Worst Yet to Come
Malitu took her one year baby, Asnaku, to Derara Gorbie Health Post, where she was immediately admitted to an outpatient therapeutic programme, at the beginning of May.
Concluding his two-day visit to Ethiopia in mid-May 2012, John Ging, a United Nations humanitarian official, had kind words and rare praise for the administration of Prime Minister Meles Zenawi. He admired the administration’s efforts in mitigating the impact of drought, comparing Ethiopia with the rest of the Horn of Africa. Ging even recommended the country’s experience in humanitarian emergency response beyond the region, for the drought ridden Sahel area.
Nonetheless, a reading between the lines of his rather gracious remarks reveals deep concern over impending humanitarian crises, particularly in the southern part of Ethiopia. The operations director of the Office for the Coordination of Humanitarian Affairs (OCHA), a UN agency responsible for assessment of and response to natural disasters, is not looking at the rosy side of what largely is recognised as Ethiopia’s ability to withstand drought.
Ging’s concern seems to have grown after his visit to Boricha Wereda, Sidama Zone, Southern Nations Regional State, where he witnessed a firsthand account of the treatment of malnourished children at therapeutic feeding centres. He talked to mothers who were unable to feed their children, particularly after the belg (short) rains failed, thus leading to two-thirds of the sweet potato harvest collapsing.
Boricha, 30km south of Hawassa (Awassa), seat of the Southern Nations’ administration, led by Shiferaw Shegute, falls in the Sidama Maize Belt. Once considered a food secure and lightly populated area, Boricha has come to be an object of grave concern whenever the issue of child malnourishment is raised, since 2003, the year when Ethiopia saw the largest ever (15 million) number of its citizens go hungry.
Indeed, Boricha is one of the 59 hotspot weredas of food shortage in Southern Nations, according to the administration’s own admission.
Not without a reason, though. Farmers in the area are heavily dependent on the belg season, which begins in February, to grow maize planted once a year, as well as drought-resistant produce, such as sweet potato and enset (false banana).
Rain during this season is indispensable, but it came two months late, this year. This led to an increase in the number of cases of malnourished children.
“It is heartbreaking to see children so acutely malnourished,” Ging said after visiting a health centre at Yirba, the seat of the Boricha Wereda Administration, 305km south of Addis Abeba. “Their immediate suffering and the long-term damage to their learning abilities leaves us all in agreement that more must be done to protect and prevent children from ending up in these centres.”
He may have referred to children such as Asnaku Hengiso, a one year-old, whose parents are residents in Derara Gorbie Kebele, Boricha Wereda.
Three weeks ago, Asnaku was admitted to a health centre in Yirba, one of the two medical facilities in Boricha that have a stabilisation centre for children diagnosed with severely acute malnutrition (SAM). Upon admission, Asnaku had difficulty breathing, while she was crying, rather continuously. Having low weight for her height, she had visible severe wasting and swollen feet due to tissue retention of water, symptoms typical of a SAM patient as defined by the World Health Organisation (WHO).
Thirty nine children registered at Yirba Health Centre suffering from SAM in April 2012. With the number growing quickly since February, none of the cases involved an alarming stage, except for the death of a child reported in May.
A week after Ging’s visit, 17 children with SAM and their mothers were packed in two small rooms at the health centre in Yirba, where two dogs were seen lying by the door of one of them. The rooms’ floors were largely devoted to scattered mattresses. A number of sky-blue mosquito nets were hanging from the ceilings. Computer print on white papers, were glued to the doors as signs stating that these rooms were designated as stabilisation centres.
Nurses assigned to this stabilisation centre made regular visits to the rooms, with their faces hardly showing sense of urgency, if any. They treated the children with a business as usual attitude. Diagnosing similar cases for the last four years, they seemed to be accustomed to the severity of the malnourishment and its attached medical complications. Comparing it with last year, for instance, when their monthly registered SAM cases went as high as 43, they might have felt at ease with the current statistics.
Aid agencies, however, are alarmed with the current development, and their outlook for the future is grim. The December to March rainfall in the region was poor and critically affected the February to May harvest of sweet potatoes, a critical lean season for food, show reports, such as from the World Food Programme (WFP).
The below average rainfall pattern, combined with the late start and poor rain of the belg season, remained from mid-February to May, affecting the food security prospects of the region. The Southern Nations, known for previous years’ high level of chronic food insecurity and high population density, is the most affected area, aid workers say.
“In Southern Nations, the food security and nutritional situation has continued to deteriorate in many areas, and the admission rate of malnourished children into treatment centres is high,” Judith Schuler, public information officer at the WFP, told Fortune, via email.
A joint screening conducted by the regional government and the UN Children’s Fund (UNICEF) on close to half a million children showed that 13,935 of them were severely malnourished. The number of moderately malnourished children was found to be four times larger.
Asnaku’s mother, Malitu, 35, took one of her four children to the centre at the beginning of May, where Asnaku was immediately admitted to outpatient therapeutic programmes (OTP).
Children are admitted to OTP when the measurement of their arm’s circumference is below 11cm and they have at least one sign of oedema. After Asnaku was registered for OTP, Malitu was handed Plumpy’nut, a peanut based ready-to-use therapeutic food, to feed her baby.
“I do not have any capacity to get the type of food my baby needs,” Malitu told Fortune on May 23. “We finished the sweet potato and maize in our stock. We all eat enset, now, as we could not plant another [crop] because there was no rain.”
Sweet potato and other root crops are items that are used during times of hardship in Southern Nations. Coupled with enset, this produce is consumed as a coping mechanism whenever drought hits the area. In recent years, such resilience mechanisms are becoming precarious. This year alone, the sweet potato-growing areas of Southern Nations experienced an 80pc to 100pc failure of the harvest, according to the OCHA’s report, released on May 7.
The failure of this produce is attributed to the late arrival of the belg rains.
The weather turning its back on farmers in this region bothers Hasamo Ayamo, a farmer and fellow villager of Malitu. He plants maize, enset, and sweet potato during the belg season, every year. After a delay of about two months, rain started to fall in his area in April. To his dismay, he was not able to even plant sweet potato, which he claimed would give a harvest after three months.
“We mostly save the sweet potato for our children,” Hasamo told Fortune, chatting with a fellow farmer, who helped him in the interpretation of his modest Amharic. “But, we do not have any this year. The children are in trouble.”
Like Malitu, Hassamo took his daughter to Derara Gorbie Health Post, where the local population goes for any health-related emergency. The centre has three tiny rooms each covered with a roof of corrugated sheet metal, a bare ceiling, and a cement floor. Tables and chairs, a water tanker, cartons for Plumpy’nut, and small plastic bottles filled with water purification solution are the main properties of the Health Post.
The wall of the Health Post was covered with health statistics, charts, and graphs. There was enough information to prepare a mini-demographic health survey. From the data on the population size of the kebele, which was classified by gender and age, to the main cause of morbidity, all was written on large white papers. Even the monthly report of OTP admissions and discharges was openly posted on the walls.
Like other health posts in Boricha, one of the rooms in Derara Gorbie is dedicated to measuring the weight of children. All of the health posts use local makeshift weighing scales. They tie a fibre rope to the ceiling, attach it to a weighing device with a hook on two sides, and, then, pass it through holes in a plastic washtub. Any children admitted for OTP must lie in the washtub for weight checkups.
John Ging, a United Nations humanitarian official, said the top quotation after visiting a health center at Yirba, the seat of Boricha Wereda administration, 305Km south of Addis Abeba.
Desta Geberemichael, one of the two health extension workers in charge of Derara Gorbie Health Post, checked the weight on the makeshift weighing scale. After the weekly checkups on May 23, Hassamo’s daughter was found in a much better position compared to Asnaku. The extension worker referred Asnaku to a stabilisation centre at Yirba, after seeing her unimproved swollen feet and symptoms of diarrhoea and vomiting.
After Asnaku’s transfer, the number of registered children with moderately acute malnourishment at this post decreased to seven. For a kebele with 938 children under the age of five, the number of malnourished children appears to be hardly alarming. But, the devil is in details.
A significant number of children are out there with a critical food shortage problem, although they do not qualify for OTP, due to the admission criteria, according to Desta. Around 100 children have this problem, she estimated. The number may alarmingly increase if they do not receive food aid in time, she feared.
“The people eat now what they have stored,” says Desta, whose job gives her access to almost each household in the wereda. “[But,] they are left with no more food in their households.”
Indeed, although modest, help from the regional administration and NGOs is available in this wereda. Malitu and her four children survive on the 280 Br the family gets from a safety-net programme. It is a federal programme designed by the government, after the drought of 2003, to help drought-exposed farmers receive aid in kind or cash in exchange for community work. Heavily supported by donors, the federal government spends two billion Birr a year in order to support no less than 7.6 million people across the country.
Malitu has a husband who is bedridden. She cannot even prepare his land for planting. Thus, her survival depends on food aid. Facing high grain prices in the market, she prefers aid in kind rather than the six Birr daily wage she gets through community works.
Unlike her, Hassamo has better prospects, he believes.
The haricot bean he planted alongside maize when the late rain started to pour in April is his only hope up until the next main harvest comes in September. In the meantime, his family uses the haricot bean, harvested three months after planting, as a means of survival. Nonetheless, he will certainly face a food shortage. In the absence of swift intervention, such situations are bound to lead to worst-case scenarios, early warning reports caution.
“In the absence of timely and sufficient humanitarian responses, crisis or emergency-level food insecurity is possible between April and June,” warns a food security alert released in April by Famine Early Warning Systems Network (FEWS-NET).
The WFP’s public information officer conquers with this view.
AREAS WITH CRITICAL FOOD SHORTAGE
The shaded part of the map, mostly covering the eastern and southern part of the country, is where food insecurity level is forecasted to reach to crisis between April and June, according to a report of the USAID funded Famine Early Warning Systems Network (FEWS NET). The exclamation mark represents hot spot areas, where the situation would likely to be worse without current or programmed humanitarian assistance.
“With little or no production of sweet potato or other belg crops in March or April, the period since March has been quite stressful for many households,” she said.
Around 3.2 million people continue to require emergency food assistance by this month, estimated the government’s Humanitarian Requirements Document for National Needs, launched in January 2012. Of those, 97,830 are located in Southern Nations. The number of malnourished children and pregnant and lactating mothers has reached 204,400, a recent joint Southern Nations and UNICEF screening revealed.
There is, unfortunately, too much of politicking in such estimations. It is compounded by a mutual suspicion of authorities, both at the federal and regional government levels, and their counterparts in the aid community, including NGOs operating on the ground. The first accuse is that the aid community has a vested interest in exaggerating the size of people in need of humanitarian assistance in order to raise funds overseas.
“They often feel that this jeopardises the country’s positive image on the world stage,” said a foreign aid worker with several years of experience in Ethiopia.
Members of the aid community point their fingers at the regional administrators for being in competition with their counterparts in other regional states for having the lowest number of people estimated to be in need of food aid. The higher this number, the more they feel they are subjected to reprimand by party bosses at the federal level.
This was considered to be what happened early this year when the size of the population that aid agencies had projected to be potentially affected, 297,000, was much higher than what the regional authorities had forecasted at 92,000, according to diplomatic sources.
However, the federal government will soon conduct an assessment to find out the exact number of people affected, Mitiku Kassa, state minister for Agriculture, told Fortune. Citing similar incidents in previous years, Mitiku categorised the current situation as rather “normal.”
“It is under control,” he told Fortune.
Indeed, Fortune learnt that the regional authorities have added just last week 41,000 people in the list of those in need of humanitarian assistance.
Ironically, determining the exact number of the needy is a controversy that is a tip of the iceberg. A major, yet unresolved, debate is in agreeing on who deserves to be provided humanitarian aid. While the donor community strongly insist that surveys ought to be conducted taking all those on “livelihood threshold,” those in the federal and regional governments are determined in keeping it employing the counting on “survival threshold,” a senior international aid operative told Fortune.
He estimates that the number of those at the risk of food insecurity in the south would have increased to 600,000, had the counting was conducting identifying those under "livelihood threshold." These are people who are not immediately starved but with the risk of sliding back to hunger after selling the little assets they have in the household.
Despite such divergence of views on who should be eligible for food aid, the government’s food assistance, which has reached a third round, is still based on January’s estimation on “survival threshold.” It is distributing food aid for those who are affected by the late belg rains, according to Mitiku, who is also the head of the Disaster Risk Management & Food Security Sector (DRMFSS).
A federal agency that is in charge of providing relief assistance across the country, DRMFSS coordinates its operation jointly with the WFP and an NGO consortium. For a third round, it has allocated around 50,000tn of commodities to be distributed to 3.2 million people, and the dispatch had reached 60pc by May 22, according to the OCHA’s weekly humanitarian bulletin. The relief food assistance contains 15kg of cereal, 1.5kg of pulses, and 0.45kg edible oil a person. For malnourished children under five and pregnant and lactating mothers, the WFP provided an additional 4.5kg of corn soya blend (CSB) food.
To avoid delays in purchases and shipments of additional stock, aid agencies look at the arrangement of a loan from the Emergency Food Security Reserve (EFSRA). OCHA’s report revealed that approximately 85,000tn of stock was at hand as of May 21.
Unlike the state minister, officials in charge of the emergency response in Southern Nations were unwilling to discuss their work with reporters. They were very uncomfortable with discussing issues related to food shortages in the areas known to be most affected. Indeed, child malnourishment is one of the sensitive issues that experts, regional office employees, and low-level of administrators avoid openly discussing. They sometimes even go as far as denying the existence of the problem, showing the tension between them and federal authorities.
“We do not have a rainfall or any other problem in our area,” Tilahun Amelo, early warning response and food security work process coordinator in Sidama Zone, told Fortune with fury, in a telephone interview.
Beyene Petros (Prof), a veteran opposition leader who came from Hadiya, one of the hotspot areas of drought in Southern Nations, gets calls from his party apparatus operating on the ground, which has alerted him of the alarming developments.
“The current population density has surpassed the carrying capacity of the land,” Beyene told Fortune, speaking of the real source of the problem.
The irregularity of rainfall also happened during his childhood, he claimed. However, what has changed, now, is the deterioration of farmers’ coping ability.
There is also apprehension among regional authorities when requested for permission to visit the therapeutic feeding centres. Those on the ground often demand letters of permission issued from zone, wereda, regional, and sometimes federal level.
In the absence of such a letter, it was not possible, three weeks ago, to visit a hospital in Yirgalem, one of the 19 weredas in Sidama Zone, where severe malnourished children with medical complications in the Zone are admitted.
Admasu Arsicha, general manager of the hospital, denied access to this newspaper, which failed to get permission from one of the officials at the Zone’s administration, despite several attempts.
The situation in Hawassa was not different. Officials at the Region’s bureaus were reluctant to talk about the impending humanitarian crises in the Regional State, and chose to point to the “right person” to talk to. There was hardly any response to questions, though.
By Tesfalem Waldyes,
special to Fortune.