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 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.

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.

Nearly 385 million children living in extreme poverty, says joint World Bank Group – UNICEF study

NEW YORK/ADDIS ABABA04 October 2016 – Children are more than twice as likely as adults to live in extreme poverty, according to a new analysis from the World Bank Group and UNICEF. Ending Extreme Poverty: A Focus on Children finds that in 2013 19.5 per cent of children in developing countries were living in households that survived on an average of US$1.90 a day or less per person, compared to just 9.2 per cent of adults.  Globally, almost 385 million children were living in extreme poverty.

Children are disproportionately affected, as they make up around a third of the population studied, but half of the extreme poor. The youngest children are the most at risk – with more than one-fifth of children under the age of five in the developing world living in extremely poor households.

“Children are not only more likely to be living in extreme poverty; the effects of poverty are most damaging to children.  They are the worst off of the worst off – and the youngest children are the worst off of all, because the deprivations they suffer affect the development of their bodies and their minds,” said UNICEF Executive Director Anthony Lake. “It is shocking that half of all children in sub-Saharan Africa and one in five children in developing countries are growing up in extreme poverty.  This not only limits their futures, it drags down their societies.”

The new analysis comes on the heels of the release of the World Bank Group’s new flagship study, Poverty and Shared Prosperity 2016: Taking on Inequality, which found that some 767 million people globally were living on less than $1.90 per day in 2013, half of them under the age of 18. 

“The sheer number of children in extreme poverty points to a real need to invest specifically in the early years—in services such as pre-natal care for pregnant mothers, early childhood development programs, quality schooling, clean water, good sanitation, and universal health care,” said Ana Revenga, Senior Director, Poverty and Equity at the World Bank Group. “Improving these services, and ensuring that today’s children can access quality job opportunities when the time comes, is the only way to break the cycle of intergenerational poverty that is so widespread today.”

The global estimate of extreme child poverty is based on data from 89 countries, representing 83 per cent of the developing world’s population.

Sub-Saharan Africa has both the highest rates of children living in extreme poverty at just under 50 per cent, and the largest share of the world’s extremely poor children, at just over 50 per cent.  South Asia has the second highest share at nearly 36 per cent—with over 30 per cent of extremely poor children living in India alone. More than four out of five children in extreme poverty live in rural areas.   

In addition, the report reveals that even at higher thresholds, poverty also affects children disproportionately.  About 45 per cent of children are living in households subsisting on less than $3.10 a day per person, compared with nearly 27 per cent of adults.

UNICEF and the World Bank Group are calling on governments to:

  • Routinely measure child poverty at the national and subnational level and focus on children in national poverty reduction plans as part of efforts to end extreme poverty by 2030.
  • Strengthen child-sensitive social protection systems, including cash transfer programs that directly help poor families to pay for food, health care, education and other services that protect children from the impact of poverty and improve their chances of breaking the cycle in their own lives.  
  • Prioritize investments in education, health, clean water, sanitation and infrastructure that benefit the poorest children, as well as those that help prevent people from falling back into poverty after setbacks like droughts, disease or economic instability.   
  • Shape policy decisions so that economic growth benefits the poorest children. 
  • UNICEF and the World Bank Group are working with partners to interrupt cycles of poverty and to promote early childhood development – with programs ranging from cash transfers, to nutrition, healthcare and education.

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 Ethiopia specific information:

  • There are 13 million Ethiopian children who live in poor households, 2 million of whom live in extreme poverty.
  • Children are more severely affected by poverty (32.4 per cent) and extreme poverty (5.2 per cent) than adults (29.6 per cent and 4.5 per cent, respectively).
  • The poorest children are found in households whose head is employed in the informal sector. 13.1 per cent of these children live in extreme poverty.

Ethiopia: Government and partners launch the mid-year review of Humanitarian Requirements Document (HRD) for 2016

US$612.4 million urgently needed to address food and non-food needs for 9.7million people  

Addis Ababa, 12 August 2016: On 12 August, the Government of Ethiopia officially launched the revision of the joint-Government and partners’ Humanitarian Requirements Document (HRD) for the second half of 2016. The revised HRD seeks US$612.4 million to help 9.7 million people with emergency food and non-food assistance.

“The findings of the comprehensive belg assessment show changes in the humanitarian context that require immediate action. While the overall response strategy remains the same, we need to respond to address increased needs in some areas,” noted Commissioner Ato Mitiku Kassa, Head of the National Disaster Risk Management Commission (NDRMC). “Thanks to the collaboration between the Government and humanitarian partners, we have done a lot this year. We need to sustain the generous support from the international community in the second half of 2016.”

Ethiopia continues to be affected by drought, exacerbated by the strongest El-Niño on record, which significantly eroded coping capacities. Some regions experienced flooding with unusually heavy belg spring rains in April and May 2016, causing temporary displacement and a surge in disease outbreaks. At the same time, some areas did not receive sufficient rainfall and people still do not have adequate access to water, resulting in continued food and nutrition needs that requires additional health and water response. The Government-led inter-agency belg seasonal assessment, undertaken at the end of June, allowed for a timely revision of the 2016 HRD to ensure well-prioritized response until the end of the year.

“The Government of Ethiopia maintains its very strong and decisive leadership in responding to this crisis and has helped avoid what could have been a humanitarian catastrophe’’ stated Ms. Gillian Mellsop, the acting Humanitarian Coordinator. “As was highlighted at the side-event at the World Humanitarian Summit in May, Ethiopia’s response model is an excellent example of how preparation, disaster risk management and response prioritization can mitigate the impact of natural disasters,” added Ms. Mellsop.

“Nevertheless, despite marked achievements earlier this year, the humanitarian situation in Ethiopia remains critical. With a combination of drought, which significantly weakened coping capacities, and extensive flooding that has caused displacement, disease outbreaks and the disruption of basic public services, we must maintain our scaled-up response,” Ms. Mellsop stressed.

“We should not underestimate our achievements this year, especially considering that we have received more than $1 billion in funding so far” Mr. Paul Handley, Head of Office for OCHA Ethiopia, emphasized. “However, we need to scale up and prioritize our response for the rest of the year to provide assistance to the most vulnerable. It is vital that the international community continues to support the Government to ensure that we do not lose the positive momentum we have gained towards ending the humanitarian crisis.”

UNICEF’s response in pictures (Click on the picture for more)

Emergency: Drought Response 2015/16

Amidst risks posed by drought, joint response brings scabies under control

By Paul Schemm

ADIGUDOM, Ethiopia, 27 April 2016 – For Kibrom Mekonnen, the itching was the worst at night, all over his hands and chest and keeping him awake.

“When I slept it just kept itching,” said the 14-year-old, sitting in the examination room at the Adigudom Primary Hospital in Hintalo Wejarat Woreda (district) in the Tigray Region. “But I was afraid if I started scratching, it would get worse.”

Scabies response in drought-affected areas
Kibrom Mekonnen, 14, listens as a nurse explains how to use the special soap and medication to combat scabies. ©UNICEF Ethiopia/2016/Balasundaram

Kibrom’s instincts were right because he has scabies, a contagious skin infection caused by mites that burrow along the top layer of the skin, lay eggs, hatch and spread throughout causing terrible itching.

The real danger, however, can be in the scratching which opens up sores in the skin.

“By itself, it is irritating and itchy but it also exposes you to other infections,” explained UNICEF Heath Specialist Yayneshet Gebreyohannes. “It can result in systemic infections if left untreated.”

Drought brings scabies revival

Scabies has actually been fairly rare in Ethiopia for the past several years, but with the sharp drop in the availability of water due to the worst drought the country has faced in decades, it reappeared.

Casual contact, a handshake or even a hug, is not enough to transmit the mites. There has to be prolonged skin contact or sharing of clothes, which means that outbreaks often happen within the tight confines of homes and schools.

With less water available to wash and maintain personal hygiene, there have been outbreaks in the country.

In the Tigray Region for instance, there were 27,000 new cases reported between October last year to March this year, and nearly 10,000 of those were in Kibrom’s woreda.

Since then however, there has been a significant drop in the number of cases due to the Government leadership and solid response and also UNICEF support to prevent and treat the disease.

In addition to providing medicated soap and permethrin lotion to treat the disease, UNICEF has distributed brochures and teaching guides to educate people about how to combat it and most importantly, not to stigmatize the victims.

Stopping the itch

Kibrom thinks he was infected by a visiting relative, about his age, when the latter visited from a rural village and shared Kibrom’s bed about a week earlier.

Scabies response in drought-affected areas
Kibrom applies sulphur ointment, one of the methods used to treat scabies, to his hands. UNICEF has partnered with the Federal Ministry of Health in its scabies response and has provided permethrin lotion, medicated soap and brochures and guides to inform communities about the diseases. ©UNICEF Ethiopia/2016/Balasundaram

The nurse examines his hands where telltale rashes have appeared in the folds of the skin at the joints.

She walks him through the three-day treatment of soap and medication and promises to visit his family home to advise them on precautions to be taken and provide medication for the rest of the family.

For instance his clothes will have to be treated with boiling water, as will his bed linens and many of the fabrics in the house.

Kibrom is lucky in that his home has piped water, but when water is unavailable, health workers advise people to tie clothes into plastic bags for three days – the lifespan of the mite.

Kibrom is also lucky because his area was targeted by the information campaign so that someone at school identified his condition and explained to him what the horrific itching was all about. Otherwise, he might have just tried to endure – and possibly infected others.

“I kept thinking it was going to go away on its own,” he recalled.

The scabies response is part of UNICEF’s health, communication, and water, hygiene and sanitation  response for drought and flood-affected populations. UNICEF also provides financial support, supplies including medicines and vaccines, and technical assistance to the Government for the prevention and treatment of major causes of childhood illnesses and deaths such as acute watery diarrhoea and other diarrhoeal diseases, vaccine preventable diseases, as well as other diseases such as meningitis.