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.

Regional experts confirm the polio outbreak is successfully interrupted in Ethiopia and Kenya

Vigilance in Somalia and region still needed before the region is declared polio-free once more.

By Shalini Rozario

Dr. Jean-Marc Olive, Horn of Africa (HOA) Polio Technical Advisory Group (TAG) Chair, chairs proceedings of the HOA Polio Outbreak Final Assessment
Dr. Jean-Marc Olive, Horn of Africa (HOA) Polio Technical Advisory Group (TAG) Chair, chairs proceedings of the HOA Polio Outbreak Final Assessment, and is seated with representatives from the Kenyan Government, WHO, UNICEF and partners such as Rotary International, The Gates Foundation, CDC among others. ©UNICEF Ethiopia/2015/Rozario

17 June 2015, Nairobi, Kenya. Government representatives, technical experts, donors, and polio partners gathered on Wednesday, 17 June 2015 to review the polio outbreak status in the Horn of Africa (HOA) Region. The final assessment concluded the following:

  • The assessment team commends the overall robust outbreak response in the HOA with strong vaccination, communication strategy and strengthened surveillance.
  • The assessment team believes that transmission in Kenya and Ethiopia has been interrupted; however, continued undetected low level transmission cannot be ruled out in Somalia

Overall progress in the region was reviewed since onset of the outbreak in April 2013, which resulted in a total of 223 WPV cases across the region (10 in Ethiopia), and remaining challenges ahead were identified. Chaired by the Horn of Africa polio Technical Advisory Group (TAG) Chair, Dr. Jean-Marc Olive, the meeting gave opportunity to strategically reflect on the current outbreak status and required next steps for all three countries. Dr. Ephrem Tekle, Director of the Maternal and Child Health Directorate, Ethiopia Federal Ministry of Health responded positively to the wild poliovirus (WPV) interruption in Ethiopia, and also acknowledged the work ahead to further improve routine immunisation. “Successes achieved in the polio response are due to the political commitment and the support of partners,” said Dr. Ephrem. “We have been successful on SIAs (supplementary immunisation activities) and NIDs (National Immunisation Days). However, I don’t think we are yet fully successful on routine immunisation; there is a lot to do on routine immunisation even though WPV transmission is interrupted.” Dr. Ephrem acknowledged the strong focus on the involvement of religious and clan leaders in the Somali Region, and mobilisation of the community which have been instrumental to some of the immense achievements in the polio legacy process. He cited an example of community leaders asking for a generator so they could continue routine immunisation services. In moving ahead, Dr. Ephrem stressed the importance of sustaining the polio gains made, using the momentum to improve routine immunisation in the country, and also emphasised the importance to intensify the same efforts in regions bordering South Sudan, such as Benshangul Gumuz and Gambella, in light of the immense population migration. The HOA TAG Chair congratulated Dr. Ephrem and the Ethiopia team on their efforts and wished the country success for strengthening routine immunisation in the country, a challenging task. Closing remarks were provided by governments and partners such as Rotary International, CDC, The Gates Foundation, Red Cross, Core Group, USAID, Communication Initiative, UNICEF, WHO and the HOA TAG Chairman. Next steps for countries include working towards the polio legacy transition plan and using polio assets and achievement to further strengthen routine immunisation and beyond. Countries will continue to implement specific recommendations from the external assessment team, and the outbreak response in Somalia will be assessed again after three months. Following the Somalia assessment, the next HOA TAG meeting in August, and continual monitoring of regional progress, it is hoped that soon, the entire HOA region will be declared “polio-free.”

Through the generous support of polio donors and partners such as the Centres for Disease Control and Prevention; Crown Prince Court, Abu Dhabi, UAE; European Union; the Bill and Melinda Gates Foundation; National Philanthropic Trust; Slim Foundation; Rotary International; Swedish International Development Cooperation; and others, successful interruption of the outbreak in Ethiopia has been achieved. Continued collaboration is critical to sustain gains for polio and routine immunisation for healthy children and families in Ethiopia.

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World Polio Day 2014 commemorated in Ethiopia

By Shalini Rozario

On 24 October 2014, UNICEF, WHO, Rotary International and Federal Ministry of Health (FMOH) gathered to commemorate World Polio Day, which also coincided with United Nations Day. In a Joint Statement issued by WHO, UNICEF and Rotary, the partners appreciated frontline workers in the fight against polio and called for sustained support for eradication efforts.

World Polio Day celebrated in Addis Ababa Ethiopia in the premises of the UNECA compound.
World Polio Day celebrated in Addis Ababa Ethiopia ©UNICEF Ethiopia/2014/Ayene

The World Polio day commemoration commenced with a moment of silence for the late Past District Governor (PDG) Nahu Senaye Araya, President of the Rotary National Polio Plus Committee. Ato Araya’s family, in attendance, was presented with a certificate of appreciation by WHO, UNICEF and Rotary for his years of dedicated service to the polio programme.

Dr. Pierre Mpele-Kilebou, WHO Representative to Ethiopia, stated in his welcoming remarks, “Today is a reminder of our duty to make sure that no more children are paralyzed by the disease that can be prevented with a simple, easy to administer vaccine.” The screening of two short videos, Help #EndPolio Forever and Curbing the polio spread through nation wide immunisation campaign, followed his welcoming remarks.

Patrizia DiGiovanni, Acting Representative to UNICEF Ethiopia commended the contribution of partners in her key note address and emphasized the gains being made to reach all children with the polio vaccine and improved child survival interventions. “As the World Polio Day coincides with UN Day, we place our efforts within the broader context, as we work to uphold a child’s right to health as a basic human right for all. With the deadline fast approaching for measuring progress against achievement of the MDGs, our minds turn to the Ethiopia’s remarkable achievement of reaching MDG4. I believe, if we had the ability to achieve this goal three years ahead of schedule, we can certainly work together to ensure all eligible children are fully immunized by their first birthday.”

PDG Tadesse Alemu speaks at the World Polio Day
PDG Tadesse Alemu speaks at the World Polio Day commoration in Addis Ababa, Ethiopia ©UNICEF Ethiopia/2014/Ayene

On a keynote address by PDG Dr. Tadesse Alemu, who recalled the commitment and dedication of PDG Nahu Senaye Araya, said “Swift and unprecedented changes in the world has impacted efforts of polio eradication. We must have strong push to end polio now. Dr. Taye Tolera, Special Advisor to the State Minister of Health, Federal Democratic Republic of Ethiopia, delivered remarks from the Ministry of Health. He stated, “This joint commemoration clearly shows that all partners and allies have maintained the stamina in the commitment and support to the Expanded Programme on Immunization and the Polio Eradication Initiative.” He called for continued commitment: “We all should be proud of our shared achievements. But, we should continue the journey until this highly interconnected world we all share is free of polio before 2018.”

As part of the World Polio Day events, Rotary International announced earlier in the week a US$44.7 million grant to fight polio in Africa, Asia and the Middle East on 21st October this year with Ethiopia to receive US$ 2 million for polio eradication efforts in the country.

Read the press release by UNICEF here.