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Bakol Region, Somalia Nutrition Surveys & Analysis April 2000

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Bakol Region, Somalia Nutrition Surveys & Analysis April 2000 BBAAKKOOLL RREEGGIIOONN,, SSOOMMAALLIIAA NNUUTTRRIITTIIOONN SSUURRVVEEYYSS && AANNAALLYYSSIISS APRIL 2000 FINAL Nutrition surveys in Hoddur, Wajid and Rabdure were undertaken by UNICEF. Food security contextual data, and analysis and interpretation of nutrition data were undertaken by FSAU with contributions from SACB Nutrition Working Group. Final document was produced by FSAU. Bakol. Nutrition Assessments and Analysis. 2000 SUMMARY Bakol is recognised as one of the most food insecure regions of Somalia. Events in recent years such as successive crop failures and insecurity have demonstrated that the population is an extremely vulnerable one. Health and welfare as well as livelihoods have suffered. One of the more easily measured indicators, nutritional status, has demonstrated this decline most vividly. The community that offers to provide humanitarian assistance to this region faces many challenges. Some of these challenges lie within Somalia. Many other challenges lie within the responsible organisations themselves. Bakol region has become a focus of attention in recent months due to the steadily worsening food security situation that has resulted in much population movement and continues to threaten the livelihood of around 104,000 people in the region. This paper attempts to review both recent and historical nutrition data from the region and to interpret both the trend and the current situation using information from all accessible sources. Over the course of six months, during which the food security situation deteriorated steadily (with the exception of some minor relief during the rains in November), three nutrition surveys were undertaken in the region. All surveys demonstrated extremely high rates of global malnutrition with the highest being in Rabdhure with a rate of 30% and the lowest in Wajid at 21%. Hoddur had a global malnutrition rate of 22.7%. During normal times, malnutrition levels in Bakol region have been within levels considered acceptable for the environment. Malnutrition levels recorded during the three recent surveys in Bakol region have been between twenty and thirty per cent. Many organisations plan an emergency intervention when rates of 15% are seen. Other organisations use 20% as the cut off point. With the exception of one food-aid organisation in Somalia, no organisation questions the seriousness of these levels of malnutrition. By any standards, these levels are unacceptably high and would normally indicate that an emergency response is indicated. An emergency response should consist of general food aid, supplementary feeding, therapeutic feeding and other non-food interventions like health and water programmes. Since last September, the demand for information on nutrition in Bakol has been high. In the absence of efficient nutrition surveillance systems, this information has largely relied on nutrition surveys. Following the circulation of the ‘Famine alert’ in January, the demand for surveys grew and UNICEF undertook two further surveys in Wajid and Rabdhure. The results were not surprising to those who had recorded the steadily worsening food security situation during the preceding months. The nutrition surveys did not answer the question ‘How bad is the situation in Bakol?’ because this was already known. These nutrition surveys were a reply to anyone who wanted to know ‘What is the extent of the damage already done to children in the region?’ The lack of capacity (caused by time constraints, lack of interest, other overriding influences on decision making) among organisations to understand, digest and critically analyse all available information has led to a tendency to deny or refute reports without attempting to interpret their relevance. The implementation of timely and appropriate interventions has therefore been hampered not only by insecurity and logistical constraints but also by weaknesses in decision making by humanitarian organisations. This paper does not suggest that food-aid should be the first or only response to such a crisis. It is widely acknowledged those non-food inputs such as water, health services and support for agriculture and animal health are equally critical. However there comes a point when the health and nutritional status of a population is under threat, coping mechanisms are stretched to the point of failure and people are entering a state of destitution from which individuals and families may never emerge. Emergency food and non-food interventions are then required to save both livelihoods and lives. The paper recommends that we (members of the humanitarian community in Somalia) evaluate events in Bakol, and responses to them in order to identify reasons why serious malnutrition was not prevented. We need to examine reasons for the failure of the humanitarian aid community to understand and interpret early warning systems and food security information. Regional intersectoral co-ordination of activities among Page 2 of 2 Bakol. Nutrition Assessments and Analysis. 2000 implementing organisations needs to be strengthened. In this situation, donors are the only ones who can demand accountability from humanitarian organisations and this responsibility has to be taken seriously. Information systems on food security in Somalia are advanced and efficient in comparison to information systems in other sectors – like health. Understanding this information should lead to more efficient and effective programming, but in the case of Bakol, this has not happened. We, the members of the humanitarian aid organisations have a responsibility to ensure that basic minimum standards are maintained in the delivery of services. In the case of Bakol, where lives and livelihoods have been lost and immeasurable suffering has occurred due to malnutrition, illness and displacement, we have to ask if this is really the best we can do. The consequences of such a crisis on the population cannot be measured and yet the hidden costs in terms of lost and damaged lives and livelihoods have to be acknowledged. Page 3 of 3 Bakol. Nutrition Assessments and Analysis. 2000 Introduction When it comes to convincing the humanitarian aid community that a serious problem exists, it seems that BBC is still more powerful than early warning systems and nutrition surveys combined. During a recent meeting of humanitarian organisations in Nairobi, the information that a nutrition survey in Rabdhure town had shown a global malnutrition rate of 30% was presented. The representative of one prominent organisation responded, with a shrug of the shoulders, that this was ‘normal’. Many people consider the sound of gunfire normal in Somalia too. Such abnormal and inappropriate responses need to be examined and explained. Difficulties in planning and implementing appropriate actions should be acknowledged, but we cannot continue to deny the existence of problems. Furthermore, a poor response to early warning systems and the demand for evidence in the form of malnourished children, when the problem has already impacted people’s health, demonstrates a continuing weakness in the management and planning of many programmes. Information systems on food security in Somalia are advanced and efficient in comparison to information systems in other sectors – like health. Understanding this information should lead to more efficient and effective programming, but in the case of Bakol, this has not happened. We, the members of the humanitarian aid organisations have a responsibility to ensure that basic minimum standards are maintained in the delivery of services. In the case of Bakol, where lives and livelihoods have been lost and immeasurable suffering has occurred due to malnutrition, illness and displacement, we have to ask if this is really the best we can do? Bakol region has become a focus of attention in recent months due to the steadily worsening food security situation that has already resulted in much population movement and continues to threaten the livelihood of approximately 104,161 people in the region. This paper attempts to review both recent and historical nutrition data from the region and to interpret both the trend and the current situation using information from all accessible sources. Understanding the issues influencing nutrition in Somalia’s most chronically food insecure areas continues to present challenges to those concerned with planning and implementing humanitarian interventions in the country. The challenge includes determining the reality of nutrition status of populations that are often not easily accessed and attempting an interpretation of the results, usually in the absence of even the most basic epidemiological data. Historical information is often available in the reports of ad-hoc assessments that have been undertaken in times of previous crises. Interruptions in humanitarian projects are caused by insecurity and funding gaps/delays. Background Bakol region covers an area of approximately 26,000 sq. km. and consists of five districts, Hoddur, the headquarters of the region, Wajid, Tieglow, El-Berde and Rabdhure.1 There are two main food economy groups in the region2, (i) agro-pastoralists, who make up 70-80% of the Bakol population and are predominantly located in Hoddur, Wajid and Tieglow districts with a small proportion found in Rabdhure district and (ii) pastoralists, who make up 20-30% of the population and are mainly located in Rabdhure and ElBerde districts. The urban population (those not involved in crop or livestock production) in this region is negligible, between 0 and
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