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.

Five in six children under two not getting enough nutrition for growth and brain development – UNICEF

 NEW YORK/ ADDIS ABABA, 14 October 2016 – Five in six children under two years old are not fed enough nutritious food for their age, depriving them of the energy and nutrients they need at the most critical time in their physical and cognitive development, according to a new UNICEF report.

“Infants and young children have the greatest nutrient needs than at any other time in life. But the bodies and brains of millions of young children do not reach their full potential because they are receiving too little food, too late,” said France Begin, Senior Nutrition Adviser at UNICEF. “Poor nutrition at such a young age causes irreversible mental and physical damage.”

UNICEF data show that poor nutritional practices– including the delayed introduction of solid foods, infrequent meals and lack of food variety – are widespread, depriving children of essential nutrients when their growing brains, bones and bodies need them the most. The findings reveal that: 

  • Young children wait too long for their first bites. One in five babies hasn’t been fed any solid foods by the age of 11 months.
  • Half of children aged six months to two years are not fed the minimum number of meals for their age, increasing their risk of stunting.
  • Less than one-third of children in this age group eat a diverse diet – meaning from four or more food groups daily – causing deficiencies in vitamins and minerals.
  • Almost half of pre-school aged children suffer from anaemia.
  • Only half of children aged six to 11 months receive any foods from animal sources – including fish, meat, eggs and dairy – which are essential to supply zinc and iron.
  • The high cost of foods from animal sources makes it difficult for the poorest families to improve their children’s diet. In Sub-Saharan Africa and South Asia, only one in six children from the poorest households aged six to 11 months eats a minimally diverse diet, compared to one in three from the richest households.
  • Improving nutrition for young children could save 100,000 lives a year.

Making nutritious foods affordable and accessible to the poorest children will require stronger and more targeted investments from governments and the private sector. Cash or in-kind transfers to vulnerable families; crop diversification programmes; and fortification of staple foods are key to improving nutrition for young children. Community-based health services that help caregivers learn better feeding practices, and safe water and sanitation – absolutely critical in preventing diarrhoea among children – are also vital.

“We cannot afford to fail in our fight to improve nutrition for young children. Their ability to grow, learn and contribute to their country’s future depends on it,” Begin said. 

Ethiopia has experienced rapid, sustained improvement in under-nutrition during the past 15 years. For example, the country has seen a steady reduction in stunting – the fastest rate of improvement in Africa – and a decline in the percentage of underweight and wasted children. Yet, Ethiopia remains in a precarious situation, with large absolute numbers of affected children: 5.3 million children are stunted and 1.2 million children suffer wasting. UNICEF’s nutrition programme collaborates with the Government of Ethiopia to reduce these numbers further, working on multi-sectoral coordination to improve the nutrition of all children, pregnant and lactating women and their families

The Government of Ethiopia recognizes that addressing malnutrition is essential to achieving sustainable development. It therefore has issued the Seqota Declaration to end child malnutrition by 2030. The Declaration lays out a plan to stop the cycle of under-nutrition by bringing together all sectors of the Government, paying particular attention to the importance of nutrition during pregnancy and in the first years of a child’s life. 

Over the past decade, Ethiopia has seen a steady reduction in stunting from 58 per cent in 2000 to 40 per cent 2014, in the percentage of underweight children from 41 per cent to 25 per cent, and in wasting from 12 per cent to 9 percent (Mini EDHS: 2014) 

These trends indicate an improvement in chronic malnutrition over the past 15 years. Yet, 28 per cent of child deaths in Ethiopia is associated with under-nutrition. In addition to this high contribution to the under-five mortality rate, high prevalence of various forms of malnutrition among vulnerable groups in Ethiopia has serious implications for social development and economic growth. In a study conducted in 2009, the total annual cost of under-nutrition was estimated at US$2,775,000, equivalent to 17 per cent of the country’s GDP in 2009.

UNICEF’s strategies for nutrition ensure the achievements of results in four areas: 1) upstream nutrition policy support and multi-sectoral engagement; 2) improved nutrition knowledge and caring behaviours; 3) strengthening of systems for nutrition service delivery; and 4) strengthening partner capacities to respond to nutrition in humanitarian crises.

To accelerate the reduction of chronic and acute malnutrition, UNICEF is working in partnership with sectoral government counterparts, including in health, agriculture, education, social protection, trade and industry, and women, children and youth affairs.

UNICEF also works with United Nations agencies such as the Food and Agriculture Organization (FAO), United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), World Food Programme (WFP) and World Health Organization (WHO); UNICEF National Committees; donors such as the aid agencies of Canada, Ireland, Japan, the Netherlands, Spain, the United Kingdom and the United States, as well as the European Union; civil society organizations; and local and international academic institutions.

EU’s Satellite images provide life saving water to drought affected communities in Ethiopia

By Samuel Godfrey

An ongoing UNICEF supported borehole drill in Musle Kebele of Kore Woreda.
An ongoing UNICEF supported borehole drill in Musle Kebele of Kore Woreda. The borehole drilling site was identified through combined remote sensing technology with conventional methodologies (hydrogeology and geophysics). © UNICEF Ethiopia/2016/Ayene

Ethiopia is in the middle of an El Nino induced drought which has left 5.8 million people across the country without access to adequate water. More than 220 districts of Ethiopia are facing water related emergencies that arise due to either a lack of availability or quality of water.

As the WASH cluster lead, UNICEF supports 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. In addition, UNICEF is exploring innovative ways to use satellites to detect deep groundwater for large scale, multiple-village water supply systems. As part of the overall drought emergency response, UNICEF supports programmes in child protection, education, health and nutrition.

Groundwater, compared to rivers/lakes or other surface water, supplies 80 percent of all drinking water in Ethiopia. Water from the groundwater aquifers supports emergency water supply, urban water supply and livestock watering. With limited rains, many of these shallow groundwater wells have run dry and these communities rely on expensive commercial trucks to haul in water.

The more sustainable groundwater is located at extremely deep depths. In some cases, more than 300 metres below the ground which is the equivalent in height of the Empire State Building. To locate water that deep and then to drill and extract it is a major challenge.

Satellite image of Afar Elidar woreda Potential drilling sites
Satellite image of Afar Elidar woreda potential drilling sites

To tackle this problem, the European Union and UNICEF have selected 9 of the worst affected districts across Ethiopia to use ‘satellite’ technology to locate groundwater. The EU Joint Research Centre (JRC) are providing their expertise by availing ‘no cost’ satellite images which depict the physical and topographical characteristics of the districts from satellites 100s of KM in the sky. These are then combined by UNICEF hydrogeology experts to locate appropriate sites for the drilling of essential deepwells for drought affected communities.

Results to date are extremely encouraging that it should be expanded to a larger scale of the country. On a recent visit to a well sited using this technique in Afar, the UNICEF Executive Director, Anthony Lake said “This approach is very cost-effective, compared to delivering water by truck. Indeed, every permanent well costs the equivalent of only three deliveries of water by truck.”

Mr. Lake added “This is only the beginning. With our partners in the European Union and the Government of Ethiopia we are expanding this effort through out the country, distributing water to villages, schools, health centres and cattle troughs.”

UNICEF would like to express its thanks to the European Union Delegation and the EU-JRC, for their establishment of a remote sensing partnership with UNICEF and providing the un-reserved support so far, which we believe to be strengthen and extended further in the future.

Innovative approaches like these are already showing results for boys and girls in the hard to reach areas of Ethiopia.

Dr. Samuel Godfrey is Chief of WASH for UNICEF Ethiopia, and has a PhD and MSc in Civil Engineering and Water and Waste Engineering.

UNICEF’s largest global purchase of Therapeutic Food for children in drought-stricken Ethiopia through donor support

Drought in Ethiopia
A mother feeds a her malnourished child a Ready-to-Use Therapeutic Food (RUTF), a high protein and high energy peanut-based paste, in Arsi zone, Oromia, Ethiopia. In Ethiopia, after two years of erratic rainfall and drought, one of the most powerful El Niño weather events for 50 years is wreaking havoc on lives and livelihoods. ©UNICEF Ethiopia/2016/Ayene

ADDIS ABABA, 22 April 2016 – Today, UNICEF thanked donors for their generous contributions and the Government for its strong leadership, which together have enabled a concerted response to the current El Niño driven drought in Ethiopia, particularly in treating children with severe malnutrition.

With support from donors, UNICEF has procured 543,631 cartons of Ready-to-Use Therapeutic Food (RUTF), which represents 22 per cent of the global order for 2015 and is one of the largest single purchases in UNICEF’s history. The donors include the Governments of Canada, Germany, Japan, Sweden, United Kingdom and United States and partners including ECHO and the Bill & Melinda Gates Foundation.

To date in 2016, UNICEF procured in 2015 a further 73,344 cartons of RUTF out of a global procurement estimated at 565,623 cartons, which corresponds to 13 per cent of the global supply. In addition to RUTF, other supplies including therapeutic milk, routine drugs and hygiene and sanitation commodities have been procured as part of the drought response. To accommodate this large volume of supplies and enhance preparedness for the drought response, UNICEF rented a new warehouse in the Gerji area of Addis Ababa, earlier this year.

“On behalf of the Government of Ethiopia and UNICEF, I would like to express my sincere appreciation to the humanitarian donors for their timely and generous financial contributions to purchase Ready-to-Use Therapeutic Food that will save the lives of millions of children diagnosed with severe malnutrition,” said Ms Gillian Mellsop, UNICEF Representative to Ethiopia. “I would also like to especially thank the Ethiopian Customs Authority, the Ethiopian Food Medicine and Health Care Administration and Akakas Logistics, this enormous supply chain operation would not have been possible without their active support. By accelerating our joint nutrition interventions, we can transform the lives of millions of children to become healthy citizens and reach their full potential.”

Ethiopia is experiencing one of the worst droughts in decades due to El Niño weather condition which continues to wreak havoc on the lives of children and their families’ livelihoods. According to the latest Humanitarian Requirement Document issued this year, 6 million children are at risk from hunger, disease and lack of water. Malnutrition rates have greatly increased – 450,000 children are expected to be treated for severe acute malnutrition (SAM) this year.

Inauguration of new UNICEF warehouse
Inauguration of new UNICEF warehouse (L-R) Ms Gillian Mellsop, UNICEF Representative to Ethiopia, Dr Kebede Worku, State Minister of the Federal Ministry of Health, and Ms. Emma William, Deputy Head, DFID Ethiopia ©UNICEf Ethiopia/2016/Tsegaye

As part of the joint drought response coordinated by the Government, UNICEF is leading the Nutrition, Water Sanitation Hygiene, Education (together with Save the Children) clusters and the Child Protection sub-cluster. Together with other partners, UNICEF implements life-saving humanitarian responses including procurement and supply of therapeutic food and milk, drugs, other medical supplies, plus water/sanitation and education and child protection supplies.

UNICEF also supports the treatment of severely malnourished children through the community-based management of acute malnutrition, with training, quality assurance and coordination with other partners. Regular nutrition screening helps ensure that malnutrition in children is diagnosed and treated early, thereby reducing cases of severe acute malnutrition and life-threatening complications.

The supply of RUTF procured by UNICEF to date to respond to the current emergency is worth US$28 million including freight and in-country distribution. With the continued effort of the Government and support from humanitarian actors, 350,451 children were treated for severe acute malnutrition in 2015.

Reuniting Ethiopia’s children with their families after migration horrors

By Paul Schemm

UNICEF- IOM partnership on assisted voluntary returning children from Ethiopia
Ahmad, 17, demonstrates how traffickers in Yemen held him for ransom. A joint project between UNICEF, the International Organization of Migration and the Ethiopian Government, the transit centre in Addis Ababa, Ethiopia reunites migrant children with their families. © UNICEF Ethiopia/2016/Mulugeta Ayene

ADDIS ABABA, March 31, 2016 – As Ahmad* was being chased through the Yemeni desert by the motorcycle-riding human traffickers that had tortured and beat him in their camp for months, he thought he would never see his home village in southern Ethiopia again.

“I didn’t think I was going to make it home,” recalled the young 17-year-old with an expressive face and wide eyes as he described his five months of attempted migration to Saudi Arabia that resulted in him getting ransomed by traffickers twice and ended in a harrowing midnight escape when he rolled off the truck containing bodies of fellow migrants he had been sent to help bury.

Ahmad is now safe in a transit centre in the Ethiopian capital of Addis Ababa, just a few short days away from the trip back home and being reunited with his family as part of a collaboration between UNICEF, the International Organization for Migration and the Ethiopian Government.

The lure of migration

UNICEF- IOM partnership on assisted voluntary returning children from Ethiopia
Children play ping pong in the courtyard of the transit centre where they await their return to their families after failed attempts to migrate. A joint project between UNICEF, the International Organization of Migration and the Ethiopian Government, the transit centre reunites migrant children with their families. © UNICEF Ethiopia/2016/Mulugeta Ayene

Thousands of Ethiopians leave the country searching for opportunities, with many heading for oil-rich Saudi Arabia via the Red Sea port of Djibouti and through Yemen, which is currently deeply embroiled in a civil war.

Many are preyed upon by human traffickers who often leave them stranded, or worse hold them for ransom. Many who make the trip are minors left stranded far from home.

UNICEF and the IOM have begun bringing these children back to Ethiopia and housing them for a week in the Addis Ababa transit centre while their families are contacted.

“Most of them have travelled through very harsh circumstances, some were robbed and they all went long days without food,” said centre director Mohammed Farah who just last week sent almost hundred children back to their homes. “Most of them are traumatized.”

The children are given new clothes, showers and counselling to try to overcome some of the experiences they have been through.

Many are at first uncommunicative but with time and group therapy they begin to interact with their peers, said Farah.

The centre helped bring home 598 children in 2015 and already in the first few months of 2016 it has sent another 157 to their families, including 10 girls. Families receive a 1,000 birr (US$50) resettling aid as well.

Most of the children helped by the programme are between 15 and 17 years-old but there are cases of even younger children caught up in the lure to immigrate.

The IOM-UNICEF partnership to bring these children back to their families has been singled out by the UNICEF Eastern and Southern Africa Regional office as a success story.

Coping with the trauma

UNICEF- IOM partnership on assisted voluntary returning children from Ethiopia
Kabir, 16, looks out the window of the transit center in Addis Ababa, Ethiopia where he awaits the journey back to his family that he hasn’t seen for the past five months. The joint project between UNICEF, the International Organization of Migration and the Ethiopian Government reunites children migrants with their families. © UNICEF Ethiopia/2016/Mulugeta Ayene

Sitting in the clean, white-washed activities room, Zerihun*, 17, talked about being ransomed by traffickers in Yemen and beaten repeatedly when his family couldn’t provide the money.

“They beat me until I became really sick and then they thought I would die so they left me outside,” he recalled, admitting that he still has trouble sleeping from the trauma. In the end, he survived the terrible experience and was able to run off into the desert and find a Yemeni village. There, he received assistance that eventually put him in contact with the IOM, enabling him to return home.

Some migrant children at the centre said they left for Saudi Arabia because they had seen many others go and thought it was a chance to make something of their lives  and return with money.

Kabir*, just 16-year-old, thought he could use his skills as a herder and help manage the massive herds of sheep and goats imported into Saudi Arabia annually for the Muslim feasts, but he too just ended up ransomed by traffickers who had hired Ethiopians to communicate – and beat – their prisoners.

He said when he returned home, he would be sure to warn others about the perils of migration.

“I want to restart my education and help my family,” said Kabir. “It is death if you go there – it is better to transform oneself and thrive inside your own country, that’s what I would tell them.”

*Names changed to protect the children’s identities.

EU gives €3 million to improve the nutritional status of children in Ethiopia

Funds to reach over one million beneficiaries in Ethiopia 

Asmera Bere feeds her son, Amanuel Shibabaw, feeds to her child a nutritious porridge made from locally available products, at the health post as a demonstration to cook at home
Asmera Bere feeds her son, Amanuel Shibabaw, a nutritious porridge made from locally available products, at the health post as a demonstration to cook at home ©UNICEF Ethiopia/2014/Sewunet

ADDIS ABABA, 21 March 2016 – The European Commission today announced a €3 million grant to UNICEF to improve the nutrition for severely malnourished children in the drought affected areas in Ethiopia. 

The EU funding aims to strengthen the current emergency response and reach an estimated 40,000 Severe Acute Malnutrition (SAM) children. It will help provide supplies (40,000 boxes of Ready-to-use Therapeutic Food (RUTF) and 19,700 packs of amoxicillin). The funds will also support one round of Extended Outreach Strategy (EOS) screening which provides biannual vitamin A supplementation and de-worming to children under 5 years of age. Screening for acute malnutrition for children and pregnant and lactating women will also be covered.

“The El Niño phenomenon is impacting entire regions in Africa, notably Ethiopia. The EU support will help UNICEF provide life-saving assistance to the most vulnerable. It will help more than a million children suffering from malnutrition get treatment,” said Jean-Louis De Brouwer, Director of Operations in the European Commission’s Humanitarian and Civil Protection department (ECHO).

“We are grateful to the EU for its continued support for life saving interventions addressing malnutrition in Ethiopia,” said UNICEF Representative to Ethiopia, Ms Gillian Mellsop. “Children are always the most vulnerable group in emergencies but when support is made available, we can change their lives for the better.”

The EU funding targets close to half a million children under the age of five along with nearly 140 000 pregnant and lactating women in the Somali region. UNICEF, at the request of the Government, is responsible for the procurement of supplies for Severe Acute Malnutrition (SAM) management as a key input to the emergency nutrition responses throughout the country. It also provides technical and financial support to ensure programme quality and coverage. 

UNICEF is supporting the Government in responding to the emergency by scaling up and strengthening the treatment of children with severe acute malnutrition, increasing the intensity and frequency of screening of children and pregnant and lactating women, and ensuring key preventative nutrition services are provided to prevent excess morbidity and mortality.

According to the revised Humanitarian Requirement Document (HRD), over 10.2 million people in need of food aid and estimated 435,000 in need of treatment for severe acute malnutrition by the end of 2016. This has significantly devastated livelihoods and greatly compromised the health and wellbeing of children and women, through malnutrition and hygiene-related diseases across Ethiopia with six regions hit particularly hard.