Mobile Health and Nutrition Teams Providing Crucial Services for Pastoralist Mothers As They Cope with Drought

By Rebecca Beauregard

GASHAMO, SOMALI, 15 February 2017 – Mutas does not look at his mother. He is not looking anywhere, rather he lays still, his unfocused pupils covered occasionally by heavy eyelids. While we talk, his mother, Bedra Dek, keeps her eyes entirely on him. Her one-year-old son is suffering from severe acute malnutrition (SAM) and despite the food and water shortage and her two other children, she explains that all her thoughts are focused on him improving.

“When your child is well, spiritually you feel happy. This is what I am waiting and hoping for. Nothing else is in my mind except this,” Bedra speaks softly, her eyes never wavering from her son.

About six months ago, Mutas became sick with a cold. Since then, he has fought that illness and intermittent diarrhoea while they lived in remote rural areas. Living in remote areas means even farther than where we are now, which is over 300 km from the regional capital and 63 km off the paved road through desert sand – no roads. Bedra walked yet another 15 km to the settlement just outside Al-Bahi kebele (sub-district) after hearing that there was a mobile health and nutrition team (MHNT) providing lifesaving services. She knew Mutas was not improving, and indeed, shortly after her arrival, he had become lethargic and largely unresponsive.

MHNT in Somali drought 2017
Bedra Dek, 21-years-old, looks at her one-year-old Mutas Abdulahi, who is ill from malnourishment. ©UNICEF/2017/Tesfaye

At 21-years-old, Bedra has 7- and 4-year-old daughters in addition to Mutas. They are a pastoralist family, living in a rural village and often traveling vast kilometres in search of water and grazing land for their livestock.

While the semi-arid Somali region is often dry, the drought brought on by the negative Indian Ocean Dipole (IOD) in the past few months is beyond anything Bedra has experienced. Her family’s herd of over 200 goats and sheep is now down to four, and their physical appearance is too poor to sell in the market.

Upon arriving in Al Bahi, she went to the MHNT, which has temporarily set up as a static clinic in the site to service the hundreds of families in the area. MHNTs were initially set up over a decade ago in this region as a unique and necessary component of the emergency health service delivery system to reach nomadic families such as Bedra’s. They respond to disease outbreaks, provide routine immunizations and basic healthcare including treatment of common illnesses, conduct screening and manage uncomplicated cases of malnutrition as well as refer to higher levels of care as necessary. Here, the team has encountered high levels of malnutrition and the majority of children have low immunization status. The team is both responding to emergency care needs as well as conducting mass immunization and other preventative measures to ensure that a temporary settlement like this does not create further disease and suffering.

Once a child is diagnosed with SAM, they are provided with ready-to-use-therapeutic-food (RUTF) and medications which should help them to quickly improve. To ensure progress, mothers are instructed to come weekly to have their children checked. We meet Bedra, as she waits with Mutas for his weekly check.

MHNT in Somali drought 2017
The homes of pastoralists gathered at the temporary Al Bahi site starting from December 2016, in Gashamo woreda, Somali region. ©UNICEF/2017/Tesfaye

UNICEF continues to support the GoE’s MHNTs through vehicle provision, transportation allowances, emergency supplies and technical guidance. UNICEF emergency health and monitoring consultant, Kassim Hussein, was present when Mutas was referred. When asked about his role, he explained how he roves around the region providing technical support. “During emergencies, things may be done in a haste, there may be staffing or technical knowledge gaps, or the situation may reach extreme levels and the team is too busy to report. I make rounds to all the teams, providing technical support and ensuring standards of care and supplies are available at adequate levels. I then report back to UNICEF and the regional health bureau,” explains Kassim.

Now Mutas is being seen by Mohammed Miyir, the team leader of the MHNT in Al-Bahi temporary settlement. Originally, he diagnosed Mutas with SAM; now his condition has developed medical complications, making him unable to receive fluids or medicine. This development signals the need for him to be sent to a stabilization centre (SC) at the Gashamo woreda (district) health centre, where he will receive in-patient advanced care until he reaches a minimal level of improvement in his responsiveness and weight.

Bedra is perplexed. Just minutes before they told her this news, she had said she wanted anything for him to improve. Now that it may happen, a new reality hit her. Her two daughters will need to be left behind – there is no room in the MHNT car. This is often an issue mothers out here face. With husbands caring for the grazing livestock, if they need to go to a SC for further treatment, who will take care of their other children? Some find neighbours to watch their kids, other mothers choose to stay and hope for the best, concerned about finding their children again as people are so mobile.

For Bedra, she has another 10 minutes to decide until the car will be ready for her.

Severe Water Shortage No More

 Project Taps into Existing Groundwater to Bring Sustainable Water to Community

By Ayuko Matsuhashi

SHINILE, SOMALI, 17 January 2017 – Munasib Omer, Chief of Bisle kebele (sub-district) in Shinile woreda (district), tells how excited the community is about the ongoing drilling work of a borehole in the kebele. “Thank you! Thank you to those who are providing the water to this kebele.”

Harshim Town Fafan Zone Somali region
Chief of Bisle kebele, Munasib Omer Maydhane, explains how Bisle has not had sustainable water while standing in front of an abandoned reservoir. ©UNICEF/2017/Tsegaye

He continues, “Since I was born, there has been no sustainable water supply in this community. We are entirely dependent on rainfall and travel 15 km one way to get water from a dried river bed. Here, we can use our hands to dig through the sand and find some water. But in the last 10 years, we have suffered from water shortage. NGOs and the government have been providing water through trucking but this is not enough and not predictable as the road condition is so difficult for trucks to access. Our primary problem has been always water.” He points to the road from which the UNICEF car arrived. “As you may have seen, there are many empty houses [along the way]. People left because of the water shortage.”

A mother of four children, 32-year-old Fadumo Ali talks about how difficult it is to raise children without a secure water source. “Sometimes there is no water to give to our children. We cannot wash them.”

UNICEF’s implementing partner, Hydro, began drilling a borehole in November 2016 at a location 1.5 km outside the Bisle community, which has a population of 11,000 people. This crucial drilling work is made possible by the DFID emergency fund. While it is difficult to find water by drilling in lowland areas due to the nature of the hydrogeological complexity in the Somali region, water was found at a depth of 210 meters and the drilling was completed at depth of 299 meters. According to a pump test, the borehole is providing more than 30 litres per second. The post-drilling construction is planned to be completed by March 2017. This news has brought hope for a better future to the Bisle community.

Pump test
People from Bisle kebele play with the water during a successful pump test of the borehole. ©UNICEF/2017/Godfrey

Fadumo is now looking forward to the day that she will no longer need to worry about water. She will have a few extra hours per day once the borehole is functional as she will not travel in search of water. “When I have regular water and more time, I want to do more about sanitation and hygiene for my children. I will clean my children more often.”

Through the generous contribution of donors, UNICEF will continue to support regional water bureaus across the Somali region to implement similar sustainable interventions that will support children and their families.

 

 

 

UNICEF commits to speed up its efforts to end the violent practice of Female Genital Mutilation/Cutting (FGM/C) 

Addis Ababa, 06 February 2017 As the world observes International Day of Zero Tolerance on Female Genital Mutilation/Cutting (FGM/C), UNICEF Ethiopia commits to accelerate its efforts to end the violent practice of FGM/C through strengthened partnerships with key actors in support of the national theme, “Let us keep our promise and fulfil our commitment by ending FGM/C.”

“FGM/C is a harmful practice inflicted on girls which deprives them of their rights to sexual and reproductive health, endangers their health by causing complications during delivery and even untimely death,” said Gillian Mellsop, UNICEF Representative to Ethiopia. “In order to fast-track the elimination of the practice once and for all, we need to work at grass roots level, at scale and hand in hand with communities – boys and girls, women and men, and most importantly, traditional and religious leaders who are influential communicators with the potential to reach the hearts and minds of millions of people. We also believe that it is equally important to address health and psychological complications caused by FGM/C- by providing the necessary health services for survivors to help them lead a healthy life.” 

According to the 2016 Ethiopian Demographic Health Survey (EDHS), FGM/C among the age group of 15-49 is most prevalent among the ethnic groups of Afar and Somali regions (98 per cent and 99 percent, respectively), followed by Welaita and Hadiya (92 per cent for both). In addition, 54 per cent of urban women have experienced FGM/C as compared to 68 per cent in rural areas. FGM/C is less prevalent among women with higher education and those in the highest wealth quintile. The 2016 EDHS shows a decreasing trend in FGM/C nationwide with the prevalence in 15-19 year olds down to 47 per cent as compared to 65 per cent in the 15-49 age group.

UNICEF supports the Government’s efforts through enhancing capacity to implement both preventive and responsive programmes at scale, and strengthening coordination mechanisms at different levels. UNICEF works with the National Alliance to progress ongoing roadmap development to end FGM/C and Child Marriage. It also, supports the involvement of faith based, traditional and community leaders, as communities usually link this harmful traditional practice to cultural and religious norms. In this regard, UNICEF signed a Memorandum of Understanding (MoU) in August 2016 with major religious institutions in the country to improve the lives of children, women and adolescents by promoting positive behaviour and social norms and to bring about the necessary societal shifts in communities.

UNICEF supports the Government in the health sector in the Afar and Somali regions to address FGM/C related complications by providing training to health workers; raising the communities’ awareness on health risks caused by FGM/C; identifying girls and women affected by FGM/C; developing training materials; recruiting gynaecologists and equipping selected hospitals with basic FGM/C care equipment.

UNICEF Ethiopia seeks US$110.5 million in emergency assistance for 9.2 million children and their families

Malnutrition poses “silent threat” to children, agency’s 2017 appeal says 

NEW YORK/GENEVA/ADDIS ABABA, 31 January 2017 – 48 million children living through some of the world’s worst conflicts and other humanitarian emergencies will benefit from UNICEF’s 2017 appeal, which was launched today.

From Syria to Yemen and Iraq, from South Sudan to Nigeria, children are under direct attack, their homes, schools and communities in ruins, their hopes and futures hanging in the balance. In total, almost one in four of the world’s children live in a country affected by conflict or disaster.

“In country after country, war, natural disaster and climate change are driving ever more children from their homes, exposing them to violence, disease and exploitation,” said UNICEF Director of Emergency Programmes, Manuel Fontaine. 

UNICEF’s Humanitarian Action for Children sets out the agency’s 2017 appeal totaling $3.3 billion, and its goals in providing children with access to safe water, nutrition, education, health and protection in 48 countries across the globe. 

An estimated 7.5 million children will face severe acute malnutrition across the majority of appeal countries, including almost half a million each in northeast Nigeria and Yemen.

“Malnutrition is a silent threat to millions of children,” said Fontaine. “The damage it does can be irreversible, robbing children of their mental and physical potential. In its worst form, severe malnutrition can be deadly.”  

The largest single component of the appeal is for children and families caught up in the Syria conflict, soon to enter its seventh year. UNICEF is seeking a total of $1.4 billion to support Syrian children inside Syria and those living as refugees in neighbouring countries.

In total, working alongside its partners, UNICEF’s other priorities in 2017 are:

  • Providing over 19 million people with access to safe water;
  • Reaching 9.2 million children with formal or non-formal basic education;
  • Immunizing 8.3 million children against measles;
  • Providing psychosocial support to over two million children;
  • Treating 3.1 million children with severe acute malnutrition.

In the first ten months of 2016, as a result of UNICEF’s support:

  • 13.6 million people had access to safe water;
  • 9.4 million children were vaccinated against measles;
  • 6.4 million children accessed some form of education;
  • 2.2 million children were treated for severe acute malnutrition.

UNICEF Ethiopia’s 2017 Humanitarian Appeal for Children (HAC) is for US$110.5 million, which includes US$17.3 million required to provide assistance to refugees.  Together with the Government of Ethiopia and humanitarian partners, UNICEF Ethiopia aims to reach 9.2 million children and their families with access to safe water and hygiene, nutrition, health and protection services and give hope for the future by providing education in emergencies.

Aysha Nur a mother of four is receiving a medical treatment for her child
Fatuma Ahmed 4 is checked for malnutrition by a mobile health extension officer at Lubakda Kebele of Kori Woreda in Afar Regional state. Lubakda, a remote site served by one of Afar’s 20 Mobile Health and Nutrition Teams (MHNTs), is 4km from the nearest health post and 30km from the nearest health centre. ©UNICEF Ethiopia/2016/Tesfaye

“In 2017, UNICEF Ethiopia prioritizes humanitarian needs of those affected by the Horn of Africa drought while continuing to support development initiatives to ensure all children and their families have clean water, adequate sanitation as well as access to nutrition and health services. Additional priorities are to support education for children facing emergencies and to protect children against violence and abuse,” said Gillian Mellsop, UNICEF Representative to Ethiopia. “Our ability to respond adequately to the needs of millions of children contributes to future growth and stability in Ethiopia. Through linked humanitarian and development programming, the Government of Ethiopia, UNICEF and our partners’ investments helps build families’ and communities’ resilience against future emergencies.”

While the funding will be critical to UNICEF’s ability to respond to immediate needs, it will also be used to take appropriate action to strengthen preparedness, improve early warning systems and reduce vulnerability as well as contribute to more resilient communities. 

In 2016, UNICEF raised US$108.7 million to provide around 7 million children and their families with life-saving humanitarian assistance to mitigate the impact of the El Niño-induced drought. With severe water shortages, malnutrition and disease outbreaks, the anticipated humanitarian need in 2017 has reduced only slightly, from 9.7 to 9.2 million people.

Though an adequate 2016 ‘kiremt’ rainy season was recorded in many areas of the country, drought conditions and residual effects from the El Niño emergency continue to cause water shortages, malnutrition, disease outbreaks and related protection and education issues, including the closure of hundreds of schools in drought-affected areas.

A new drought expanding across the lowland areas in the Horn of Africa, induced by another weather phenomena, the Indian Ocean Dipole (IOD), is further exacerbating humanitarian needs in the south and south eastern regions of Afar and Somali, as well as parts of Oromia and SNNP. Neighbouring country Somalia is also severely affected, causing 1,325 refugees crossing into the Ethiopian Somali region in the first 17 days of January. Ethiopia is already one of the top refugee-hosting countries in Africa, with 783,401 refugees as of November 2016 hailing from South Sudan, Somalia, Eritrea and Sudan.

Surviving hard times through therapeutic foods

Story – Bethlehem Kiros

Photos – Meklit Mersha 

SOUTHERN NATIONS, NATIONALITIES AND PEOPLE’S REGION (SNNPR), November 2016- Poverty and drought have left people in many parts of Ethiopia to grapple with food shortage; SNNPR is no different. Children are most affected, as evidenced by a high number of severe acute malnutrition (SAM) cases. Fortunately, the Government of Ethiopia implements the Community-Based Management of Acute Malnutrition (CMAM) programme, supported by UNICEF with generous contribution from ECHO. The programme enables children affected by malnutrition to receive life-saving services at stabilization centres (SC) and health posts, such as 32-year-old Bogalech Boreda’s twin infants.

Bogalech Boreda, 32, has 6 children. Her youngest 10-months-old twins Tegegn and Kibru Elias have both become severely malnourished because she could not nurse them sufficiently.
Bogalech’s 10-month-old twins Kibru and Tegegn have been in the Outpatient Therapeutic Feeding Programme (OTP) for SAM more than once. Since Bogalech has three more children at home, she says feeding the twins has not been easy.

IMGL0279-2
She gets help from her older children when they return from school, such as Caleb, 12, pictured here holding one of the twins.  Still, taking care of the infants occupies most of Bogalech’s day, making it impossible for her to work. Her husband is unemployed with an additional two children from another wife, his earnings from a small plot of farm land are not enough to provide for them.

IMGL0168-2
The health extension workers (HEWs) of Morancho Kutela health post have arranged for Bogalech to receive targeted supplementary food multiple times since the twins were born. “I normally had enough milk to nurse my children in the past,” explains Bogalech, “but now, there are two of them and I also do not eat enough at home, so they have been suffering since they were born.”

IMGL0189-2

Three weeks before the picture was taken, Tegegn suffered from diarrhoea and was referred to the Stabilization Centre (SC) at the kebele’s (sub-district) health centre. After a few days of antibiotics and therapeutic milk treatment, he was referred to the health post for OTP to continue his treatment as an outpatient. Since his brother’s situation was not much better, both were enrolled to receive the RUTF.

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In the two weeks since the boys’ treatment began, Bogalech says she has seen progress on her babies’ health and appearance. “They love the [RUTF], they just cannot get enough of it. And the thought of having something to give them when they are hungry gives me such relief,” she adds. Since she is nursing them and providing additional food in her home, she hopes they will grow strong and healthy.

IMGL0176-2
Their middle-upper arm circumference (MUAC) and weight is measured every week until they reach their target weight for discharge. Currently at 6.2 kg, Tegegn’s target weight for discharge is 6.9 kg, which is still about 2 kg underweight for an average 10-month-old boy according to World Health Organization guidelines. His MUAC was 10.9 cm when he was first enrolled for treatment and has now reached 11.25 cm.

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Bogalech dreams of starting an avocado and corn flour business in the market to support herself and her children.

 

Laying the foundation of future generation

A new pre-school programme is helping Ethiopian Children to get ready for school

By Demissew Bizuwerk

Mengi-Benishangul Gumuz- Ethiopia 28 September 2016 – In one of the classes at Mengi Elementary School, in the Benishangul-Gumuz region of Ethiopia, Edidal Abdulkerim, six, and her friends sing about the five senses with melodious tone along with a small tape recorder. Before the next song starts, their teacher Abdulaziz Ahmed asks questions to make sure that the children got the message right.

The children are learning with stories, plays and songs and the expression on their faces says it all. This is their first ever school experience at the age six and seven. Perhaps, just before their critical age of learning passed by.

“It feels great to sing, write and colour,” says Edidal cracking a beautiful smile. “I have many friends here and we play together.”

Benishangul Gumuz - Education
Edidal draws with her friends in her class room. She is one of the 30 students in Mengi Elementary School who are enrolled in an eight week education programme – during a summer break- called Accelerated School Readiness (ASR) ©UNICEF Ethiopia/2016/Tadesse

Edidal, is one of the 30 students in Mengi Elementary School who are enrolled in an eight week education programme – during a summer break- called Accelerated School Readiness (ASR). This new programme is designed to prepare rural children, who have not had the chance to attend any form of early childhood education, for primary education by helping them develop cognitive, behavioural as well as foundational ‘pre’ academic skills.

ASR offers 160-hours of pre-literacy and pre-numeracy learning and helps children to develop social skills.  It is an interim strategy which helps children aged between six and seven make a successful transition from home to school while formal pre-primary classes are gradually introduced across the country.

A daunting task of ensuring quality remains ahead despite Ethiopia’s significant achievement in expanding access to primary education. There are quite a number of children in early primary classes who do not acquire the minimum expected level of skills. And the numbers are alarming. The average mean score for reading skills in grade 4 for instance is found to be only 45 per cent, which is below the minimum passing mark of 50, set in the education policy[1]. And this statistics even goes lower in remote rural villages such as Mengi.

“There are many reasons which can explain this poor performance of children in rural Ethiopia,” says Maekelech Gidey, UNICEF Education Specialist “But the main one has to do with school readiness”. The country lacks adequate pre-school facilities where children can be supported and encouraged to better understand their environment and develop skills, which are vital for success in school and later in their lives.

It is only 48 per cent of Ethiopia’s 7.7 million children aged between three and six who have access to early learning[2], and many young children, especially rural girls like Edidal, were not part of this statistics.

Children who start their formal primary schooling on weak early childhood learning are more likely to fall behind their peers and consequently drop out of school too early.

It is this challenge that prompted the development of the ASR initiative.  In 2015 the programme was introduced and piloted in the Benishangul-Gumuz region after designing a well fitted curriculum and training of teachers.

Benishangul Gumuz - Education
Edidal shares a smile with her best friend Narmin in Mengi primary school. They are both enrolled in an eight week education programme – during a summer break- called Accelerated School Readiness (ASR) ©UNICEF Ethiopia/2016/Tadesse

How does ASR work?

First, teachers and community leaders identify the village children in the month of May each year.  If the nearby schools have O classes already, then the children will be enrolled for eight weeks in the month of July and August. Otherwise, they will undergo the same programme during the first two month of the academic year in Grade 1.

For the ASR to succeed, it needs a dedicated teacher like Abdulaziz and the children have to attend the programme regularly. Missing even a single day of class means missing a lot in the programme.

“Some children who live far away from school skip class when it rains or when their parents go to the market early,” says Abdulaziz. “So I visit their homes to tell their parents about the advantages of this education to their children and the importance of attending class regularly.”

Intizar Abdulkerim, a seven year old who loves to learn about the environment, says her mother is sometimes reluctant to send her to school when she needs help with the household chores. “I feel sad when I stay in the house during school day,” says Intizar “every time I skip class, I lag behind my friends.”

It looks like old habits do not go away easily. The perception of parents towards the education of their daughters still needs to be worked on. “Boys attend the programme more regularly than girls,” says Abdulaziz. “Yet my best performing students are girls,” he added pointing towards Edidal and Intizar.

Edidal and Intizar will be entering Grade 1 in the coming academic year with a solid base. The combination of play and learning activities of the ASR have inculcated the children with the necessary pre-school skills that they need to succeed further.

A preliminary assessment on the impact of the ASR has revealed that, the programme is effective in having children acquire pre-school skills in mathematics and literacy. This is a good news for experts from the region’s education bureau and UNICEF who have been working on the programme since its inception.

The ASR experience in the Benishangul-Gumuz region is also extended to Oromia region based on its cost effectiveness and impact.

While Edidal wants to become a teacher, Intizar’s dream is to be a doctor. There is still a long way to go until the young girls’ dreams are a reality. Yet, for now, the foundation of their future is laid on fertile grounds. 

[1] Ethiopian Fifth National Learning Assessment (NLA), MoE 2016

[2] MOE, Education Statistics Annual Abstract 2008/ 2015-16

Government of Ethiopia and Humanitarian Partners Launch 2017 Humanitarian Requirements Document

ADDIS ABABA, 17 January 2016 – The Government of Ethiopia and humanitarian partners today officially launched the Humanitarian Requirements Document (HRD) for 2017. The HRD seeks US$948 million to help 9.2 million people with emergency food and non- food assistance mainly in the southern and eastern parts of the country.

“Last year the Government of Ethiopia, with the support of international donors and humanitarian partners, was able to mount the biggest drought response operation in global history. Today, we need that partnership once again as we face a new drought, with 5.6 million in need of urgent [food] assistance,” says Commissioner Mitiku Kassa, Head of the National Disaster Risk Management Commission (NDRMC). “The Government of Ethiopia has committed US$47.35 million as a first instalment for the 2017 HRD,” added the Commissioner.

Failed rains in southern and eastern parts of the country caused by the negative Indian Ocean Dipole have left 5.6 million people in urgent need of food assistance. The 2017 HRD presents prioritized plans in water and sanitation (WASH), agriculture, relief food, nutrition, health, education, protection, shelter and non-food items in the affected areas. Out of the $948 million sought for the 2017 response, US$598 million is targeted for relief food, $105 million for nutrition, and US$86 million for WASH needs.

From the HRD funding requirements, the UNICEF Humanitarian Action for Children (HAC) appeal for Ethiopia is US$110.5 million. This includes US$13.6 million to respond to the new influx of South Sudanese refugees in the Gambella region. While the funding will be critical to UNICEF’s ability to respond to immediate needs, it will also be used to take appropriate actions to strengthen preparedness, improve early warning systems and reduce vulnerability, contributing to more resilient communities.

“Within the overall humanitarian requirement appeal for Ethiopia, UNICEF’s priority is to provide children and their families with clean water, adequate sanitation, and access to nutrition and health services. Our other priorities are to help children catch up on schooling they have lost and to protect children against violence and abuse. UNICEF is very grateful to donors who have been so generous in funding our emergency response in 2016 and hope they will continue to provide support in 2017,”says Ms Gillian Mellsop, UNICEF Representative to Ethiopia.

“The needs presented in the HRD for 2017 have been established through a robust, Government-led multiagency meher needs assessment, which took place over three weeks in November and December 2016,” says the UN Resident and Humanitarian Coordinator Ms Ahunna Eziakonwa-Onochie.

“Humanitarian partners stand ready to support the Government in addressing the needs of those Ethiopians affected by this new drought. To do this we count on urgent support from the international community to help us to again save lives and protect Ethiopia’s impressive development gains,” says Ms Eziakonwa-Onochie. “If well resourced, the 2017 Humanitarian Requirements Document will ensure a well-coordinated, timely and prioritized humanitarian response”