Monthly FSAU Food Security Analysis Unit - NUTRITION UPDATE

JANUARY 2005

OVERVIEW

This month we highlight the situation in Sool and Sanaag where part of the population has experienced some recovery and those in more insecure areas have yet to receive the urgent assistance on which their lives depend.

An overview of the effect of the Tsunami on coastline populations is provided along with reports which highlight the chronic serious food insecurity affecting the lives of populations in Juba Valley and Galgadud Region. In this issue of ‘Nutrition Update’; Sool and Sanaag update 1 Preliminary results of a nutrition survey in District indicate a level Juba Valley Update 2 which falls within the rates now typically seen in Southern Somalia – levels Baidoa survey preliminary results 3 that indicate very poor nutritional status of the population. Civil insecurity Rapid assessment in Galgadud 4 continues to affect the district causing displacement, disruption of market Tsunami highlight 4 activities and destruction of harvest.

SOOL AND SANAAG HIGHEST LEVELS OF MALNUTRITION IN MOST INSECURE AREAS

A recent round of FSAU surveillance activities has indicated very high levels of malnutrition in Lower Nugal Valley and an improvement in the nutritional status of the populations in the Sool Plateau.

Between 20th and 29th November 2004 the fourth round of sentinel sites surveillance was undertaken covering nine sites located in the highly vulnerable areas of Sool Plateau and Lower Nugal valley livelihood zones.1 Both qualitative and quantitative data were collected from randomly selected households in each site. A minimum of 50 under-five children were targeted and assessed in each site.

A total of 534 children aged 6 - 59 months were assessed. The global acute malnutrition level (W/H <-2Z scores or oedema) within Lower Nugal valley was 33.9% (28.2 – 40.1) and severe acute malnutrition level (W/H <-3Zscores or oedema) 6.6% (CI: 3.9 - 10.3). In Sool Plateau, the global acute malnutrition level was 12% (CI: 8.4 – 16.4) and the severe 3.3% (CI: 1.5 – 6.1). Two oedema cases were observed.

The predominantly pastoral population has experienced three years of drought that has resulted in significant loss of animals, assets, high indebtedness, destitution, rangeland degradation and heavy reliance on external aid for a food source. Strong social support and humanitarian interventions have sustained the lives and livelihoods of many households while the good 2004 Deyr rains received in both livelihood zones will contribute to a slow but steady recovery for households with livestock. Households that lost all livestock and are now destitute continue to face a bleak future.

1 FSAU in collaboration with MOHL Somaliland has undertaken three rounds of sentinel sites surveillance (December 2003, February 2004 and April 2004) covering mainly the Sool Plateau livelihood zone. Following a review of the sites covered, six previously selected (Shimbiraale, Balibusle, Hingalool, Awrboogeys, Sarmanyo and Godaalo) and three newly identified sites (Carroley, Huddun and Boame) were purposively selected for the fourth round of data collection.

The FSAU is managed by FAO. The Nutrition Surveillance Project is funded by USAID/OFDA and receives support from the EC SURVEILLANCE PROJECT PARTNERS INCLUDE MOHL SOMALILAND, MOSA PUNTLAND, FAO, UNICEF, WHO, SRCS/ICRC, SCRS/IFRC, WVI, HEALTH CONSORTIUM, IMC, MSF-S, COSV, AAH, MUSLIM AID-UK, INTERSOS, CISP, ZAMZAM FOUNDATION, COMMUNITIES OF WABERI, HAMARWEIN AND HAMAR JABJAB, IRC, ACF, COOPI, MSF-H, MSF-B. FSAU Monthly Nutrition Update January 2005

As reflected on the charts, all sites in Sool Plateau reported global acute malnutrition rates below 16.5% while those in Lower Nugal Valley reported above 23%. Compared to past rounds of sentinel sites surveillance, malnutrition levels within Sool Plateau were gradually decreasing with the exception of Hingalool and Awrbogeys. In Lower Nugal Valley, only one site was covered in past rounds of Sentinel Site Surveillance and a gradual deterioration in the nutritional status was observed there.

The reported prevalences of communicable diseases were as follows: Lower Nugal valley sites; diarrhoea 17%, measles 18%, ARI 32% and malaria 1%. Sool Plateau; diarrhoea 11%, measles 0%, ARI 12% and malaria 2%. Diarrhoea and measles had a Malnutrition levels w ithin Sites in Low er statistically significant association with children’s nutritional status Nugal Valley Livelihood Zone 45 and prevalences The majority of the 47 cases of measles were Dec -03 Feb-04 Apr-04 Nov -04 reported in Carooley (57.4%) and Huddun (38.3%). 40 35 30 Malnutrition levels in Sites w ithin Sool 25 Plateau Livelihood Zone 20 Percent 35 15 Dec-03 Feb-04 Apr-04 Nov -04 30 10 25 5 0 20 Godaalo Carroley Huddun Boame 15 Percent 10 5 Adult nutritional status was assessed among 534 women 0 Shimbilale Hingalool A rwbogays Sarmanyo Balibusle aged between 15 and 49 years using mid upper arm circumference (MUAC). In Sool Plateau, 5.4% of the women were malnourished2, a significant decline since April 2004. In Lower Nugal Valley, about 10% of the women were malnourished. The majority (75.6%) of the malnourished women were pregnant.

In Sool plateau, the under-five mortality and crude mortality rates were 0.9/10000/day and 0.2/10000/day respectively; lower than those observed in previous rounds. Within Lower Nugal Valley the under-five and crude mortality rates were 6.5/10000/day and 1.78/10000/day.

Most households were applying extreme coping mechanisms and consumption of micronutrients rich foods was minimal with the Lower Nugal Valley population having a less diverse diet. The level of destitution has increased in both livelihood zones. Insecurity has impacted significantly on humanitarian activities. Access in Sool Plateau for food and non-food interventions has been much easier than in Lower Nugal valley. Even with the good 2004 Deyr season, recovery will be slow due to the significant loss in livelihood assets. Humanitarian assistance remains vital at least for the next three to six months and longer among the destitute population. Improved humanitarian access to these populations is a priority.

JUBA VALLEY UPDATE

The Juba Valley has experienced periodic civil insecurity and food insecurity in the past three years although the impact on both the pastoral and agro pastoral Malnutrition rate Vs attendance at Bulo Haji MCH, 2004 livelihoods has not been very significant due to their access to diverse livelihood 300 14 sources and strong social support network. 250 12 10 The 2004 Hagar rains and the above normal Deyr 2004/2005 rains have improved 200 the food security and nutrition situation in the pastoral and agro pastoral 8 150 livelihoods as shown in this graph from Bulo Haji MCH (an agro pastoral area 6 100 west of Kismayo town). Kudha MCH which serves a predominantly fishing Attendance 4 community with mixed pastoral livelihood along side Indian Ocean also showed 50 2 Rate M alnutrition relatively low malnutrition rates of less than 5% (W/H<-2 z score or oedema). 0 0

h il y e ly r ry y a st e er er Both pastoral and agro-pastoral households reported increased consumptions of r arc Apr M J un Ju be nua M ob Ja brua Augu Oct vemb milk and milk products, particularly ghee, during the Deyr 2004/05 period. F e o Children below five years of age received milk at least three times per day and no Septem N Decemb Attendance Malnutrition Rate major outbreaks of communicable diseases have been reported.

2 MUAC <23 cm among pregnant women; <18.5 cm among lactating mothers as well as those neither pregnant nor lactating 2 FSAU Monthly Nutrition Update January 2005

On the other hand, the Juba riverine Bantu community of district remain a vulnerable population due to chronic food insecurity, lack of access to safe water, poor sanitation, poor health services, weak social support network as well as poor social and care environment for women and children. In the Marere Therapeutic Feeding Centre, managed by MSF-Holland, the cases of admission remain high, with a monthly admission of about 140 children. The ongoing interventions (feeding programs and health care services) are necessary for continuing recovery for the Bantu community. In the first week of January 2005, an estimated 300 Mt of food from WFP, consisting of maize, lentils and vegetable oil was delivered to the Marere feeding programmes for distribution. Insecurity continues to delay and interrupt relief efforts.

BAIDOA NUTRITION SURVEY – PRELIMINARY RESULTS

Baidoa district is located in Bay Region of Southern Somalia and has an estimated population of 202,000 (WHO, 2004). The district covers vast high potential sorghum production areas as well as pasturelands which support agro-pastoral livelihoods. Since July 2002, serious civil insecurity has been encountered, thus interrupting livelihoods and humanitarian operations. Population displacement (e.g. displacement of families in January 2004 to Wajiid) and destruction of underground food stores (in mid 2002 and late 2004) have been experienced. Constant interruptions of humanitarian activities have resulted. IMC, SRCS and DMO with support from UNICEF have been operating health facilities in the district. World Vision sponsors agricultural and education programmes since 2001.

Past nutrition surveys conducted within the showed high Bay- Agro-Pastoral High potential sorghum 3 South-East Pastoral: Cattle, sheep & goats levels of malnutrition and health facility based surveillance data indicate Southern Agro-Pastoral: Camel, cattle, sorghum Southern inland pastoral: Camel, sheep & goats poor nutrition situation. Relatively high monthly admissions in the DMO Regional Boundary District Boundary managed supplementary feeding programme are regularly recorded. Major Road Secondary Road UNICEF in collaboration with IMC, SRCS, FSAU and DMO conducted a nutrition survey in October 2004 in Baidoa District to establish the nutrition situation as well as document the factors influencing nutrition situation in Baidoa. A two stage cluster sampling methodology was used in the random selection of the 901 children from 486 children surveyed. Preliminary results show a global acute malnutrition rate (w/h<-2 z score or oedema) of 16.3% and severe acute malnutrition rate (W/H<-3 z score or oedema) of 2.9%. The results are not significantly different from the July 2000 results (GAM of Indicator No. % 17%). The malnutrition rates indicate a critical Children aged 6-59 months surveyed 901 100 nutrition situation according to the WHO Number of households surveyed 486 100 categorisation but are within the range usually Global acute malnutrition (W/H<-2 z score or oedema) 147 16.3 recorded in Southern Somalia. Severe acute malnutrition (W/H<-3 z score or oedema) 26 2.9 Children with diarrhoea, 2 weeks prior to survey 153 17 As shown here, morbidity levels were relatively Children with ARI , 2 weeks prior to survey 169 19 high and the immunisation coverage (41%) and Children with malaria, 2 weeks prior to survey 149 16.5 Vitamin A supplementation (45%) were Children with measles, 1 month prior to survey 33 3.7 relatively low. Currently, the immunisation Vitamin A supplementation, 6 months prior to survey 402 44.6 activities are undertaken in the health facilities, Immunised against measles (n=821) 335 41 which are mainly located in Baidoa town. This Children fed 3 or more times a day 410 46 reduces access for the Baidoa rural population. Households accessing medical services (N=486) 275 56.6 Households not accessing toilet (N=486) 165 34 Further results indicate that crop production (48%) and purchasing (26%) were the main means of securing food while sale of crop (32%) and casual labour (27%) are the main sources of income among the Baidoa town.

The past four cropping seasons have been good compared to the post war average, with the sorghum production being good. However, insecurity has hindered the transportation of crops to fetch better market value outside the Bay region. Baidoa town was a major business hub linking Mogadishu with Bakool and Gedo regions before these recent insecurity.

Analysis of the results is ongoing.

3 Baidoa town nutrition survey in August 1999 indicated a global acute malnutrition rate of 21.6% and the Baidoa district nutrition survey conducted in July 2000 recoded a global acute malnutrition rate of 17%. 3 FSAU Monthly Nutrition Update January 2005

RAPID NUTRITION ASSESSMENT IN GALGADUD VILLAGES

A rapid nutrition assessment was conducted between 28th November and 8th December 2004 in Abudwaaq, Haraale and Balanbale villages of Galgadud Region. The region has been experiencing one of the worst humanitarian crises in over a decade due to effects of drought, civil insecurity, deteriorating terms of trade and environmental degradation. A nutrition survey in September 2004 showed levels of malnutrition in the area were very significantly above the usual.

A total of 327 children aged 12-59 months were assessed using measurement of Mid Upper Arm Circumference (MUAC). The table below indicates malnutrition levels (MUAC < 12.5cm or oedema) of 19.5% and 24% in Haraale and Balanbale respectively and 12% in Abudwaaq. Area Oedema <11 cm <12.5 cm >-12.5-< 13.5cm > 13.5 cm Total Abudwaaq 0 4(1.7%) 24(10.4%) 47(20.3%) 156(67.5%) 231 Many children and women Haraale 0 0 9(19.5%) 15(32.6%) 22(47.8%) 46 have moved from Haraale to eastern Dhusamareeb Balanbale 1(2%) 0 11(22%) 16(32%) 19(38%) 50 and Adaado districts as IDPs. Poor water quality remains a serious problem thus increasing susceptibility to diarrhoeal diseases particularly among children. The main water source in Haraale is open baleys (natural seasonal water catchments) while open shallow wells and boreholes are the main sources in Abudwaaq and Balanbale. Haraale, and Balanbale are located about 40-80 Km from the nearest functioning health facility. Although the Deyr 2004/5 rains has improved pasture and water, recovery of livelihoods and population wellbeing remains uncertain while insecurity continues. Analysis of the assessment results is ongoing.

TSUNAMI EFFECT ON THE SOMALIA COASTLINE

a On 26th December 2004, the devastating effects of the tsunami were felt Alul

K in many parts of South East Asia, and spilled over to the Somalia

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d aso a coastline. The worst affected area in the Somalia coastline is a stretch of s l o a B around 650 km between (Bari region) and Gara’ad ( region) Iskushuban i in the northeast Somalia. The extent of the impact varied along the entire r a B Somalia coastline, including areas in the South. An estimated 150-300

a l Gardo i lives were lost in addition to widespread damage to infrastructure, water e B

r e sources, and materials for the fisheries livelihood that dominates the d n e B affected areas. we ro Ga Indian al Ocean Nug An appeal for assistance for Somalia was raised through the Humanitarian Eyl Burtinle Coordinator’s Office in early January 2005 and a task force, under the Jariban Humanitarian Response Group of the Somalia Aid Coordination Body Galkayo LEGEND Area most-affected (SACB), formed to follow up the humanitarian assistance delivery as well by the Dec. 2004 Tsunami as in-depth impact analysis. Immediate following the tsunami, rapid Mudug Coastline assessment teams analyzed the impacts from ground and air. Hobyo Regional Boundary Humanitarian assistance has been ongoing since the disaster struck District Boundary despite difficult security and infrastructural conditions. UNICEF has provided non food items like blankets, jerry cans, plastic sheeting, cooking utensils, mosquito net and soaps; has intervened in the water and 025 50 100 150 200

Kilometers Produced: January 2005 1 cm equals 33 kilometers sanitation sector (rehabilitation of wells) and has undertaken measles vaccination and vitamin A supplementation in the affected population. Food distribution by WFP has been ongoing since the disaster struck. UNHCR is also providing non food items (blankets, mattresses, household goods and plastic sheets) towards shelter rehabilitation while WHO has provided medical kits to Hafun and Bender Beyla residents. CARE-Somalia is providing free cash to enhance the affected population’s purchasing power. Other humanitarian agencies are planning to deliver diverse relief assistance to the affected coastline population.

The SACB Humanitarian Response Group requested UN-OCHA and FSAU to coordinate an interagency, multi-sectoral assessment to develop a comprehensive and consensual understanding of any remaining gaps in the humanitarian response, and, especially, to identify needs for livelihood recovery in the affected areas. The field work will begin on Jan 29th, with mission findings available by mid-February.

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