Drought Emergency Highlights Entire Families Not Receiving Primary Education

By Rebecca Beauregard

DANOT, SOMALI, 15 February 2017 – “A woman never tells her age,” says Sadeh Abdihayii with a smile, affirming that this taboo is common around the world. She then admits to be 40 years old. We continue, asking her how many of her children are in school. With eight children ranging from nine months to 20 years old, none of them, including Sadeh, have been to school. Ever.

Sadeh had hoped one of them could go to school, but circumstances did not allow. “It seems sensible to learn, but we have not been able to,” says Sadeh.

40-year-old Sadeh Abdihayii laughs when asked about her age
Sadeh Abdihayii, 40-years-old, laughs about her age with her eight children gathered around her. Neither Sadeh nor her children have ever been to school. © UNICEF Ethiopia/2017/Nahom Tesfaye

Living through drought

Sometimes Sadeh’s family lives in the vicinity of an organized village or town, such as now just outside Qorile kebele (sub-district), yet often they can be far away from any organized services including healthcare and schools. This is the life of a pastoralist family.

Sadeh’s family is one of the over 800 families that have temporarily settled in Danot woreda (district), in the eastern horned-tip part of Ethiopia. The Government of Ethiopia (GoE) has set up these temporary sites to provide life-saving medical and nutrition services, water and food during this drought period for one of the most vulnerable communities in the country, livestock-raising pastoralists.

Drought has hit these lowland areas across the Horn of Africa many times over the years, but Sadeh has never experienced one that devastated her livestock to this extent. Due to the negative Indian Ocean Dipole (IOD), a weather phenomenon, the December rains failed, making it 12 months since many villages in the area have experienced rain.

It is understandable why school has not been possible for many of these children, whether considering the current food and water shortages, or the nomadic patterns of their  life. The regular school system does not fit into this lifestyle and it is a reality that is not often at the forefront of parents’ worries. With little or no safety net, pastoralist mothers and fathers are concerned with water, food and grazing land.

The GoE however, in partnership with UNICEF, has developed alternative methods to reach children, even those in remote areas.

Adapting education to the pastoralist context

With support from UNICEF, the Ministry of Education (MoE) has developed a pastoralist education strategy which is implemented across Somali and Afar, as well as some parts of Oromia and Southern Nations and Nationalities and Peoples’ (SNNP), regions where pastoralists are prominent.

The core intervention is a school equivalence programme, adapted for children ages 7 to 14, where students learn the equivalent of the first four grades of primary school before transitioning into formal schools. This Alternative Basic Education (ABE), is based on the national education system but has altered facets wherever necessary to make it feasible for the pastoralist context. Such alterations include low-cost construction of schools as well as flexible locations and schedules to accommodate children who herd their families’ animals or move in certain seasons.

While ABE is the most commonly implemented strategy for inclusion of pastoralist children, reaching 276,777 students over a period of six years, the GoE encourages families to enrol their children in formal schools whenever possible. UNICEF supports this initiative by identifying and addressing barriers to children joining school. Such interventions range from rehabiliting WASH facilities at schools to ensure proper toilets and water is available, to constructing temporary learning spaces or formal schooling in addition to providing exercise books for families who cannot afford the expense. Additionally, the GoE implements a school feeding programme to encourage school attendance, currently in 252 schools across Somali region.

More than ever, these crucial interventions are  needed now , particularly as hundreds of ABE schools across Somali region are currently closed due to drought conditions.

‘Maybe somehow one day’

Halimo Bandais, 20-year-old mother of a toddler is the eldest daughter of Sadeh.
Halimo Bandais, 20-year-old mother of a toddler, is the eldest daughter of Sadeh. She has never been to school. © UNICEF Ethiopia/2017/Tesfaye

Families gathered near Qorile, such as Sadeh’s, are encouraged  to enrol their children in the Qorile primary school, which is within walking distance, even if it may only be for short term. While the drought situation is dire, there is now an opportunity for thousands of children to attend school while their families are receiving temporary assistance to keep their livelihoods afloat.

Sadeh’s eldest child, Halimo Bandais, comments, “I thought about school sometimes. But I have always been looking after the animals and we are moving here and there. How could I? But some of us will, perhaps my child.” Perhaps he will attend school one day. For now, hundreds of school-age children such as the girls neighbouring Sadeh’s tent, Feysa and Isthel, may be able to finally start their education while in the temporary settlement sites with adequate funding.

UNICEF is committed to the right of every child to receive an education. With contributions from international donors, the GoE, along with UNICEF and other education partners can expand programmes such as ABE or temporary learning spaces to ensure children such as those temporarily settled in Qorile, have an opportunity to access education.

German funds for the Horn of Africa drought response to increase from 100 million Euro to 300 million Euro

On 03 April 2017, UNICEF, WFP, and UN-OCHA went on a joint one-day field visit with the German Minister for Development Cooperation (BMZ) to Kebri Dahar and Waaf Duug Temporary Resettlement Site in Doolo Zone, Somali Region, Ethiopia. The Minister was accompanied by 16 German journalists, BMZ officials, German Embassy partners, GiZ and KfW. The Somali Regional President and key regional government counterparts have also joined the field visit. The visit was part of the German Minister’s visit to Ethiopia to discuss the Marshall Plan for Africa with Ethiopian Government and AU Officials. 

The Minister and his delegation visited the Urban WASH programme (borehole and water trucking) in Kebri Dahar town, as well as UNICEF’s emergency Health, Nutrition and WASH programmes in the Waaf Dhuug Resettlement Site for drought displaced people. More specifically, the Minister was able to see a Mobile Health and Nutrition Team operating with the German funded vehicles, a stabilization centre for severely malnourished children that utilizes German funded Ready to Use Therapeutic Food (RUTF) and a water point. The Minister also visited WFP’s school feeding programme at the Waaf Dhuug primary school and a WFP food distribution.   

Bundesminister Dr. Gerd Müller visits Waaf Dhuug Temporary Settlement Site in Somali Region of Ethiopia
Bundesminister Dr. Gerd Müller visits a school for community and settlers at Waaf Dhuug Temporary Settlement Site in Somali Region of Ethiopia. ©UNICEF Ethiopia/2017/Zerihun Sewunet

Waaf Dhuug Temporary Resettlement Site (TRS) hosts 4,500 host community and 3,882 drought displaced people, of which more than 85 per cent are women and children from surrounding grassing areas. The site was established in January 2017 and is one of the 58 Temporary Resettlement Site established by the Somali Regional Government in response to the drought emergency. Majority of the pastoralist community have moved into the TRS due to extensive loss of livestock as a result of the drought. They have left their villages in search of water and health and nutrition services for themselves and their children. Discussing with the Minister, Kadar Kaydsane, 35 years old and a mother of 10  said, “We walked for five hours to get to Waaf Dhuug and we lost all our livestock on the way. We came here to find water and other services provided by the Government.” 

Bundesminister Dr. Gerd Müller visits Waaf Dhuug Temporary Settlement Site in Somali Region of Ethiopia
Bundesminister Dr. Gerd Müller discusses with the community at Waaf Dhuug Temporary Settlement Site in Somali Region of Ethiopia. ©UNICEF Ethiopia/2017/Zerihun Sewunet

The Minister and German development partners recognized the importance of investing in building resilience, for instance through funding water schemes and strengthening Government systems, such as the Health Extension Programme. The Minister further appreciated the German Government’s strong partnership with UNICEF and was impressed by the integrated drought emergency response at the resettlement site, but recognized that the challenges are very complex and the required funding remains significant. As a response to the dire need of the people affected by the drought, the Minister announced that German funds for the Horn of Africa drought response will be increased from 100 million Euro to 300 million Euro.

 

Menstrual Hygiene Management Programme Kicked off with a Training of Trainers in Oromia and Somali Regions

By Kalkidan Gugsa

OROMIA and SOMALI, February 2017 – Poor menstrual hygiene management (MHM) negatively impacts the education, health and empowerment of girls and women, as well as the environment. The impacts are compounded during emergencies, such as the protracted drought crises across Ethiopia. What fuels these negative effects of managing menstruation are cultural taboos and other societal barriers.

Girls across Ethiopia face social, cultural and economic barriers related to menstruation which not only prevents their right to dignity, but often prevents their right to education due to inadequate menstrual hygiene education, insufficient WASH facilities and poor access to sanitary materials.

With support from the Netherlands Government, UNICEF Ethiopia, in partnership with regional health and education bureaus (RHB, REB), is implementing an MHM programme to break the silence and bring change in beliefs and attitudes towards menstruation. The programme aims to support girls and women across the country to overcome the barriers that prohibit them from managing menstruation with dignity.

Why MHM?

Menstrual hygiene management is a complex and sensitive issue that requires a contextualized, multi-sectoral approach to adequately support girls and women across Ethiopia. A package of services that leads to improved MHM includes private, minimum-standard toilets, handwashing stations and adequate waste disposal in addition to allowing the safe space for discussion to increase awareness amongst men, boys and girls utilizing social and behavioural change communication (SBCC) methods. In addition, improvements in the supply chain for sanitary pad production complements the community- and school-based efforts in MHM.

In collaboration with UNICEF, the Ethiopia Ministry of Health developed a national MHM guide based on the package of services, which is designed to address the topic across the contexts of schools, communities and workplaces as well as in emergencies.

By working with both the RHB and the REB, and supporting the development of a sanitary supply chain, improved MHM facilities and services will keep girls in school where they can reach their full potential.

MHM social and behaviour change communication materials in Amharic and Oromiffa languages
MHM social and behaviour change communication materials in Amharic and Oromiffa languages

On 15 February 2017, UNICEF kicked off the community- and school-focused MHM training of trainers (ToT) workshops for a total of 120 staff of the RHB and the REB in Oromia and Somali regions. These were the first of such trainings made possible by support from the Netherlands Government.

The TOT workshop established coordination between the education and health sectors and equipped focal persons with global, national and regional menstruation facts. It also introduced participants to the MHM package of services: SBCC activities concerning menstruation, establishing safe spaces to enable girls to receive peer support, counselling and emergency kits as well as improved WASH facilities and sanitary pad production.

Throughout the training, participants highlighted the lack of discussion on this important topic, with one male participant explaining, “In our societies, the lack of information about menstrual hygiene creates a culture of taboos and misinformation about menstruation and therefore potential health problems. Now we know what to do from this training and how to react.”

The regional and woreda (district) focal persons who participated in the ToT, in turn will cascade the training to health extension workers (HEWs), school management committees and school club coordinators (teachers). The trained HEWs and teachers will then facilitate activities for the Health Development Army and the WASH, gender and girls’ club members in their respective areas.

The sanitary supply chain

The sanitary pad supply chain component of the programme establishes women’s groups to produce reusable sanitary pads and provides support to local manufacturers through partnerships to improve the production, packaging, distribution and use of sanitary pad products in target regions. On the manufacturing end, partner companies will engage in backward integration of the production of raw materials such as absorbents and liners. On the sales end, pharmaceutical and family planning outlets, such as pharmacies, drug stores and clinics, will be utilized at local and regional levels to bring the improved products to communities.

Additional MHM training and launch workshops are planned to kick off in March and April 2017 in Gambella, SNNP and Afar regions. Together with Government partners, UNICEF will support the positive change in the dynamics of MHM in Ethiopia and contribute to better futures of girls across the country.

Borehole Rehabilitation Contributes to Children’s Education and Futures

By Ayuko Matsuhashi

MIESSO, SOMALI, 15 January 2017 – “When the borehole was broken for a year and a half, I used to go to the nearby river for water, which is 12 km away from here. I have five children but I only managed to get one or two jerry cans of water for my family. I was not able to clean or bathe my children regularly at that time. That was difficult,” says Fathiya Ali Aadan, a 32-year-old mother of five living in Miesso town.

 

Harshim Town Fafan Zone Somali region
Fathiya Ali Aadan, 32 year-old, enjoys an household water connection which comes from the rehabilitated borehole in her premise ©UNICEF/2017/Tsegaye

Miesso is a small, remote town in the same-named woreda (district) located about 150 km west of the administrative city, Dire Dawa. Out of five non-functional water supply systems in Miesso woreda, one borehole was rehabilitated in the town by the Regional Water Bureau (RWB) in December 2016 with assistance from UNICEF, from the generous support of the Office of U.S. Foreign Disaster Assistance (OFDA). The emergency water, sanitation and hygiene (WASH) intervention benefits 3,500 households in the town as well as the school and health centre.

 

The Miesso woreda administration office reports that there are currently 86 non-functional boreholes in the woreda, a key intervention necessary to improve the water situation, which is only one part of the challenges facing families in the region. Since most of the region is prone to drought and pastoralist livelihoods critically depend on water, non-functionality of water schemes requires immediate response to save lives of people and their livestock. It also affects children’s opportunity to learn.

At Mulli School, which includes grades one through twelve, a 14-year-old, grade eight student Ibrahim Mohamed explains, “Before, we had to return back home to get water when there was no water at school. It was a big interruption of class.” The impact of water scarcity also causes some schools to close, such as last year after the failure of deyr rains (October-December). Additionally, pastoralist families may move in search of water, thus taking children and even teachers away from school.

“Now we can drink water, keep our clothes clean, wash our hands after using the bathroom and most importantly for me, there is no longer need to go back home to get water during class. Girls need water for menstrual hygiene at school as well,” says Hayat Yusuf Adan, a 13-year-old, grade eight student.

Thanks to the rehabilitated borehole, Hayat’s school managed to remain open. While water supply at school tends to be neglected during emergency, it is clear that water availability contributes to retaining children in school. UNICEF is committed to support the Government of Ethiopia and implementing partners to improve the WASH situation for schools and families across Somali region to protect the futures of children and the livelihoods of their families.

Mobile Health and Nutrition Teams Save Lives in Remote Drought-affected Areas

By Rebecca Beauregard

GASHAMO, SOMALI, 15 February 2017 – Under the shade of a tree and settled on plastic mats, the mobile health and nutrition team (MHNT) is in full operation. An array of bright coloured fabric represents the crowd of mothers and children gathered around them, all in varying stages of screening, vaccinations, treatment or referral. In the rural Somali region, Gashamo woreda (district), 63 km off the paved road, the MHNT has been operating as a static clinic for the past two months as part of the response to the Horn of Africa drought caused by the negative Indian Ocean Dipole (IOD).

MHNT in Somali drought 2017
The MHNT in full operation with MHNT team leader Mohammed Miyir at its centre in white. ©UNICEF/2017/Tesfaye

Facing food and grazing shortages and in need of water, drought-affected pastoralist families and their livestock began traveling long distances in search of water. As one of the most vulnerable communities across the country, unique interventions are required to provide them a safety net in times of emergency.

The Government of Ethiopia (GoE) has provided a swift response by setting up five temporary sites in Gashamo woreda, which offer health and nutrition services as well as food and water. This arrangement is crucial and specific to pastoralist communities, where families are scattered across hundreds of kilometres of harsh semi-arid desert.

28-year-old Mohammed, a senior clinical nurse by training, works alongside two nurses who treat and manage cases, in addition to two health extension workers (HEWs) who screen patients and conduct community health education. Mohammed and his team were assigned to this hotspot priority one site by the Somali Regional Health Bureau (RHB), following a recent updating of hotspot woredas, which are most affected by malnutrition according to the latest meher seasonal assessment.

“My family is 200 km away and I am not sure when I will visit them. Probably when the drought is over,” says Mohammed. “But our work here is very important, there are thousands of people who otherwise would not have access to any health services. Especially during a severe drought, our services save lives.” He explains further that while the Ethiopian health system is highly developed, utilizing catchment areas for a tiered health facility structure is not feasible in pastoralist communities.

“Pastoralists are always on the move in order to provide grazing and water for their livestock, so expanding health facilities in these remote areas does not add value. Right now, there are over two thousand families in this location, so why not set up a permanent health post to serve them? Because perhaps in one or three months, there will be 20 families here, or none. Across the region, there are remote areas where people come and go, so the normal health system does not serve its purpose [in this context].”

MHNT in Somali drought 2017
Mohammed, 28-years-old, explains the unique pastoralist context at Al Bahi temporary site where over 2,000 households have gathered. ©UNICEF/2017/Tesfaye

This is the reason MHNTs were created and why they have helped improve the health and nutrition situation of pastoralist families for the past decade. From regular risk assessments and categorization of vulnerable woredas by the Ministry of Health and partners, including UNICEF, MHNTs are deployed for a minimum of three months, depending on the emergency situation and needs. With the onset of a sudden disease outbreaks or other emergencies, the MHNT will temporary relocate to the affected area to provide initial rapid response and then return to their assigned woreda.

The MHNTs work six days per week, traveling from location to location and setting up mobile clinics along the way. They make contacts with social mobilisers, volunteers from the community, to ensure everyone knows the day and place where the MHNT will be. The social mobilisers know their community well, even those families that are spread out across a vast terrain, and they guarantee everyone receives the information. Every time, a crowd of mostly women and children are gathered, anticipating the needed treatment and care.

The MHNTs conduct screening for malnutrition, provide routine immunizations and basic healthcare treatment, ante-natal care and emergency delivery services, common illness management, health education and promotion, as well as refer patients to higher levels of care as and distributing household water purification supplies as necessary. When the latter happens, they often utilize their vehicles to bring patients to the nearest health facility, as it would be near impossible for timely care otherwise.

UNICEF supports the GoE’s MHNT programme with the generous effort from donors, through vehicle provision, transportation allowances, emergency supplies and technical guidance. There are 49 MHNTs currently operating in Somali and Afar regions, moving around their respective regions according to the identified need.

Our visit is cut short as the team has just identified two children who are not responding to malnutrition treatment – as per the protocol, severe acute malnutrition (SAM) cases should return to the MHNT on a weekly basis to record progress or be referred to higher levels of care. These cases have been escalated to SAM with medical complications and the mothers are encouraged to gather their belongings and take the MHNT car to the nearest stabilisation centre about 30 km away. “Working in a static clinic may be nice,” says Mohammed, who has been working on the MHNT for nearly seven years, “and over time, as Somali region becomes more developed, the health system may be able to cover all areas. But until then, I know there is a great need and I am proud to be working on this team.”

Rehabilitation of Borehole Saves Thousands of Lives and Livestock during Drought

By Ayuko Matsuhashi

A signboard on the sight of rehabilitated borehole
A signboard on the sight of the rehabilitated borehole ©UNICEF/2017/Tsegaye

HARSHIM, SOMALI, 19 January 2017 – “For three months, the borehole was not functional and people suffered a lot. There was little rain, so most of the birkas[1] became empty. Additionally, water from birkas is usually contaminated so we suffered from diarrhoea,” Muse Hassan Ali, 45-years-old recalls the time that he and his neighbours did not have access to safe and sustainable water in his town. Birkas are underground water storage systems intended to collect rain water during the rainy season and store for use during the dry season. Birkas can also be used to store water transported by trucks during emergencies.

According to the Harshim woreda (district) administrator, Sied Abraham, this borehole in Harshim town is the only sustainable water source that survived the 2015 El-Niño drought. It was drilled by the Somali Regional Water Bureau (RWB) following a UNICEF groundwater mapping in 2009 to identify potential drilling sites. The depth of the borehole is 535 meters, one of the deepest in the Somali region. After this borehole became non-functional due to electromechanical failure last year, UNICEF, with generous financial contribution from European Commission’s humanitarian aid department (ECHO), supported the RWB to rehabilitate the borehole by replacing a submersible pump, generator and an electric cable.

An immediate rehabilitation of the only sustainable water source in the woreda was crucial not only for Harshim town, but a large part of the region. It typically benefits over 9,000 people in Harshim and neighbouring woredas as well as people who cross the border from Somalia. At the end of 2016, it also served people in far-reaching woredas when drought conditions worsened once again due to the negative Indian Ocean Dipole (IOD). The RWB and partners began providing emergency water trucking, using this borehole as their source. Thus, its well-functioning affects a high number of direct and indirect beneficiaries across the region.

_MIK9116
Roda Ahmed, 35 years old and Rahma Ahmed, 30 years old collecting clean water from the on-site water point ©UNICEF/2017/Tsegaye

Roda Ahmed, 35 years old, is with her five children collecting water. “This is a source of life. Now I can cook and feed my children,” she says. Another woman from Harshim town also with five children, Rahma Ahmed, explains, “Since this borehole has been working, we stopped drinking water from birkas.

In addition to people collecting water near the borehole, the on-site trough draws in many pastoralists and their livestock. It takes more than a day for Farah Aden, 60 years old, to walk to the Harshim borehole with his 10 camels. “We are grateful for this borehole. Water is always a great cost for livestock. The functionality of this borehole has impacted our life a lot.” Indeed, during drought periods such as this one, entire herds may be wiped out, as evidenced by dozens of dead carcasses along the roads across the region.

Pastoralists come to Harshim town from neighbouring woredas and Somalia looking for water
Hundreds of livestock come from all over the Harshim woreda and drink water at the on-site trough ©UNICEF/2017/Tsegaye

As he contemplates this grave issue in his region, Muse pauses before emphasizing, “Still, this is not enough. There is a great pressure on this borehole. The generator is working 22 hours every day.”

UNICEF and partners will continue efforts to support the Government of Ethiopia to increase water coverage and functional water schemes in the Somali region to save the lives of children, their families and their livestock and contribute to a better future for all.

[1] traditional water harvesting pond

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.