The rising incidence of malnutrition among vulnerable groups due to the drought, may not have been preventable but the good news is that the surveillance and screening mechanisms seem to be working effectively. DAWIT ENDESHAW, FORTUNE STAFF WRITER travelled to Afar with the Save the Children team and brings this first hand report on how measures to mitigate the impact of the drought are working.
On the morning of Monday January 11, 2016, Semera, the capital of the mainly pastoralist and arid Afar Regional State, had fair weather, a stark contrast to the usual heat and, especially, the ongoing drought, which is affecting the region, like many other parts of Ethiopia.
The impact of the El Niño induced drought has been harsh and it could grow worse. So far 30,000 families are said to have lost their entire herds of livestock, with the total toll on animal lives in the region estimated to be 200,000 so far, according to Save the Children.
This figure was presented at a briefing at Agda Hotel & Resort in Semera for visiting CEOs of Save the Children from Finland, Norway and the United States. Attending were the region’s Vice President, Awol Arba and Abahina Koba, head of the Livestock Development Bureau of Afar.
“Afar was hit early, and hit hard,” said John Graham, Save the Children’s country director for Ethiopia.
The CEOs, Hanna Markkula from Finland, Tove Wang from Norway and Carolyn Miles from the US, were accompanied by John Graham, Ethiopia’s Country Director for Save the Children International. They came to assess drought affected areas in Afar and Amhara as the humanitarian crisis worsens in what is said to be the worst drought in 50 years. Fortune accompanied the group to observe the situation.
Save the Children is currently focusing on two areas in the world, Syria and Ethiopia. The drought in Afar is very serious and we have been following it since 2014, Graham said.
The hotel compound had the only green grass to see around, and the goats it had for slaughter were grazing there. Normally, the goats would have been out in the fields, said a worker at the hotel, but there is no grass out there now.
Baro Ahmed, 43, a pastoralist, who lives in Chefera Wereda of the State, has lost 20 of his nearly 40-strong herd because of the drought, he told Fortune through a translator; repeatedly striking the ground with his stick.
That was where the visitors first headed.
To save the rest of his flock, Baro was forced to travel from three to seven days in search of grazing areas. That took him as far as Ambassel, in Amhara’s Southern Wello Zone.
“We deal with the farmers in Wello in order to use their grazing land,” Baro said, adding that they may not always be welcome.
The change is perceived by all.
“When I first arrived in this town 11 years ago, the grass used to be knee high! But now look at it! There is nothing and people are in difficult conditions,” said Mulugeta Sete, an extension health worker at the Underkello health post in Chefera Wereda.
The health post has 7,789 residents in its catchment area. There were pregnant and lactating mothers as well as children, whose nutritional status Mulugeta was checking. The health post also gives supplementary foods to malnourished children. It has recorded the incidence of malnourishment in nine pregnant women, 30 lactating mothers and five children between December 30, 2015 and January 4, 2016.
At another health post in Dubti, which the group visited the same morning, there were similar people lining up to get services. Here severe acute malnourishment (SAM) has also been recorded. A child whose upper arm circumference is below 11cm, is considered to be malnourished. Of the 30 children tested that day, six were identified to be in the SAM category. There were 22 other children with similar conditions identified in earlier weeks.
The one year old child of a 19 year old mother, Hawa Mohammed, had an upper arm circumference of 10.5cm because of which he has been getting three to four packets per day of Ready-to-Use Therapeutic Foods (RUTF). The dosage varies with the status of the malnutrition, and it stops once the children’s arms exceed the 11cm mark.
While some children have responded to such treatment by gaining about one kilogram a week, it may not always be so. Rahma Awol’s 14-week old daughter was reported to have SAM when she first checked on December 16, 2015. The circumference of her arm was 10.6cm and her body weight 4.9kg, according to the record at the health post. Two weeks later, both were down to 10.3cm and 4.8kg. Her condition was exacerbated because of a teething diarrhoea. Fortunately, this infant’s condition has been improving with a daily dose of two RUTF per day.
The health post treats only the children in the outpatient therapeutic programme (OTP), while children whose conditions are complicated by other health problems are referred to health centres and hospitals for additional medical care, referred to as stablization.
One such referral centre is Dubti Hospital. Reports there show that 29 SAM cases were referred to the hospital in September, while there were 20 and 10 in October and November, respectively.
“Things seem to be improving in this regard,” said Abraham Hagos (MD), working at the hospital.
Fortune observed three children, under-five, at the stabilization centre in the hospital. One child had been referred to the hospital for the second time. He travelled 180Km from Dubti, where he lives with his grandmother. The physician explained that he had become affected by SAM for the second time because of poor follow-up at household level.
Current forecasts indicate that there could be 136,000 cases of moderate to acute malnutrition in Afar by August 2016, according to the Humanitarian Requirement document released jointly by the government and humanitarian partners in December 2015. At the national level it is expected that there will be 400,000 cases of SAM by the same time.
The Save the Children group proceeded from Afar to the highlands of North Wollo in Amhara, to visit affected areas in four weredas including Raya Kobo and Gubalafto. North Wello Zone is one of the top five zones in Amhara hit by the drought. North Wollo has 289,576 people that will need to receive food aid as of January, 2016.
On the drive from the lowlands of Afar to these Amhara highlands, one notices the weather changing to cold and cloudy and the land becoming greener. Afar-bound cattle could also be seen, most likely returning home from the greener pastures to which they had travelled.
North Wello Zone provided RUTF for 350 children that came as outpatients in October and 500 children in November, while 63 of these were referred to hospital for stabilization because of additional complicated health problems during the two months.
The zone currently has 27 children under-five in stabilization centres.
Data from the Weldiya office of Save the Children indicate that children treated with RUTF as outpatients in August, September, October and November were 283, 707, 396 and 616, respectively. One hundred and eight children were referred to hospital for stabilization during those months.
Screenings in October and November had also revealed 5,000 and 9,000 pregnant and lactating women affected by malnourishment. The larger number of women in November was found when the screening area of the zone was increased from 50pc the previous month to 84pc, said Kifelu Abaarom, nutrition head at the Zone’s Health Bureau.
Humanitarian Requirement’s document project that these figures will reach 1.7 million for moderate malnutrition and 0.4 million for SAM by 2016 at the national level. In terms of monetary value, the whole drought mitigating efforts are projected to cost 1.4 billion dollars, the joint report says. Save the Children has so far mobilized 100 million dollars, according to John Graham.
The impact of the drought is getting worse and worse but also things are not getting out of hand, Graham told Fortune.
“Inevitably when you have a drought and shortage of food, you are going to have children falling into malnutrition, but the great thing about what we saw is that through these screening systems, malnutrition is being detected early and is being dealt with,” Graham told journalists at a press conference held at Elilly Hotel in Addis Abeba on Wednesday, following the visit to Afar and Amhara. He indicated that his organisation, the largest NGO in the country, was working in this regard with the Afar regional government and the Government of Ethiopia.
The visiting CEOs said that they were going to work to mobilize additional resources for drought mitigation from the government of Ethiopia and their respective governments as well as people. Most of the affected parts in Ethiopia have missed three consecutive rains. The situation could get worse if the coming Belg and Kiremt rains were to fail, demanding much more resources for mitigation. Save the Children works in 60 of the worst affected areas in Ethiopia, providing food, water and medicine, having delivered emergency food aid to 250,000 people and treated over 4,000 cases of child malnutrition since the drought started, according to a press statement.
The government is looking for 1.2 billion dollars of emergency funding, less than half of which have so far been availed.
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