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.

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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.

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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.”

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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.

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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.

 

Government of Ethiopia and Humanitarian Partners Release 2017 Humanitarian Response Planning Document

ADDIS ABABA, 11 January 2016 – The Government of Ethiopia has released the Joint Government and Partners’ Humanitarian Document, an initial humanitarian response planning document for 2017 while the comprehensive Humanitarian Requirements Document (HRD) is being finalized. Based on the early warning data and modelling undertaken by partners such as UNICEF, the document reflects the joint humanitarian response planning and provides a shared understanding of the crisis, including the most pressing humanitarian needs.

While Ethiopia battles residual needs from the El Niño-induced drought, below average rains in the southern and eastern parts of the country caused by the negative Indian Ocean Dipole, another climatic phenomena, have led to new symptoms of drought. It is anticipated that 5.6 million people will need emergency food assistance in 2017, in addition to those still suffering from effects of El Niño. Ongoing assessments for the HRD will provide total figures of those in need for 2017.

In 2016, international donors contributed US$894 million toward the humanitarian response efforts and from that figure, UNICEF raised US$108.7 million to support the Government of Ethiopia and partners to reach around seven million people with access to health and nutrition care, education, safe water, sanitation and hygiene services, and protection support. At least 73 per cent of those reached were children.

The total anticipated financial requirements for the 2017 HRD is US$1.1 billion, of which, 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.

Immediate responses have already taken shape from regional governments allocating funds to water trucking and fodder provision in the south and south eastern regions, those most affected by the below average rainfall. In 2016 and years prior, UNICEF has supported such emergency interventions, in addition to child health and nutrition, sustainable water and sanitation, quality education for boys and girls, and the protection of children from violence and exploitation. UNICEF Ethiopia looks forward to continuing this support with the Government of Ethiopia and partners in 2017, for every child and their family.

Italy supports vital events registration in Ethiopia

The Italian Government funds UNICEF with Euro 500,000 to UNICEF to strengthen vital events registration system in Oromia and SNNP regions

ADDIS ABABA, 7 December 2016 – The Italian Agency for Development Cooperation funded UNICEF with a total contribution of €500,000 to strengthen the civil registration system for children’s rights to identify in two regions of Ethiopia: Oromia and SNNPR, in collaboration with the respective regional Vital Events Registration Agencies (VERAs). 

The support is crucial as it represents the preliminary condition towards the creation of a fully functional civil and vital registration system of birth, death, marriage and divorce. The funding aims to improve and standardize the Civil Registration and Vital Statistics (CRVS) system and contribute to children’s right to identity to protect them from abuse and exploitation, as well as ensure their access to basic services.

Financial contribution signing ceremony between Italy and UNICEF.

The support comes at a critical time in light of Ethiopia’s creation of a fully functional nationwide civil and vital registration system of birth, death, marriage and divorce in August.

The funding aims to improve and standardize the Civil Registration and Vital Statistics (CRVS) system and help protect children from abuse and exploitation, as well as ensure their access to basic services.

In addition, vital events registration is an important pre-requisite for measuring equity, monitoring trends, and evaluating the impact and outcomes of broader development programmes, such as the Sustainable Development Goals (SDGs).

At the signing ceremony, the Ambassador of Italy to Ethiopia, H.E. Giuseppe Mistretta stated that “the registration of birth represents the first step towards the recognition of an individual within a society, allowing him or her to access to basic services and protect him or her from abuses and violence. Avoiding anonymity and invisibility, birth registration sets the basis for an efficient planning of the governmental policies and strategies of good governance”.

“All our current and upcoming projects of the Italian Agency for Development Cooperation in Ethiopia are aligned with the priorities and strategies set by the Government of Ethiopia. This initiative’s  objectives are also expressed by the Proclamation on Vital Events Registration and National ID (Proclamation No. 760/2012), adopted in August 2012. Coherently with the government strategy, the initiative we are signing today aims at improving the institutional and technical capacity of Regional Vital Events Registration Agency (RVERA) in Oromia and SNNPR to effectively lead and coordinate the registration of vital events” said Ms. Ginevra Letizia, Head of the Addis Ababa Office of the Italian Agency for Development Cooperation.  

Ethiopia has one of lowest levels of birth registration in the world at just 7 per cent. With the new system, however, registration of vital events in Ethiopia has been modernized. From regional up to federal and city level administration, UNICEF is supporting standardisation of registration and certification services, which has been officially launched nationwide.

“UNICEF appreciates the timely contribution from the Italian Government to count every child, and in the process, to make every child count. With proof of age and identity, we can protect every child from diverse child protection concerns including abuse, neglect and exploitation, early marriage, child labour and trafficking, and help them to access basic social services, including education and health,” said Gillian Mellsop, UNICEF Representative to Ethiopia. 

After a harrowing journey, a bittersweet homecoming for Ethiopian migrant children

By Christine Yohannes

ADDIS ABABA, 29 June 2016–One year ago, 14-year-old Tesfaye* set off from his hometown of Hadiya in the Southern Nations, Nationalities, and Peoples’ Region of Ethiopia towards South Africa. Like many young people, Tesfaye sought what he thought would be a brighter future abroad.

Unfortunately for Tesfaye, his journey came to an abrupt halt after one month when he was arrested in Zambia. Along with 39 other Ethiopian children, he was charged under the Anti-Human Trafficking Act that prescribes a minimum mandatory sentence of 15 years for smuggling or consenting to be smuggled.

UNICEF- IOM partnership assisted voluntary returning children to Ethiopia
Tesfaye 15 and one of the youngest from the returnees is slowly readjusting to the possibility of reuniting with the family he had decided to leave behind. He is now finding relief in the piece of paper as he draws and writes his past struggles to be a living example to his peers who would consider a similar escape. UNICEF in collaboration with IOM returns children from third countries. Which is facilitated through a Cooperation Agreement signed between the two agencies since 2013 and renewed in 2016. This collaboration supports the Government of Ethiopia’s (GoE) Safe Return and Reunification Programme for Unaccompanied and Migrant Children. ©UNICEF Ethiopia/2016/Tsegaye

Although he was not yet 15 at the time, Tesfaye was tried as a 23-year-old because of the eight-year difference between Gregorian calendar used in most of the world, including Zambia, and the Julian calendar used in Ethiopia. Tesfaye was unable to explain the situation due to his limited English and was subsequently convicted and jailed in Mukobeko Maximum Security Prison in Kabwe, which houses adult criminal offenders,along with other children who had been detained.

A long  journey

In response to news of this detainment, UNICEF and the International Organization for Migration (IOM) worked together with the Zambian Human Rights Commission and Zambian officials to get the children released from prison and sent home. Following high level advocacy and personal commitment from IOM and UNICEF staff members, all 39 children were pardoned by the Zambian President.

IOM Zambia provided support to the Zambian authorities to ensure that protection assistance, including safe shelter and medical assistance was provided to all children once they were released from prison. Their first stop for these children once in Ethiopia is the IOM Assisted Voluntary Return and Reintegration (AVRR) Transit Centre, which is operated in close collaboration with UNICEF and the Government of Ethiopia, in Addis Ababa. The centre receives some 100 to 200 unaccompanied minors every month who have returned from other transit or destination countries.

UNICEF supports the Ethiopian Bureau of Women and Children Affairs with trained social workers to conduct documentation, family identification and reunification of the children. The social workers provide psychosocial support services at the transit center and accompany the children to their families, where they also provide a reunification grant to each child’s family.

Although Tesfaye is now safe in the IOM Transit Centre, he will not soon forget the ordeal he went through. He says, “I want to teach and raise awareness for others that might try to do this,” adding, “It should stop with me!”

Dreams cut short

Jacky* 17, also from Hadiya, was a straight-A student with big dreams for his future when he left home in search of better opportunities. “I do not blame my country for my decision to leave and for trying my luck in South Africa,” he says.

He recalls 25 days of travelling on foot, his subsequent arrest and confinement in a prison room shared with over 200 other detainees, going days without food and enduring brutality and theft.

“I sold my cow and my inherited share of my father’s land to pay for my trip, only to be arrested a 120km from my destination,” said Jacky. “I had high hopes for my future in South Africa but being exposed to deadly diseases in prison made me realize that it is worth striving for a better life in my own country.”

Home at last

UNICEF- IOM partnership assisted voluntary returning children to Ethiopia
UNICEF in collaboration with IOM returns children from third countries. Which is facilitated through a Cooperation Agreement signed between the two agencies since 2013 and renewed in 2016. This collaboration supports the Government of Ethiopia’s (GoE) Safe Return and Reunification Programme for Unaccompanied and Migrant Children. ©UNICEF Ethiopia/2016/Tsegaye

Harrowing as their stories are, at least Tesfaye and Jacky are home at last. Some children remain in Kabwe as they had come of age while in prison. The Zambian Human Rights Commission , with support from UNICEFand IOM, continues to work to enable the release of these children and their return to Ethiopia.

Going forward, UNICEF, in partnership with IOM, will support the Child Justice Forum and the Zambian Human Rights Commission to prevent this from happening to other children in the future. UNICEF will also extend its support by monitoring prisons and police cells to identify and help children in similar situations as there are reports of more smuggled and trafficked children; eight more children await trial on a similar accusation.

“I cannot say I have come [home] when half of me [more children] is still in prison” Jacky continued “ I have learned from my mistakes, so I would like to teach everyone about creating jobs in our lands.”

*Names of the children have been changed to protect their privacy

Ethiopia: Vital events registration launched

By Nikodimos Alemayehu and Marie Angeline Aquino

ADDIS ABABA, Ethiopia. August 2016 – Ethiopia launched throughout the country on 4 August 2016 a permanent, compulsory and universal registration and certification of vital events such as birth, death, marriage and divorce.

Vital events registration kicks off in Ethiopia
(L-R) Ms. Gillian Mellsop, UNICEF Representative to Ethiopia , H.E Ms Elsa Tesfaye, Director General of Vital Events Registration Agency (VERA), H.E Dr Mulatu Teshome, President of the Federal Democratic Republic of Ethiopia and H.E Mr Getachew Ambaye, Attorney General holds a symbolic certificate for birth registration. ©UNICEF Ethiopia/2016/Ayene

The inauguration ceremony took place in the presence of the Ethiopian President Dr Mulatu Teshome, UNICEF Representative Gillian Mellsop as well as representatives of other ministries and development partners.

“The Government of Ethiopia has given great emphasis to vital events registration across the country by putting the appropriate policies in place, establishing a system up to the lowest administrative level and deploying massive resources in this endeavor,” said Teshome at the ceremony. “I am confident that, with the collaboration and commitment of all stakeholders, we will succeed in the operationalization of the system, just like we have succeeded in other development sectors in the country.”

Mellsop underscored in her address the importance of the registry in protecting children and combatting child trafficking.

‘’With no proof of age and identity, Ethiopian children become a more attractive ‘commodity’ to a child trafficker, and will not even have the minimal protection that a birth certificate provides against early marriage, child labour, or detention and prosecution of the child as an adult.”

Ethiopia ranks among the lowest in sub-Saharan countries on birth registration with less than 10 per cent of children under the age of 5 with their births registered.

The issue is especially urgent because 48 per cent of the 92 million-strong population is under the age of 18 – 90 per cent of whom are unregistered. The Government has committed itself to reaching at least 50 per cent of children with registration and certification services over the next two years.

UNICEF’s support to Ethiopia’s national civil registration is based on a recognition that birth registration is an important element of ensuring the rights and protection of children.

For children, being registered at birth is key to other rights such as access to basic social services, protection, nationality and later the full rights of citizenship, including the right to vote. Moreover, not only is vital events registration essential for compiling statistics that are required to develop policies and implement social services, it is also, as Mellsop points out, “a pre-requisite in measuring equity; for monitoring trends such as child mortality, maternal health and gender equality.”

Inaugural ceremony of National Vital Events Registration in SNNPR capital Hawassa
One-month child Samrawit at a birth registration centre in Southern Nations, Nationalities and People’s Region (SNNPR) capital Hawassa August 6, 2016. ©UNICEF Ethiopia/2016/Ayene

UNICEF has supported the Government in putting in place a decentralized registration and certification system, which is informed by a legislative framework promulgated in August 2012.

UNICEF is a catalyst in creating this new system with support that includes the reform of the legislative framework, the development of a national strategy and its implementation across the country.

An important element of the Civil Registration and Vital Statistics (CRVS) system is its interoperability with the health sector. On this aspect, UNICEF has worked in collaboration with the Ministry of Justice and Ministry of Health in its efforts to formalize the interoperability, culminating in the signing of Memorandum of Understanding (MoU) between the two ministries.

The important of involving the Health Ministry is because it already has its own well organized and decentralized network stretching across the country. This arrangement allows the health facilities found in nearly every community to manage notifications of births and deaths.

The actual registration and certification of all vital events started on 6 August 2016 at the lowest administrative level of the kebele (sub-district).

With Ethiopia’s new conventional vital events registration system in place, there are better opportunities for accelerating vital events registration in Ethiopia, and realizing one of the fundamental rights of children – the right to be registered upon birth.

In drought-stricken regions, children search for water and a lifeline for their hopes

In drought-stricken regions of SNNPR, children travel for hours to collect water for household needs.
In drought-stricken regions of SNNPR, children travel for hours to collect water for household needs ©UNICEF Ethiopia/2016/Ayene

HALABA SPECIAL WOREDA & MAREKO WOREDA, SNNPR, 22 March 2016 – In the northern part of the Southern Nations, Nationalities and People’s Region (SNNPR) of Ethiopia, bright yellow jerry cans are everywhere: on main roads and dirt roads, carried by hand or piled high on donkey carts being led on long journeys. Whatever the method, the goal is the same: water.

In SNNPR, 73 out of the total 136 rural woredas (districts) are grappling with water scarcity. Out of those, 45 are severely affected. In many of these woredas, water scarcity is an old problem, made much, much worse by the ongoing drought, which is the worst this country has experienced in decades. The result of a double blow of climate change and the El Niño phenomenon, the drought has led to food shortages and threats to livelihoods and survival. 

When there is no water, education takes a backseat

Wogbela, 15, travels to a neighbouring area for water, returning home the next day
Wogbela, 15, travels to a neighbouring area for water, returning home the next day. “I am late to school every day,” he says ©UNICEF Ethiopia/2016/Ayene

Lack of water affects everything: food, health, education and children’s futures. In Washe Faka Primary School, located in Washe Faka Kebele (sub-district), Mareko Woreda of SNNPR, approximately 20 students have left school in search of work to support families whose livelihoods have been turned upside down by the drought. The children who remain in school are struggling.

“Students are coming to school with empty stomachs and leaving early because they can’t focus,” says Selfa Doloko, the school principal.

Fifth-grader Wogbela, 15, is struggling too. Every day after school, he travels hours to a water point in a neighbouring area. Because of the distance from his home, he has to stay overnight at a relative’s house. There are closer water points, but the long lines often mean hours of waiting.

“I used to go every other day, but the drought has dried up the ponds here, so I have to get water for the livestock in addition to water for the family,” he says.

In the morning, Wogbela travels home with his supply of water. He is tired by the time he gets home, but has to rush to school. “I am late to school every day,” he says, worried. Education is important to him, but it takes a backseat when there is no water.

Relief in sight

HALABA WOREDA, SNNPR – 24 JANUARY 2016
Munira, 13, is a student at Asore Primary School, located 30 metres away from a new UNICEF-supported water point. “It is much easier now. We can drink and wash easily,” she says. ©UNICEF Ethiopia/2016/Ayene

This is the story of so many children here, but thankfully for some, there is finally relief in sight.

For the students of Asore Primary School in Halaba Woreda, a new UNICEF-supported water point approximately 30 metres away means a new shot at learning. Students like Munira, 13, an eighth-grader at the school, can finally breathe a sigh of relief. “I used to travel two to three hours a day to fetch water. The wait at the water point was even longer. Sometimes the taps did not work and I would have to spend the whole day there and go home the next day. It was so tiring and a waste of time,” she says, glad that clean water is now just a short walk away.

Abdusamad, 16, another eighth-grader at the school, adds, “Some students had to drop out of school because they had to spend so much time collecting water. I’m more confident now that I can finish my studies and I want to help bring the students who dropped out back to school.”

As part of the drought emergency response, UNICEF, as the WASH cluster lead, is supporting the Government of Ethiopia and other partners in the rehabilitation, maintenance and construction of new water supply systems, provision of water purification and treatment chemicals, scaling up of water trucking activities, and provision of  sanitation and hygiene facilities in schools. UNICEF is also exploring innovative ways to use satellites to detect deep groundwater for large scale, multiple-village water supply systems.

With 5.8 million people around the country in need of access to safe drinking water, UNICEF and partners are racing against the clock to provide urgent help.

For children like Wogbela, it cannot come soon enough. “I hope things change soon,” says Wogbela, “so that I can get back to learning.”

Butajira’s ideal health facilities give hope to ending maternal and new-born death in Ethiopia

By Wossen Mulatu

Butajira Hospital and Health Center Media Visit ahead of the EU-ESDE project lauch, 2 April 2014
Dr. Ayenachew Abebe, Medical Director of Butajira Hospital gives briefing about the activities of the hospital in maternal and new-born health. Butajira Hospital and Health Centre Media Visit ahead of the EU-ESDE project launch, 2 April 2014 ©UNICEF Ethiopia/2014/Fasil

Butajira, 2 April 2014: Around fifteen journalists from eleven media houses visited Butajira hospital and health center to witness firsthand the facilities for mothers and new-borns there.

The media visit was organized by the Federal Ministry of Health, European Union and UNICEF to show the commendable services provided by Butajira hospital and health centre ahead of the high level launch of the ‘Enhancing Skilled Delivery in Ethiopia’ (ESDE) which was made possible with EU’s generous €40.2 million grant.

New mother Aster Kebede’s face is filled with grace holding her new baby girl already named Etenesh Gobeza. After an hour of delivery, she has immediately started breast-feeding her child sitting comfortably on the hospital bed. It took her a day to come to the hospital from the neighboring Mareko woreda (district) with her mother Fichage Arega. Now, both of them are proudly sitting close to each other admiring the newly born child and grandchild in relief.

“I am highly content with the service provided here at the hospital. The staff were really kind to me and I had a smooth delivery. I am also grateful that such service is offered for free.” said Aster.

In Ethiopia the most critical period of care for maternal and neonatal mortality reduction (skilled birth attendance) has remained stagnant for the past two decades with only 29 per cent of mothers accessing this essential care. In addition, despite the improvements in reducing under 5 mortality rates, neonatal mortality rate has also remained stagnant showing no significant reduction from 39 in the 2005 to 37 in 2011.

Butajira Hospital and Health Centre Media Visit ahead of the EU-ESDE project launch, 2nd April 2014
Aster Kebede, one hour after delivering her baby girl Etenesh Gobeza describes her experience in the hospital to the media. ©UNICEF Ethiopia/2014/Fasil

“Both the quality and quantity of services have increased in the hospital due to the commitment and motivation of the hospital management and its staff to prevent any death of mothers and new-borns” said Andualem Mengistu, Manager of the hospital.

According to Andualem, the range of mothers who deliver at the hospital has increased from 10-15 up to 80-90 mothers per week at present. This significant increase is due to the introduction of free service for mothers who deliver at the hospital, increase in the number of midwives on duty programme and early referral system from the Health Center. In addition, the hospital implements Maternal Death Surveillance and Response (MDSR) and uses volunteers from Voluntary Services Organization (VSO) to fill the staffing and skill gap.

“Giving birth should be a time of happiness and celebration for mothers and not a time of sorrow. And newborns are not predestined to die” said Dr. Asheber Gaym, Health Specialist at UNICEF. “We need to make all our efforts to stop the unnecessary death of mothers and new-born in the country by closely working with the Government and partners” he added.

 Ali Abdella, deputy head of the woreda health unit indicates that, their main objective is to create demand so that mothers deliver at a health facility and not at home. The maternal mortality rate in the city used to be 67 deaths per 10,000 in 2010 and now it has gone down to 6 deaths per 10,000 which is a significant achievement.

According to Ethiopian Demographic and Health Survey (EDHS) 2011, Ethiopia has one of the highest maternal mortality ratios in the world estimated at 676 maternal deaths per 100,000 live births far from the MDG target of 267.

“We are now aiming at quality service and HDF (Home Delivery Free) community.” he stresses.

Translation of paragraphs from stories by journalists that took part in the media visit are posted here: [With a link to the Amharic story]

[Ethiopian Reporter] Saving a mothers life

Hospitals can solve Maternal health and newborn deaths when they have the necessary  equipments and sustainable supply. To equip new and old hospitals with the necessary equipments to sustain the supply, the European Union  has donated 40 million Euros through a project implemented by Ministry of Health and UNICEF. All health sectors will benefit from this three year project Read more.

[Ethiopian News Agency] The hospital has played a role in reducing maternal and newborn deaths

“Many newborn and maternal lives were saved because of this hospital” says Fetiya “The service is for free, so all mothers should come to the hospital and save the life of their children and themselves” Fetiya conveys her message. Read more

[DW- Amharic] Butajira hospital to benefit from new 40 million Euro EU funded project 

UNICEF and Ethiopian Ministry of Health will work together to achieve MDG5, reduce maternal and newborn deaths , by implementing a new 40 million euro project donated by the European Union. Read more