Horn of Africa Crisis

Horn of Africa crisis

August 2011 update

Health situation overview reported to be 30% and 18% respectively. In Ethiopia’s Kobe camp, crude mortality and under- The Horn of Africa crisis is putting close to five mortality averaged 4.5 and 15.4/10 000 per 13 million people in need of humanitarian day respectively between 24 June and 26 August. assistance. Of these, 4.8 million reside in A greater proportion of medical complications is Ethiopia, 3.7 million in Somalia, 3.7 million in to be expected among children suffering from Kenya, 600 000 in Uganda and 165 000 in malnutrition, as they will be more susceptible to Djibouti. In Somalia, drought and conflict have infection and communicable diseases. displaced around 1.5 million people within the country and forced up to 420 000 people to seek Global acute malnutrition (GAM) / Severe acute help in Kenya and Ethiopia. In July, daily arrivals malnutrition (SAM) in each country ranged from 1300 to 1700. The majority are women and children. An emergency is considered critical when more than 15% of children are classified as suffering from global acute malnutrition (i.e. a weight in proportion to height High levels of malnutrition less than -2 standard deviations of the WHO Growth Standards). A famine is declared if: On 20 July, the United Nations declared famine in at least 20% of households face extreme food Somalia’s Bakool and Lower Shabelle Regions. shortages with limited ability to cope, On 3 August, the declaration was revised to GAM prevalence exceeds 30%, and include Balcad and Cadale Districts in Middle crude death rates exceed 2/10 000 per day. Shabelle and internally displaced populations in Severe acute malnutrition , defined by a weight in pro- the Afgoye Corridor and in Mogadishu. In these portion to height less than -3 standard deviations of the areas, rates of global acute malnutrition (GAM) WHO Growth Standards, is a life threatening condition are reaching 50%, and death rates among children requiring urgent treatment. Children suffering from under five exceed 6/10 000 per day. SAM have a 5–20 times higher risk of death compared to well-nourished children. SAM can be a direct cause GAM rates of 47% and severe acute malnutrition of child death, or it can act as an indirect cause by dra- (SAM) rates of 35% are reported among Somali matically increasing the case fatality rate in children refugees in Ethiopia’s Dolo Ado camps, while in suffering from such common childhood illnesses as Kenya’s Dadaab camps, GAM and SAM rates are diarrhoea and pneumonia.

1 Malnutrition increases not only the risk of Coming on top of large-scale population contracting infectious diseases, but also disease movements, poor sanitation and severe severity and therefore the risk of death. This, malnutrition, the rainy season and its resultant along with poor health and immunization status in flooding is also expected to increase the risk of drought-affected areas (30% DTP3 coverage in outbreaks of diarrhoeal diseases. Somalia), limited access to food, water, shelter As of 2 September, 5526 acute watery diarrhoea / and sanitation, overcrowding in camps and the cholera cases and 232 related deaths have been stress of displacement, put affected populations at reported from Banadir Hospital in Mogadishu. high risk of contracting – and subsequently dying Children under the age of two bear the greatest from – infectious diseases. Concurrently, burden of AWD accounting for 49% of all re- infectious diseases can also exacerbate ported cases and 47% of all reported deaths. Lo- malnutrition. calized acute watery diarrhoea outbreaks are also This destructive cycle can be broken with reported in Ethiopia’s Southern Nations, Nation- appropriate nutritional support and medical alities, and Peoples (SNNP) and Amhara Regions. treatment, improved access to food, water, shelter and health care services and timely detection and Other health concerns control of outbreaks. Most of the internally displaced are women and Host communities in Kenya and Ethiopia are also children. affected and are in acute need of basic services including health care. Health systems in affected areas are weak and all too often do not offer minimal services for child

and reproductive health, much less services for High risks of infectious diseases emergency obstetric care, pre- and postnatal care, Across the region, the areas most affected by the safe blood transfusion, prevention and drought are those with the highest disease burden management of sexually transmitted infections (diarrhoea diseases, measles, malaria, meningitis) and sexual violence. and the weakest health care systems. Epidemic diseases, such as Rift Valley fever, typhoid fever and meningitis are also prevalent in these areas. Several measles outbreaks have already been reported throughout the region. In Ethiopia’s Dolo Ado camps, 291 measles and 18 related deaths had been reported as of end August. In Kenya, 790 confirmed measles cases were reported since January. Unfortunately, cross-border surveillance and response mechanisms to address regional health threats are not yet effective.

High risks of water and vector borne diseases The heavy downpours expected in some areas of the Horn of Africa during the upcoming rainy season (end-September to January) will likely trigger short periods of intense malaria transmission. The provision of medicines (artemisinin-based combination therapies) and supplies, such as long lasting insecticide treated nets and equipment for indoor residual spraying, to reinforce household protection is essential.

2 WHO’s response so far 1. Prevent and control communicable dis- In Nairobi, WHO has set up an intercountry, Horn eases , including through the strengthening of of Africa Support Team made up of four public early warning and response systems health experts to reinforce interregional and inter- (EWARN) for epidemic-prone diseases. country coordination and provide timely support to countries. The Team is now producing regional 2. Provide medicines, medical supplies and weekly epidemiological bulletins and situation technical assistance in order to support basic reports for partners. health care services for the affected population. WHO logisticians have been deployed to coordinate operations with the World Food Programme 3. Provide technical assistance for enhanced and the Logistics Cluster. Provided funds are management of medical complications of available, they will support the replenishment of severe acute malnutrition . stocks of medical supplies in affected areas for 4. Coordinate health response activities in the basic health care, surgery and emergency obstetric Horn of Africa, including at national and sub- care and response to outbreaks to treat about national levels, based on reliable morbidity 600 000 people. and mortality information. WHO’s response focuses on four main strategic objectives as advised to all health partners:

Ethiopia 2. Basic health care services WHO is using its existing supply chain networks 1. Prevention and control of communicable to distribute medical supplies in Ethiopia. WHO diseases has provided essential medicines and supplies to WHO has deployed emergency staff to Amhara, treat 670 000 people for three months across three Gambella, Oromia, SNNPR and Somali Regions countries including Ethiopia. and is using polio surveillance staff to collect data for the early warning and response system. 3. Management of severe acute malnutrition WHO recruited and deployed three staff to Dolo WHO provided technical and financial support to Ado refugee camps to provide technical support train 33 health professionals on the management to UNHCR and its partners. Specifically, WHO is of severe acute malnutrition in Ethiopia’s Oromia strengthening disease surveillance and response Region. The training was held in Adama and par- and supporting investigations on the measles out- ticipants came from 14 woredas in East Shoa, break. Bale, East Hararge and Guji zones. To reinforce acute watery diarrhoea prevention, 4. Support to coordination WHO prepositioned nine diarrhoeal diseases kits A health sector coordination mechanism is in in five regions and delivered another four to place under the leadership of the Ministry of UNHCR for the Dolo Ado camps. Each kit pro- Health and WHO. vides supplies for 100 severe acute watery diar- WHO Emergency Health Action (EHA) focal rhoea cases or 400 moderate cases. points in Ethiopia’s Regional Health Bureaus pro- In Amhara Region, where large numbers of pil- vide technical support to the Ministry of Health grims are attending the Tsedikane holy water site, and health partners. WHO also mobilized water treatment and sanita- Next steps until December 2011 tion supplies and set up a health centre to prevent • deploy additional staff to improve coordina- an acute watery diarrhoea outbreak. tion and disease surveillance/early warning WHO is working with health partners in support- in affected areas; ing the Ministry of Health to update the malaria • extend the measles immunization campaign emergency preparedness and response plan for ongoing in Somalia to drought-affected areas drought-affected areas and identify gaps. It should in Ethiopia for a target population of about be noted that, in addition, the country is short of 7.9 million children aged 6 months to 15 approximately 2.7 million long lasting insecticide years from local communities; treated nets to achieve universal coverage for • conduct two nationwide polio campaigns in household protection. September and October.

3 Djibouti countries including Kenya. Blood transfusion and trauma kits have been included to treat patients 1. Prevention and control of communicable needing surgical care. diseases The WHO and UNICEF offices in Kenya and WHO is supporting disease surveillance, early Somalia and the Kenyan Ministry of Health or- warning and response particularly for the ongoing ganized a campaign along the border with Soma- cholera outbreak. lia, in which 215 000 children under five received 2. Basic health care services measles and polio vaccination, as well as vitamin WHO is supporting two mobile clinics to ensure A and deworming tablets. the provision of health care and referral services 3. Management of severe acute malnutrition in remote areas. WHO conducted training on the management of 3. Management of severe acute malnutrition severe acute malnutrition in eight district hospitals WHO is supporting the management of SAM with and three provincial hospitals and disseminated medical complications in stabilization centres. technical guidelines. WHO also disseminated guidelines and conducted 4. Support to coordination training on the integrated management of acute A health sector coordination mechanism is in malnutrition. place under the leadership of the Ministry of WHO Emergency Health Action (EHA) focal Health and WHO. points provide technical support to the Ministry of WHO Emergency Health Action (EHA) focal Health and health partners. points are providing technical support to the Min- 4. Support to coordination istry of Health and health partners in Nairobi as A health sector coordination mechanism is in well as in the sub-offices in Garissa and Turkana. place under the leadership of the Ministry of A third one is planned in Marsabit. Health and WHO. To support the MoH, WHO has reactivated the health and nutrition sectors coordination forums at national and provincial levels as well as in a num- Kenya ber of the affected districts.

1. Prevention and control of communicable 5. Global Polio Eradication Initiative diseases Sub-national oral polio vaccine /measles cam- WHO distributed laboratory reagents to district paigns will be held mid-September in the north- hospitals and deployed six epidemiologists to east of Kenya, targeting 300 000 children. A new support coordination, strengthen disease surveil- wild poliovirus type 1 case has been confirmed in lance and assist provincial and district authorities Nyanza province (onset of paralysis on 30 July). to scale up emergency response efforts. An international response team is being deployed WHO is using polio surveillance officers to col- to support the Government in the case investiga- lect data for the early warning and response sys- tion and the development of an outbreak response tems. WHO is also producing weekly plan. epidemiological bulletins and situation reports for Next steps until December 2011 partners. • deploy additional staff to improve coordina- WHO and partners are working together with the tion and disease surveillance and early warn- Ministry of Health to identify needs and fill gaps ing in affected areas; ahead of the malaria transmission season. Some • preposition additional stocks of medicine and 470 000 high-risk internally displaced households laboratory reagents to ensure the timely de- will need to be protected through indoor residual tection and response to disease outbreaks; spraying. Rapid diagnostic tests, artemisinin- • extend the measles immunization campaign based combination therapies, intramuscular ar- ongoing in Somalia to drought-affected areas tesunate and insecticide-treated plastic sheets are in Kenya and include children aged 6 months needed. to 15 years from local communities; • organize two large-scale polio rapid outbreak 2. Basic health care services response campaigns (Short Interval Addi- WHO is using its existing supply chain networks tional Dose strategy) in Nyanza Province, to distribute medical supplies in Kenya. WHO has reaching more than 700 000 children; provided essential medicines and supplies to treat • conduct two sub-national polio campaigns in 670 000 people for three months across three October and November.

4 Somalia 3. Management of severe acute malnutrition WHO supported training on the management of 1. Prevention and control of communicable severe malnutrition in eight hospitals and the de- diseases velopment of a SAM treatment and care strategy In response to cholera, WHO trained health work- in coordination with nutrition partners. ers in affected areas on case detection and man- At the same time WHO is supporting referral and agement, supported cholera treatment units in treatment services for acute malnutrition in Banadir, Habeeb, Xarardheere and Baidoa hospi- mother and child health centres and hospitals and tals and, along with health partners, sent enough the provision of emergency obstetric care, blood essential supplies for 2000 severe cases or 8000 safety, and emergency surgical care services in moderate cases. To limit the spread of cholera, eight regions. diagnostic kits and water testing supplies were sent to health facilities. 4. Support to coordination In coordination with Health Cluster partners, WHO recruited a dedicated Health Cluster Coor- WHO is mapping existing capacities (supplies, dinator and opened sub-offices in Baidoa, Ga- trained health workers, available guidelines, etc.) rowe, Hargeisa and Mogadishu. for case management in hospitals and cholera As Health Cluster lead, WHO is organizing regu- treatment centres. WHO and Health Cluster part- lar meetings with partners in Nairobi and partici- ners are also working with the WASH Cluster to pating in inter-cluster meetings to foster an reinforce preventive measures and case manage- integrated, effective and timely response. ment and to train community health workers. Focal agencies have been identified in Banadir, WHO is using polio surveillance staff to collect Bakool, Galgaduud, Middle Shabelle, Puntland, data for the early warning and response system. and Somaliland to chair and coordinate sub- The 115 staff present in south central Somalia are national health clusters in collaboration with local also coordinating health interventions with part- health authorities. ners and managing supplies where access is a 5. Global Polio Eradication Initiative challenge. Additionally, efforts are ongoing to boost popula- Regarding malaria, WHO is preparing contin- tion immunity levels to polio and other vaccine- gency stockpiles to diagnose and treat both un- preventable diseases, to minimize the risk and complicated and severe malaria in addition to consequences of a re-infection. A first round routine stocks of artemisinin-based combination Child Health Days (CHD) campaign using triva- therapies and rapid diagnostic tests provided to lent oral polio vaccine (tOPV) was conducted in health facilities. Contingency plans for further Somaliland on 12–16 July and Puntland on 18–21 medical requirements are being made. WHO is July. “Staggered” CHDs started on 18 August in working to provide protection to 711 000 high- Banadir. risk internally displaced households either through indoor residual spraying or long-lasting Next steps until December 2011 insecticide treated bed nets where possible. • distribute long-lasting insecticide treated nets and conduct indoor residual spray campaigns 2. Basic health care services before the rainy season; WHO is using its existing supply chain networks • maintain malaria surveillance using the inte- to distribute medical supplies in Somalia. WHO grated disease surveillance and response sys- has provided essential medicines and supplies to tem; treat 670 000 people for three months across three • set up new health facilities in affected areas countries including Somalia. Blood transfusion and 13 mobile clinics; and trauma kits have been included to treat pa- • set up or reactivate 10 nutrition stabilization tients needing surgical care. centres in referral hospitals for the manage- WHO is supporting six mobile clinics providing ment of complicated severe acute malnutri- basic health services in remote areas in south cen- tion; tral Somalia. • in collaboration with health partners, train 300 village health workers in remote areas on Together with Health Cluster partners, WHO or- the community-based management of acute ganized measles vaccination for 88 000 children respiratory infection, malaria and diarrhoea under-five in camps for internally displaced peo- diseases; ple around Mogadishu. WHO is also supporting • organize a measles vaccination campaign in campaigns in Benadir and Galgadud Regions, tar- all accessible areas of south and central So- geting 700 000 and 218 000 children respectively.

5 malia and in Mogadishu, targeting about 2.5 lines and training on the integrated management million children aged 6 months to 15 years; of acute malnutrition. • support a second CHD in December using OPV; 2. Support to coordination WHO provides technical assistance to all districts • establish coordination and information hubs in the affected Karamoja Region through its dis- in Somalia’s Gedo, Kismayo, Mogadishu and trict field office in Moroto. Mudug. Next steps until December 2011 • Uganda strengthen acute flaccid paralysis surveillance and assess polio immunity levels in 1. Management of severe acute malnutrition Uganda to determine the scale of preventive WHO is supporting quarterly nutrition assess- response measures to the polio outbreak in ments in drought-prone areas, strengthening the Kenya; management of SAM with medical complications • conduct two sub-national polio campaigns in in stabilization centres and disseminating guide- October and November.

Financial gap In addition, financial requirements for polio operations in the five countries through end-2011 On 29 July, WHO appealed for US$ 29.5 million total US$ 18.1 million. for five countries. As of 31 August, US$ 9.5 million (32%) have been received, leaving a gap of US$ 20 million to support health interventions.

For more info rmation WHO Representatives Ethiopia: Dr Fatoumata Nafo-Traore, [email protected] | Djibouti: Dr Rayana Bou Haka, [email protected] | Kenya: Dr Abdoulie Dodou Jack, [email protected] | Somalia: Dr Marthe Everard, [email protected] | Uganda: Dr Joaquim Saweka, [email protected]

HoA Health Support Team in Nairobi Dr. Julius Wekesa, Senior Health Emergency Officer, [email protected] WHO Headquarters Ms Elizabeth Hoff, Director a.i. SPR/PEC, [email protected] Global Polio Eradication Initiative Ms Linda Muller, Coordinator, External Relations, [email protected] http://www.who.int/disasters © IRIN/ Stuart Price