

Next month, graphs on TFC and SFP interventions in the year 2002 will be presented.

TRAINING COURSES & ANNOUNCEMENTS

The New Yolk group for Technology Transfer, an educational organization that specializes in management training on sustainable development issues is offering scholarships to pursue short term courses in Agriculture - New and Advanced Technologies and Disaster Management - Prevention and Control among other areas. Various sessions on each of these trainings are scheduled throughout the year. The first of the trainings in Disaster Management and Agriculture are scheduled for February 2 - 13, 2003 and March 9 - 20, 2003 respectively. For more details contact the Deputy Education Director on Email: wreader@nygtt.org or contact@nygtt.org.

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

RECENT REPORTS

  • Food Utilisation Study. September, 2002. Nutrition Surveillance Project. FSAU/FAO
  • 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. December 19, 2002. FEWS NET and WFP.
  • Kenya Food Security Update. December 13, 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

Physical address: Peponi Plaza, (Block C), Peponi Road, Westlands, Nairobi.
Postal address: PO Box 1230, Village Market, Nairobi
Telephone: +254-2-3741299, 3745734, 3748297. Fax: 3740598
General email: fsauinfo@fsau.or.ke
Comments and information related to nutrition: Noreen.Prendiville@fsau.or.ke

Footnotes

1 Global Acute Malnutrition 27% <-2 z-score and/or oedema and Severe Acute Malnutrition 3% <-3 z-score and/or oedema.

2 WHO considers Jowhar to be a high malaria transmission zone. Irrigation activities create conducive breeding sites for mosquitoes. Jowhar Hospital data for the f first week of December 2002 indicated that two-thirds of the 74 inpatients had laboratory confirmed malaria.

3 Cholera outbreak affected Jowhar and immediate villages mainly

4 Global Acute Malnutrition (<-2 z score or oedema) of 21% recorded in May 2002 nutrition survey report. About 24.7% of children in Belet Weyne town were found to have Mid Upper Arm Circumference (MUAC) measurement of less than 12.5cm in September 2002.

5 Luuq District has been characterised by constant security incidences in the year 2002, resulting in only three successful food distributions in March, September and November 2002

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